How to disempower your medical students

Dearest colleagues,

So you’re running your medical school, and those pesky medical students are getting a bit too big for their boots. You’re wondering how you can narrow their horizons, bash them down, give them a few harsh home truths.

As an NHS consultant surgeon with over 40 years of experience in the field, I feel that it’s my job to offer you people some advice on difficult topics of this nature.

You’re thinking; the NHS is suffering, so why shouldn’t medical students too? Well, we’ve all been there. Here are a few simple things you can do as a medical school to get them back in line;

1. Strongly discourage them from attending strikes

Are medical students allowed to attend strikes? Yes. Should they? Absolutely not. How dare they exercise their right to protest something. They seem to have a shared delusion amongst them that one day, they too will become doctors.

This is a simply ridiculous proposition, a terrifying example of lefty liberal groupthink - what makes them think they might be working in the NHS? They’re at medical school.

Medical students have absolutely nothing to do with the NHS, and thus they should have no interest in how it is run, how much a doctor is paid, what patients think of things, and what the working conditions are. Simple.

2. Inspire your people with confidence

As medical school leaders, we must protect our students from the insane demands of junior doctors to be paid the same amount of money as we were when we were junior doctors.

The fact of the matter is, they’re being really crazy and silly and we just shouldn’t listen to them, ok. It’s really that simple.

Some will try to convince you with arguments about staff retention, the fact is, we’ll be fine, look around the ward - people complain it’s busy and cramped because of inadequate capacity. Nonsense! There are simply far too many doctors wandering around. We can afford to lose a few.

3. Join the Conservative party

These strikes are the work of far-left liberal elitists who have no business meddling with the NHS. Our beloved NHS leaders have done an outstanding job at paying everyone fairly and advocating for us to the government.

I love the government. They’ve done such a grand job of sorting us all out; I’m so glad that tonight, as we leave the hospital and drive in our Ferraris back to our 7 bed mansions in Clifton, we can sleep peacefully in the knowledge that every man, woman and child (in that order) in the country has enough food, money and warmth to keep them alive and well.

4. Speak in language they understand

In recent times the younger nurses on the ward have brought some rather wonderful ‘Tik Toks’ to my attention.

A common theme amongst them has been the key tenets of ‘Gaslight, Gatekeep, Girlboss’, and much in the same vein as ‘Live, Laugh, Love’, I really couldn’t agree more.

These powerful triads of the great English lexicon inspire me every day, and I think we can learn something from them when it comes to our medical students.

Gaslighting is the most important of the three, and that is why it always comes first. Whenever anyone brings anything to your attention, you must learn to gaslight them.

Medical students often like to ask if they are permitted to attend strikes. How should you deal with this? You simply tell them, “no.”.

They may ask for justification, and here is what you might like to say;

“Please note that as students you are not employed, and you cannot, therefore, join the strike - see notice from BMA below. You may support the strikers, for example, by taking them food or drinks, but you cannot stand on the picket line.”

From an email to Bristol University Medical Students from the medical school.

Does this mean you sort of contradict yourself? Not at all. The key is to use confusing statements which don’t fully make sense. In the example above, you tell them they cannot join a strike.

You then say that they can join the doctors to provide them snacks, but so as not to upset anyone, you emphasise that they cannot stand on the picket line. See what we did there? Probably not, and this is an excellent example of how you too can gaslight.

If anyone challenges you on any of this, simply say you are trying to support the picket by offering advice which adheres to the government’s fair and ethical strike laws, such as the one which allows a maximum of 6 members on the official picket line. You know, just so strikes don’t cause too much disruption. Yet another example of our wonderful government supporting everyone’s right to strike!

What does it mean to gatekeep? We’ve actually already seen an example of this in the above statement. By telling the medical students they’re ‘not employed’, you’ve indirectly told them they’re not part of the gang. This is gatekeeping, it’s absolutely fine to do, and it works. The key here is to make them feel really disempowered.

And finally, girlbossing. This is more of a state of mind, a way to conduct oneself whilst strutting through campus after a disciplinary meeting with a medical student about their attendance, or swooping in to place the perfect cannula where the juniors have failed. It’s more of a statement to the world, that they’re all shit, and you’re the fucking best.

5. Find inner peace

Now it’s time to go be that girlboss as described above. When delivering bad news to patients, don’t say it, slay it. Gaslight your students, juniors and subordinates - because you’re worth it.

Needless to say, all this advice is only to support you in not supporting the strike, not actively discouraging it. We must be subtle; we must ignore problems and not give our voices to these issues.

Never oppose things directly, just be really unhelpful by standing by quietly.

Next week I will be writing about the highly requested subject of ‘how to write intimidating negative and rude emails to your students’, focusing on a healthy mutual lack of respect which I feel needs catalysing.

Yours faithfully,

Dr M. Oron MRCS, PhD, MEd, IBS, ARLD

M. Gerard

2nd Year Medical student

The Fall of Bristol Bible - When “et al” Isn’t Enough

I found myself in my kitchen one evening, listening to my UWE flatmates complain about their lecturer grievances. It’s true, somehow, we thought that combining Medicine, Virology, Physics and Architecture in one house would be a good idea. Then, suddenly, out of nowhere my medic flatmate exclaimed: “WAIT, they took Bristol Bible down!”.

My heart skipped a beat, my throat tightened. I couldn’t quite believe it. I immediately took out my laptop and tried to access the website. A few pages remained at the time but have since been taken down. The crutch that 90% of 2nd years relied on was gone.

The chaos that ensued after I messaged ‘Juliet’s Medic Orchestra’ (if you’re not naming your massive year group WhatsApp something funny, you’re doing it wrong) could only be described as mass panic. We suddenly found ourselves back in the same deep end as 1st year. No more reading through summarised notes that made sense, were concise and specific to the exam ILOs; we instead had to return to the ancient art of learning to speak ‘lecturer’ alongside our demanding studies. It was the end of a glorious era of ease, and an uncomfortable return to making our own ankis and notes independently.

The 3rd year who founded Bristol Bible was ordered to close it down due to the university’s concerns of plagiarism and copyright. However, the content of the lectures themselves is taken from years of research and textbooks and is only cited at the beginning of some lectures. Therefore, one could argue that even the staff are not giving the information correct accreditation. Can one really copyright science? Bristol Bible never claimed that it was new information and referred to the university’s lectures consistently. The clue is in the name: “Bristol Bible”.

Another issue proposed was that the notes, questions and flashcards were on a public website, meaning any member of the public was free to access resources created through university funding, which we pay fees for. However, while the university had this concern, the reality is that these notes are only relevant to fee-paying second year Bristol Medical students, therefore making this point redundant. The internet is otherwise saturated with non-specific medical school resources. The only people that come to mind are the like of prospective wannabe medical students who obsess over the med school Instagram aesthetic, got 3800 in the UCAT and spend their summer after A Levels “just preparing for university”; but even then, Bristol Bible is most likely flying under the radar. Even if public access is a problem, the university has spent thousands of pounds on Blackboard and Microsoft SharePoint. Bristol Bible could’ve been moved to these platforms, so that every pre-clinical student could benefit from it (once they learned to navigate the mess that Blackboard is, of course).

I asked medical students about what they thought: “That actually ruined my day. Bristol Bible was very concise and made sense, unlike some lecturers.”

“It’s a good resource. It’s someone’s own notes; are they not allowed to share them?”

The black market for notes and Anki flashcards continues to thrive around the country in many universities, but students at the University of Bristol are more cautious than ever after the Bristol Bible incident. Small friendship groups share flashcards, and if you’re lucky, you may be able to access the Kahoots and practice MCQs of other CBL groups. The question of how the university found out about Bristol Bible remains unanswered. Did a lecturer find it? Did a student rat someone out? Either way, we have all begun to accept that it is not to return. We can only hope that others are willing to share resources within each year group. My advice to 1st years is to find a 2nd year that you can rely on – it will SAVE you And don’t forget to buy them drinks or food in gratitude.

(If you thought of the name for the 2nd year group chat, kudos to you, tell me who you are and I will buy you a drink at the end of the year.)

W. Kotynska 2nd Year Medical student

Should I chat to my GP, or can I chat GPT?

“Watch this TikTok,” my flatmate slid over her phone as we sat with our laptops propped open on the kitchen table. The protagonist of the skit responds to an interviewer’s cynical questioning with efficient answers. An applicant with supposedly little English skills buta job offer aboutto be secured.The gag line, we soon find out, is that the downward gaze of the interviewee is fixed on a phone with chat GPT open and running through answers. The TikTok ends as she stutters over pronunciation. Funny yes, but since then it is referenced all around me like a classic BaaderMeinhof phenomenon. My twitter feed is an endless cycle of commentary on chat GPT and particularly how this is being used in healthcare.

Chat GPT has recently been reported to have passed the US medical licensing exam (Granted, the questions do not feature application of ethics and empathy)

The Radiology Society of North America Journal has recently published an article fully written by chat GPT with cautions added by a human author. Health professionals could learn from journal reviews published by artificial intelligence.

If I had to explain Chat GPT to you and its impact, where would I start? Though I would first question, how have you not encountered it already? The key process behind Chat GPT is the use of human-like language. There is no uncanny valley with its slick use of correct grammar and lack of overtly technical language. As I tried to feed prompts into the chat box, I realised quickly that I had met medical students prone to slot in more jargon in their speech than the AI did. So, AI is consistently accessible.

I have struggled to provide it a label, the many uses and functions defy that, which I suspect adds to the excitement and allure. It excels at producing drafts for you in different formats: article, email, or letter. But the problem solving is what has impressed me the most. Doctors and medical students, me included, have attempted to pose it a question regarding patient management and assess how spot on the management is. I stress the word management, asthesequestionshaveadiagnosisplacedinthe prompt. “How would you manage a 55-yearold Caucasian woman with hypertension?” It provided a clear summary with the ease of a google search and no faffing about on NICE guidelines.

The #medproductivity influencers are alight with possibility. How can this make my life easier? I, the compassionate human, the AI, an extension of my brain. If it is not possible, just throw the whole doctor away. If Chat GPT can provide management and solutions whilst other health care professionals already have the caring aspect covered, what is your use?

The ease of a google search being the key phrase here, it becomes another efficient and succinct search summary, we still require the knowledge and research, (particularly evidence-based research) that guides the management algorithms we rely on in our learning and provision of healthcare. Our curriculum teaches us to value other very human factors that lead to changesand switches in management. The patient struggles with the side effects and wants to switch from sotalol to bisoprolol. Can an AI understand this and let it override the preferred management?

One image that occurs is that we are no longer competing and pushing for the extras expected without compensation from us in medicine such as publishing or performing audits. I can almost see that in the future we remove the competitive nature that permeates career progression. I am not pitted against my peer simply based on who is keener to plug in data into an excel sheet as this is a simple task done by AI!

Could it be that the brightest and the best are onto something when they employ artificial intelligence to tackle the mundane aspects like endless emails and academic writing?

Take the example of placement. You are on an anaesthetic block, and you are asked to write up a patient reflection.

A Bristol university medical student knows this is a task best accomplished after procrastination and a large chunk of time conveniently forgetting it was required at all. Bristol uni medics, particularly, are not accustomed to encounters with writing essays. Theoretically you could have a situation in which you employ Chat GPT in the McDonalds car park, a few hours before the end point review. The white letters pinging

Fighting Anti-Intellectualism: A defence of the MBChB

The UK is losing its Doctors, fast. With over 8000 medical vacancies in secondary care as of December 2022, this loss of staffing is one of the many straws cruelly tossed upon the camel’s back. At medical school, the idea of leaving is whispered, a taboo, the words “Australia’, and “Management consulting” murmured in hushed voices between trusted compatriots. However, this is the reality in which we live - a recent BMA survey suggesting 4 in 10 junior doctors plan to leave medicine as soon as they can find another job. The solution to this seems obvious, doesn’t it? Make medicine more appealing: pay us more, improve conditions, include some actual training in so-called specialist training, and fix the computers on the ward. Unfortunately, things that seem obvious to us, don’t quite appear to have occurred to those who make the decisions, their approach being to simply train more doctors and hope it all shakes out alright at the other end.

onto the phone screen with alarming speed, rattling off generic sentences. But we reach the issue with this quite quickly. The sentences are generic and at times, lacking a human’s natural flair that leaks into their writing. No wonder anti AI tech is being both developed and used currently. Open AI (who are the creators of chat GPT) are watermarking the output. This means the words spewed, undiscernible to us, can be statistically predicted and will flag up when you start scanning for generated information.

Since writing this article, Chat GPT has since kicked me off and I am unable to log in. This seems to be a case of the server being completely inundated with users and traffic. A message even suggests that the service will start to offer a premium service. A paid service will be considered differently than a free, accessible service and so the assumptions written here could end up being simply that, an assumption.

D. Ilkhamovoca 3rd Year Medical student

One of theseradical approaches was announced by HEE recently, who are piloting a Medical Doctor Apprenticeship scheme, involving a paid role in which local employers can recruit and ostensibly train those with appropriate qualifications, according to local workforce needs. These apprentices are able to ‘study flexibly alongside work, so they can put newly acquired knowledge and skills into practice immediately, for the positive benefit of service users and patients’ (Read: watch the geeky medics video on venesection and spend all afternoon taking blood from patients because the phlebotomist has Thursdays off - what could possibly go wrong!).

This notion that medicine can be learnt from practise alone speaks to a burgeoning wave of anti- intellectualism, a concept first actioned by totalitarian regimes of the 20th century, before bleeding into mainstream populist politics, a process catalysed by corporate mass media.

Anti- intellectualism describes a hostility and mistrust of intellectuals, and a dismissal of the study of art, literature, andimportantly, science, as impractical, unnecessary and frivolous. This is not to suggest that all Doctors are intellectuals, but that the theory and art of medicine as an intellectual pursuit needs to be protected.

Discussions around a similar tide of antiintellectualism within Nursing Education are highlighted in a 1976 article discussing paternalism and the role of the nurse (Ashley, 1976). In this piece, Ashley describes how medical administration used the natural caring attitudes of nursing students to not only economically benefit, but to morally subdue nurses via apprenticeship training models. These apprenticeships bolstered the idea that nurses do not need to be ‘educated’ but are instead trained in practise to be obedient and self -sacrificing. As medicine becomes increasingly more dominated by women, could this movement towards an apprenticeship model lead to the same economic and social pushback that nurses suffered?

Higher education institutions have a mandate to satisfy the labour market, which in UK healthcare is a sole entity, resulting in medical education serving the singular purpose of NHS service provision. The desire to fill as many roles as possible results in a ‘competency-based curriculum’ for job readiness, rather than forming the minds of learning studentssomething that is already creeping into medical education. Of course, competency in key clinical skills is paramount for patient safety, and most Medical Schools do their best to promote criticalthinking and analytical skills in students, but the new increased demands of the labour market may force universities hands towards more practical, and less cerebral methods of education.

This shift towards university education as a means of satisfying the labour market is seen not only in medicine, but with any degree now seen as a consumer item, that can be purchased with tuition fees and exchanged for access to well-paying jobs. Valerie Frunzaru (2018) made an important link between this sense of materialism and anti-intellectualism, suggesting that those with strong beliefs in materialism are likely to have a more negative attitude towards their university education, stating that ‘It is as if knowledge for its own sake does not have an immediate practical utility in the labour market’. This distaste for the acquisition of knowledge is compounded by blended learning models, increased class sizes, and simplified assessments, with students choosing modules with minimal reading or written assignments required (Arum & Roska, 2011).

A potential psychological driving force behind these changes in attitudes is ‘The argument for an easy life’. Why would you put yourself through a classical education, challenging assessments, and long hours, when ultimately the day to dayexistence of a working individual is not improved by a deeper understanding of unrelatedsubjects?Whywouldyoutoilthrough 5 years of medicine, when you could instead be paid while learning? The answer to those questions is not simple, however, as university students we havebeenaffordedahugeprivilege - until very recently huge swathes of the population, especially women, would not have had access to the vast quantities of information and resources we now have, so to counter ‘the argument for an easy life’, embrace the joy and liberty of learning for learning’s sake. The proposed apprenticeship scheme seems appealing on a surface level, but at its root, it depends on the exploitation of people from underprivileged backgrounds, who will be paid substandard wages to work as untrained cover in underfunded and understaffed hospitals. If Britain needs more Doctors, it must train and retain them the old-fashioned way. Students from underrepresented backgrounds are slowly starting to make up more and more of the medical cohort, but more can be done. Rather than increasing student numbers for profit’s sake, recruit talented students from local schools, and provide solid financial support to those who need it, make the NHS bursary applicable to an even wider range of students, and make it truly liveable. And most important of all, nurture those student’s aptitude for science, exploration, and the pursuit of knowledge, making better Doctors for tomorrow.

D. Fawcett Hill 4th Year Medical Student