Why should we need work experience to become a doctor?
In September 1987 the Royal Surrey County Hospital hosted a 17 year old naïve and idealistic me for my work experience. They had a varied programme where we shadowed not only doctors, but also other health care professionals, including EEG and ECG technicians, came into contact with patients and generally experienced how the hospital functions as a whole ecosystem of teams rather than just doctors and nurses. I still remember the administrator that organised my placement clearly: an energetic and super-friendly woman aged somewhere around fifty who clearly had a passion for her job, and managed to vapourise my nerves and intimidation with a reassuring smile and matter-of-fact competence. If Kate Gooding is still around and reads this, (she’d be somewhere in her eighties I reckon) thank you!
My best day was the surgery and “casualty” day (I know we now call it the emergency department before anyone says anything, but this was 1987). I probably should have realised then where my medical career was headed, but at the time I wanted to do paediatrics like about half the medical school intake. In the operating theatre I observed operations and the teamwork between the different professions, I got a warm glow as a scrub nurse thanked me for my help in the team as they were very short staffed that day, which really made me feel part of the team. I got to see what it was like being a doctor.
I shadowed a surgical SHO who was on call every third night, working about 120 hours per week, but despite that her love for her job shone through, and I realised that this was the right career path for me. I even observed some anaesthesia, and saw the only Biers block I’ve ever seen since.
As some of you may know, I have partnered up with an amazing state school in Hackney which runs an access to medicine bursary, trying to provide the same opportunities to their pupils that those who attend private schools will get through connections and a much better funded system. The pupils are all high achieving, clever and motivated, and we are thrilled that all fourteen this year got interviews at various medical schools around the country including Oxford and Cambridge. I know they’re going to make great doctors and I’m proud to have been part of that process.
This week I called on a couple of London hospitals to change their policies on work experience to give their local population better access:
Most medical schools require clinical work experience as part of the application process, but trying to get that experience is not an easy task unless you know someone in the business. Some hospitals (including my organisation Imperial and my alma mater, Bart’s health) have a centralised department that coordinates it for their local population, but if you don’t live in that borough then your options are very much more limited.
If you live within the catchment area of the Royal Free hospital there is no centralised department, but you are allowed in if you manage to get a consultant to accept the placement. This often requires hundreds of “cold call” emails, most of which will be un-answered, is demotivating, and favours those who have connections. Kings College Hospital, however has no work experience opportunities currently for their local population, but there is an initiative between the Royal College of General Practitioners and King’s medical school offering experience in local GP practices. Incidentally if you want to do veterinary medicine, the work experience requirements are almost impossible to achieve without connections, unless you’ve grown up on a farm.
Medical schools don’t necessarily insist on clinical work experience in their entry requirements, but those students who have it are much better prepared for the interview, able to give real-life examples to ethical dilemmas and questions on teamwork. My clinical work experience gave me a chance to dip my toe in the water before embarking on a long training programme for a rather all-encompassing career. I realised it was going to be hard at times but also realised that it would be immensely rewarding. It gave me something to latch onto when I would be deep in revision for some seemingly irrelevant biochemistry test, and I don’t think it’s fair to expect potential medical students to start their long studies without giving them a chance to see what the job is like.
Interestingly, most of the medical schools recognise how difficult it is to obtain clinical work experience and make exceptions in their entry requirements, also taking into account charity work and customer service roles. However, I’m sure the interview performance of those who have had clinical work experience will shine through, and they will be more likely to be successful. If you have money, you can of course pay for your work experience, and there are several organisations that will charge you around £1,500 per week for work experience in the UK, and more if you want to go abroad. I know that the vast majority of the pupils in the Hackney school couldn’t come anywhere near raising that sort of money.
The system as it is currently is unfair, discriminates against those students who are poor, or have no one medical in the family. There are some projects around aimed at widening participation, but what is really needed is just a level playing field that offers the same opportunities regardless of your background.
So, if you’re a hospital doctor or general practitioner reading this, and you have a centralised work experience programme, please do your bit and allow work experience students into your department, and encourage your hospital to set up a centralised system.
If you’re in charge, and your hospital doesn’t yet do its bit for its local population, please change it, and incidentally when you’re writing the policies please make the age limit sixteen, not seventeen, otherwise half the school year won’t be able to access your scheme in time for the UCAS medical school application process (or just say year 12 or above).
Work experience for students applying for medicine (and nursing, physio etc for that matter) is immensely valuable to those pupils, not only as a hurdle for their application process, but as a window into the life they’re choosing for themselves. Please make it easy for them to obtain it.