A reflection from first year medical student Max Williamson

Published in JHH17.1 – Stories in medicine

The third national medical teachers symposium on student wellbeing organised by the University of Westminster’s Centre for Resilience focused on educating
for uncertainty, complexity and loss, with an emphasis on how undergraduate educators, by responding to these issues, can prepare the next generation of doctors for the unpredictable demands of practice. I was invited to the resilience symposium to give the views of someone just opening the doors into the medical profession. I hope what I offered to the day was useful (if naive) advice on how to relate the difficulties of being a patient to the difficulties of practicing medicine, and where to draw strength from the two.

Recent findings reveal that doctors’ and medical students’ wellbeing is being placed at risk, in what may be developing as a mental health crisis among the workforce (BMA, 2019). Research suggests that mental health deteriorates during medical school years and continues to decline as trainees enter the workforce (Dyrbye, Thomas, Shanafel, 2005; Moir et al, 2018). The focus of this year’s symposium was on educating for uncertainty, complexity and loss, with an emphasis on how undergraduate educators, by responding to these issues, can prepare the next generation of doctors for the unpredictable demands of practice in an increasingly complex profession and unstable world.

I’ve just begun medical school. In my first month, I’ve already had the privilege of meeting patients in the primary and secondary care setting: a man struggling
through the early stages of multiple myeloma, only knowing that it would progress, but with no knowledge of when; a self-employed patient with a congenital vascular malformation who, after a recent major bleed in his brain, had no idea when he could return to work; an elderly couple, each the other’s carer, both with multiple complex mobility, cardiovascular and gastro-intestinal difficulties. All the while, in my lectures I’ve been learning about the cell biology of haemopoietic linages, or the neuropharmacology of myasthenia gravis and nicotinic acetylcholine receptor antagonists. I think every medical student is staggered at times at the difference between what we are taught (or what is teachable) and the reality we face when we first enter clinics. So what was so useful about the recent resilience symposium for me was the outward acknowledgement of, and reflection on, the uncertainty that we will all face as we go through medical school and into our careers as doctors: it was an essential opening to what will be a long, difficult, and rewarding journey.

I was one of the three people who presented at the opening panel, giving an early career perspective on resilience. To my right were two essential speakers; Alexandra Adams, a fourth year medical student at Cardiff (and the face of the Faces of the NHS campaign, designed to exemplify the diversity of all those who work in the health service) and Michael Zervos, a Foundation Year 2 doctor who studied social anthropology while at medical school. I began the discussion with a talk about my own experience of cancer as a teenager. I argued that being ill at that age allowed me to cultivate resilience, and to understand uncertainty, but that also it has given me sensitivities that other medical students may not have. Drawing from my time in hospital, I also argued that the logistical and psychological pressures on medical students and junior doctors are in a sense similar to those posed by chronic illness, and the remedies to these issues are more alike than they are different: encouraging the development of peer-support and shared spaces; supporting students when they feel they need to express an issue to a senior teaching or clinical figure, as a patient would to a doctor;

Alexandra discussed her experiences of disability as a medical student with incredible poignancy. Hearing of her experiences of prejudice in medical school, from issues in accessibility to downright discrimination, showed us all how many barriers still exist within our health system. And throughout it all, her determination to succeed and to improve her own schooling was self-evident: finding solutions to dissolving these barriers will be an essential step in making medical school truly accessibly for all. and setting of goals outside of medicine. And only one month into medical school, I have found all of these social remedies to be effective ways of dealing with my own current uncertainty and avoiding burnout.

Lastly, Michael discussed the concept of liminality; that medical students exist in a precarious space between layperson and professional, and that this intrinsic
Annual resilience symposium for medical teachers SYMPOSIUM REPORT 36 © Journal of holistic healthcare ● Volume 17 Issue 1 Spring 2020 instability can make the crossing through these states uncomfortable. A poignant example of a medical student on Michael’s ward standing unsure in the doorway during
an emergency procedure brought this point home. When is it appropriate for a medical student to help in a clinical setting? Do they need permission from a professional, or should they act on their own initiative? We aren’t (and arguably can’t) be taught the answers to these questions, but reflections on their answers should be an essential part of medical school.

We also heard from some highly esteemed keynote speakers: Dr Clare Gerada MBE, Professor Joanne Harris, and Professor Dame Jane Dacre. Each discussed the potential ways of reducing the burden of uncertainty we place on medical students. One fascinating talk was by Professor Harris, discussing the anxieties that fitness to practice generates in medical students and early career professionals – how do we let these groups integrate themselves in a healthcare system with this constant reminder of watchdog? When mistakes seem completely prohibited, the pressure to be constantly correct, and certain in that correctness, is extremely high: I have already felt this pressure in my medical school. Discussions about the structural pressures of medicine also appeared in Professor Dacre’s talk, in particular the junior doctor contract strikes in 2015. I was left feeling, in a way that I hadn’t recognised before, that this is a difficult time to be a medical student. As we know more about physiology and disease than ever before, we are expected to learn more than ever before. Proper conduct and safeguarding are more important than ever, but with that comes a fear of mistakes and uncertainty. And as medicine becomes more and more expensive, the cost of our labour is valued less and less. But with each of these talks came solutions, be they small coffee break conversations between students and staff, or entire cultural changes in the NHS, and I was reminded that these difficulties are also an inevitable outcome of imperfect progress, of the kind that I can only hope to deliver as a doctor.

The afternoon continued with a pivotal Schwartz Round. It was my first experience of this type of session, where cases were presented with a focus on the pressures they placed on the caregiver. They are designed to allow for reflection, a collective breath, about the difficulties and burdens of working in healthcare. We heard from junior doctors and senior sisters, each with their own entirely unique story that were in the most part taken from ‘just another day’ in the NHS. Two examples which stayed with me: one expression of guilt about waking an elderly lady up in the early hours of the morning for routine observations, and the utter disturbance that healthcare interventions pose on people’s lives; another discussing the importance of debriefing and compassion towards other members of staff in the context of a catastrophic paediatric emergency. The group’s conversation afterward was enlightening, compassionate and full of human warmth. In highlighting the diversity of experience and common compassion of all those who attended the conference, and all those who work in healthcare, I was reminded that I have been accepted into a community with one common goal; improving the care we provide for patients, and recognising the burdens that this goal can bring.

So the third resilience symposium was a remarkable event, and I’m glad to have played a small part in it. It was an essential reminder of how difficult and uncertain the road ahead will be for me, but also of the immense rewards that medicine can provide, and the strong shoulders I will have on my side to share the burden with. I would like to thank the conference organisers for preparing me, and the rest of the conference attendees, for a complex and uncertain future within the rare privilege of practicing medicine.

References

• BMA (2019) Dyrbye, Thomas & Shanafel, 2005 Moir et al, 2018
• See Max Williamson’s personal story as a cancer patient and junior doctor on page 16