Medical School News: Resilience, Kindness, Professionalism….Oh My! Dr Catherine Swales (1997 Wadham College), Director of Clinical Studies, Oxford “When will it end?” … If I’d got a pound for every time I’ve heard that phrase about Covid I could build a new education centre, buy a yacht and sail off to retirement in the Maldives. Well, not quite – but not far off. And if it’s not Covid directly, it’s the knock-on effect of an NHS (and therefore its staff) that is creaking at the seams. Everyone is digging deep - braced for the winter and thereafter still a long haul. Under these circumstances, those elusive qualities that mean so much in students, trainees and seniors fall under pressure: kindness, resilience and professionalism. When there’s little resource left, those traits run the risk of being the first to go. Conversations become less rich and more transactional, energy levels become depleted, leading to vulnerability and isolation - and tempers fray. That said, I’m constantly amazed by my friends and colleagues (and those who were colleagues but are now friends!) and their sense of grit, of doing the job right no matter what, and still pausing to smile, to comfort and to sustain those around them. That seam of strength should certainly not be taken for granted by Government however, but I think that’s a topic for another day… So where does it all come from? Can you spot resilience at interview? Is it possible to teach kindness? How on earth do you assess professionalism? It is to be fervently hoped that most sixth formers have not had to demonstrate significant resilience so early on in their lives (although alas some do, and show extraordinary strength), and as a result there’s little ‘pilot data’ for them to be able to call on, or for interviewers to test. That said, the Oxford interview in itself might be arguably a test of resilience – but so much changes over the time between interview and arriving, and arriving and graduating. A lot of water flows under the bridge in those few years, and some of it is troubled. Our welfare teams in both preclinical and clinical are acutely aware of this and are focusing attention on helping students to learn these skills, so that they have the internal resources to lean on when the going gets tough. For many – indeed for most – that’s all they need. Our students by and large not only pace themselves, but excel in so many ways, though it would be arrogant and foolish not to recognise that for a few the pinchpoints are very profound indeed. For those there is a fine line between helping them to manage and seeing when they can’t – and helping them to see that too. There is nothing to be gained from just keeping going, to reach a finish line that is only actually a start line for a new set of challenges, with different (and sometimes fewer) mechanisms of support. A break, a pause for breath, to retreat, regroup and return can make all the difference in the world.
and centre, there is no mention of kindness. Not one. And yet I suspect it’s often what patients seek most. Inherent in kindness is the understanding that we are not alone, and that others have battles often greater than ours; it can also be one of the most powerful agents for change - but it’s not a curricular requirement. Aesop said, “No act of kindness, no matter how small, is ever wasted”, and whilst I accept, I am more than a little biased (ahem), I believe our students understand that, and are that – to each other, themselves, and the people around them.
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Can you spot resilience at interview? Is it possible to teach kindness? How on earth do you assess professionalism?
As for professionalism? Well, that remains an important area for all Schools to develop in teaching and assessment, and one with which we are all grappling. Examining it in a meaningful way is more longitudinal (and therefore complex) than ‘simply’ incorporating into an OSCE or reflective pieces – and the latter are only as valuable as the thought that goes into them. How does one examine an identity? I accept that the Situational Judgment Test tries to achieve that as part of the Foundation application process, but a recent SJT revision session with the Final years provoked such a vibrant discussion about even the most ‘obvious’ case, I wonder if ranking, rating and selecting responses can really test it in any meaningful way. Research into this area abounds of course – but the value of that also depends on which metric matters, and which gets picked … and has anyone asked the patients what they prioritise most? That’s all from me for now, except to say good luck and good thoughts to our Finalists as they make their way through an undoubted pressure point in the year: 2nd BM exams, job applications and SJT – all squashed into a few short months. A test of resilience indeed. I wish them well and am so proud of them.
And what of kindness? For all their work on Outcomes for Graduates, in which the GMC have put professionalism front
Oxford Medicine | Autumn/Winter 2021 35
