Why medical training has got to change

I couldn’t take my eyes off the screen. Squeezed next to some fellow medics in a student room, on placement in Bath earlier this term, we were watching the TV series ‘It’s a Sin’. The show follows the lives of a group of gay men in their early 20s who move to London in 1981. As the show unfolds characters get HIV/AIDS, and over time many of them die. We, the viewer, lose the people we have grown to love and are left feeling like a mother who lost her son prematurely. Previously, I had only given the most cursory interest to the AIDS pandemic. I wasn’t born till 1999, a decade after the worst of the drama, and it was not a topic I remember discussing when I was growing up in West London. ‘It’s a Sin’ prompted me to think about the human factors at play in this much earlier pandemic of the 1980s, one that was wrapped up in homophobia. A huge number of men, running into the hundreds of thousands, were rejected by their own families when they had, or died of AIDS. None of this rejection had occurred to me – that parents would burn their children’s possessions if they had died of AIDS to erase all traces of their family connection. Nor had it crossed my mind just how difficult it might have been to be a carrier of HIV. In the show, Richie is the confident, jokey protagonist. He knows he has HIV but still continues to have sex with other men. After Richie’s death, his friend Jill explains that Richie felt ashamed and felt that he deserved to get a virus because he was gay. I could not understand how a victim of a pandemic might feel such self-loathing and as if they deserve to die. The series affected me profoundly, as I know it did for many other medics who watched the series. The word spread fast among us medics: watch this series and be amazed as well as chastened. We were all left with the same question: “Why, given the huge impact of this epidemic, had we had no formal teaching on the AIDS pandemic at medical school?” The TV series prompted discussion with my friends on the existing curriculum that medics are taught. COVID has also prompted general discussion at family dinner tables up and down the country about pandemics. We all felt ill-prepared when questioned by our families on previous pandemics – not just AIDS, but other medical catastrophes throughout history. We were no longer the resident ‘we know-all-about-medicine-and-are -delighted-to-answeryour-questions’ in our families. From feeling ignorant about AIDS, I realised that my ignorance did not stop there. There were other important medical pandemics I knew nothing about: the Spanish flu, the eradication of infectious diseases, or the SARS or Ebola epidemic. I realised that the only history of medicine teaching came in my medical training was when individual lecturers deemed it relevant to their subject matter. I recall one lengthy lecture about the history of vaccinations, where the lecturer explained the story of Edward Jenner

with great animation. Other lecturers might begin their lecture with a brief timeline on the development of the advances within their speciality. But overall, in general the history of medicine has been largely an indulgent afterthought for those interested. The history of medicine is not viewed as key to our syllabus. There are no questions in finals that demand an understanding of the past. Nor are there optional courses provided that advance an understanding of the history of medicine. This must change. Teaching on how medical advancements have been made in the past needs to be included in our training. This would foster a new understanding of current treatment, informed by a more in-depth knowledge of the past. Take AIDS for example. Watching the series gave me a sense of how important it is to be sensitive to patients who have suffered from decades of prejudice. AIDS patients were often treated poorly by male doctors, who were prejudiced against their sexuality. Whilst we might hope that doctors today are immune from such prejudice, it is important to recognise that we may well have other biases and preconceptions that we are not even aware of. It might encourage medical research: time and again, the battle to introduce new treatments and approaches in medicine has been long and hard fought. Chance has often played a role too. Just knowing this would foster a new spirit of patience and a long-term perspective in medics who were interested in working in research. Knowledge of how the world has previously tackled pandemics, how new drugs and therapies have made their way into the BNF would bring a new humility to us trainee doctors. So often in the past, doctors have been mistaken. Returning to the treatment of AIDS: the series revealed how AIDS patients were wrongly given chemotherapy, as if they had cancer. I personally was humbled at the suffering they wrongly endured at the hands of the medical profession. For all these reasons, understanding the past would enrich and give perspective to doctors. Now that I know more of the history of AIDS, I would like to believe that I would be a better doctor for my own AIDS patients. In conclusion, I would advocate for curriculum change. We need a slot for understanding the history of medicine in the GMC’s ‘outcomes for graduates’ to improve the practise of tomorrow’s doctors. Watching television is good. Studying and being tested on your knowledge in a formal academic setting in the training of doctors is better

Written by Katherine Grigg

How to be an LGBTQ+ Ally

Student voices

I asked some of my fellow queer medical friends what makes a difference to them. These points might encourage you to reflect on your own behaviour and biases but remember everyone is unique and these people do not speak for the whole of the community. He/Him For me, being a good ally is simply about being aware of the LGBT+ community and about making sure that those little, small things that make people feel more accepted/included become part of a normal routine. For example, asking ‘are you seeing anyone/are you dating anyone?’ rather than saying ‘have you got a girlfriend- making no assumptions. Being aware of pronouns etc.” An ally to the LGBTQ+ community is a heterosexual and cisgender person that actively supports the community and the movement towards equality.

She/Her “Something I appreciate is not assuming the pronouns of a partner. When people ask, “have you got a boyfriend?” it’s awkward to explain no, and it sets a very heteronormative way forward that makes me feel defensive from the start. Despite knowing they are probably very accepting, a part of me worries from that point forward about coming out to someone who may not be inclusive. Medical professionals have assumed the same and it’s difficult to feel comfortable to speak An ally to the LGBTQ+ community is a openly, especially when having conversations heterosexual and cisgender person that about sexual health.” actively supports the community and the movement towards equality. He/Him “I don’t think non-queer people realise how powerful their opinion can be in a room. If I raise a point about LGBT+ inclusion or wellbeing, I often get the impression people may think it is me just shoehorning my identity into the situation. When someone who isn’t personally affected by that issue in their day to day lives speaks up on it or backs you up when you speak up on it, the others in the room definitely take more notice. I often voice something in a medical setting because I feel an LGBT+ perspective hasn’t even been considered in that situation, only for that to be met with silence or just awkward looks around An ally should both amplify the voices of individuals within the group and you. This can be so crushing; that silence often masks shame and an unspoken disapproval for your identity. Privilege is powerful and the opinion of non-lgbt+ people is often still far more resonant and audible above our own. Yes, that needs to change in due course, but until then, back us up!” An ally should both amplify the voices of individuals within the group and individually challenge the behaviour and ideas that continue to oppress and damage the LGBTQ+ community

If you want equality, you are already an ally but to be an active ally there is more work to be done

Here’s how you can get started:

1. Check your privilege and learn about the history, oppression and challenges of the LGBTQ+ community 2. Be open minded when listening to others 3. Reflect on our own unconscious biases and prejudices 4. Don’t assume people are straight and cisgender, start to think outside the heteronormative world we live in 5. Language matters – get confident with the right language when talking with LGBTQ+ people 6. Call out the problematic behaviour and language when it is used and educate others on why it isn’t acceptable 7. Know that you will sometimes make mistakes and take responsibility when you do 8. Turn your allyship into an action rather than a label by doing the work