Educate medical students on the ‘jungle out there’

 

From Dr Abdul Hamid Abdul Kadir

Recent events have brought to the fore the perennial discussion on the workplace environment, particularly in hospitals, which have been criticised as the “worst place to practise”.

Discussions have centred on the definition of harassment, or bullying, the variable extent, and the negative effect on junior doctors, at times with adverse outcomes.

It cannot be comforting for patients, who follow these reports and discussions, to fathom the implications on healthcare delivery in general, and the impact these will have on the care they would receive in hospitals.

Having gone through more than 55 years as a medical professional, first as a houseman, then as a medical officer and specialist in the armed forces, as well as with two medical schools – public and private – in the country, my experience in such matters is worth sharing.

Young doctors may assume that hospital practise is convivial and pleasant, as they would have felt while in medical school, particularly those who graduated overseas.

The senior doctors and specialists in the hospital, on the other hand, may view their commitment to train young doctors as a personal challenge.

In the real world of the medical professional environment, the clash of perception and reality should not become a debate.

It is reasonable to discuss the environment in medical institutions, and the process of educating the students, who come from various strata of society and have a cloistered life in schools, often pampered and protected. There is a good measure of molly-coddling in these early phases of life’s journey.

The students are rarely, if at all, ministered to the trials and tribulations, in the so-called hostile professional environment, of the world outside their home and school.

Much, therefore, needs to be and can be, done in medical schools.

It is important for these lecturers at medical schools to appreciate the fundamental principle, that they not only have to educate their students on the subjects in the medical curriculum, but also have to prepare them for the “jungle out there” when they finally graduate.

In the course of training their students, particularly during clinical teaching, the staff should prime the students on the reality of life as a doctor – the demands, the responsibility, the commitment, the dedicated intensity in patient care, and the need to accept verbal admonishments from senior doctors with a big pinch of salt – all with the ultimate aim of emerging unscathed from the initiation towards a better life ahead.

Students should also be instructed on punctuality, proper attire, respect for senior doctors, prompt attendance to patient needs, adherence to hospital schedules and practice guidelines, and preserving social etiquette in all areas of interpersonal contact and relationship with fellow healthcare workers.

There has to be systematic and continuous input from student psychologists and counsellors, including sessions with respected and experienced senior specialists in hospitals.

Just as important is for parents who listen to the woeful litany of their sons and daughters on their perceived harassment by senior doctors in the hospitals, to be objective and appreciate the ultimate purpose of this disciplinary training as young doctors and assist them to understand that these are to prepare them for progress in their professional career and society at large.

When these young doctors in turn become senior clinicians, they would appreciate the shortcomings of their junior staff and moderate their critical approach accordingly.

In summary:

1. Anyone applying for entry into medical courses must be screened for emotional and psychological stability and capacity to face duress. Various techniques and methods are available.

2. Medical students should be trained and guided on facing possible duress and criticism during hospital practice, and how to accommodate them.

3. Young doctors must appreciate the purpose for strict guidance and protocol imposed by senior doctors in hospitals.

4. Young doctors, especially those observed and identified to be emotionally affected, should undergo periodic counselling in hospitals, and have their grouses addressed.

5. Senior doctors must be sensitive and appreciate the personal feelings and emotions of young doctors and provide any critical advice in private face-to-face interactions, and not in open wards in the presence of other staff and patients. It must be done in good faith and with proper decorum.

6. Anger management, to reduce both emotional feelings and the physiological and psychological surge that anger causes, should receive priority concern in all areas of inter-personal professional contact: junior doctors, senior doctors, and healthcare staff, and finally, from demanding or distressed patients. - FMT

Dr Abdul Hamid Abdul Kadir is an FMT reader.

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.