During our initial weeks at Medical School, my new colleagues and I attended a session in Basic Life Support. At the end of the session, the trainer asked the students if they wanted to divulge the real reason they had chosen a medical degree. To their credit, all the students answered with great honesty. Their answers shocked me. The majority disclosed that money was their biggest motivator for studying medicine.
Current Medical School entry remains biased in favour of privately educated students. Although only 7% of British students benefit from a private education, just over a quarter of medical students are privately educated. State educated students therefore remain disadvantaged under the current regime. Ironically, these are the very students most likely to grow up with the life experiences which will best foster true empathy with their future patients. This elitist disparity does little to address the concerns expressed by Lord Francis. The Francis Report will only effect improvements if it's recommendations are heeded and understood.
Admittedly, it is a long document but the central message is clear. Henceforth, Medical School selection must aspire to indentify those students who best display the attributes of care, compassion and empathy. It is the latter which should underpin the selection process for Medical School. The intellectual capacity of medical students is assumed because interviews are largely reserved for the star pupils anyway. Medical selection remains too resistant to the arts. While nobody disputes the value of a good scientific understanding, artistic subjects will provide us with more rounded individuals.
Much has been written about empathy and for good reason. Understanding the definition of empathy is key to the future selection of medical students. First recognised by Carl Rogers in 1959, empathy has since been sub-divided in to several categories ranging from emotional empathy to cognitive empathy. The Interpersonal Reactivity Index (IRI) remains the foremost measure of empathy and explores the seven global sub-scales. The problem of course, is that this test can be learned and hence taught. Our Medical Schools need to be seeking a tool which will assess the care, compassion and empathy of potential students on the day of the interview. The tool will need to be designed to avoid easy replication which can easily be coached and taught. That is the big challenge.
The extent to which we can relate to the concerns of the person sitting in front of us is informed by our life experiences beforehand. This may explain why the United States have adopted a post graduate approach. Those extra three or four years of life experience can be vital to the emotional development of that student. If an eighteen year old states that they have worked at a local residential home, it doesn't reveal reveal how well they empathised with patients and neither does it reveal why they chose that experience. While such experience is good, it doesn't necessarily inform the selection panel. The selection day should therefore aim to see how students react when faced with stressful, emotional situations. Unfortunately, such situations can only be contrived using actors on a selection day. That said, I have always found the actors employed by my Medical School to be very realistic.
During my career in Sales Mnagement, we often went away in a large group for outdoor activities to explore our individual and collective strengths and weaknesses in problem solving. I have long advocated the utilisation of such an approach when recruiting medical students. Just being academically able is not enough for those intent on a clinical career. Such days are really useful for identifying our willingness to consider the views and opinions of those around us. They also foster good communication skills and highlight social limitations.
Given that the amount of life experience which an eighteen year old can get is often limited, we need to be exporing all their experiences of caring if we are to continue selecting students straight from school. Many may have had a caring role within their own social circle, be it family or friends. The impact of such experience needs to be expored in terms of how it has changed them.
Thus, an aspect of recruitment which could be improved is the skilled exploration of exactly why that student has chosen medicine. Many are unfortunately coached to say the right thing at the right time but a skilled questioner would recognise such responses and explore them further. By their own admission, many members of my cohort claimed to be motivated by financial rewards. Granted, they were first year students and may have matured since then. Thye may not have matured though, and that ought to be a cause for concern.
Lord Francis urges a culture of compassion, care and empathy. I question whether any of these can be atught. If we want to recruit the best doctors, we might have to accept that they may not always be the ones with the highest examination marks. We would all agree that an ideal candidate will need a baseline capacity to retain and understand key facts and concepts. The challenge is to accept that the attributes of compassion, care and empathy are just as important. The present system of spending two years frantically trying to put your curriculum vitae in the shop window is fundamentally flawed. As laudable as it is to go and help build a village in Africa, the notion of doing so has now become almost de rigeur among potential medical students as they seek to put distance between themselves and the competition. I don't doubt that some such projects will be genuine but question the true motives for many of them.
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