Everything, every day, all at once – why we need to ask less of medical students

  1. Navy PoliticsBMJ Clegg Scholar and fourth-year medical student1,
  2. Joy HodkinsonBMJ Clegg Scholar and Foundation Doctor2

  1. 1University of Glasgow

  2. 2NHS Lothian
  1. @marinadpol
  2. @JoySarahh

To improve the well-being of medical students and future physicians, we must challenge our culture of relentless productivity, say Marina Politis and Joy Hodkinson

The romanticized narrative that our college years will be the “best of our lives” can leave those of us who struggle feeling disillusioned. For many people, medical school is a frantic attempt to stay afloat against a relentless tide of work and expectations. If you’re trying to transcend the “medical student” identity and pursue other responsibilities or interests, it’s not long before a familiar and insidious internal voice questions your ability to overcome the next. academic obstacle. Simultaneously, when you prioritize your studies, social media bombards you with a perfectly curated stream of fun from other people. How does everyone balance all of this?

We wish our experiences would not resonate with others, but medicine is full of people who feel inadequate. Imposter syndrome and the expectation of continued success are fostered by those who place physicians on unrealistic pedestals. Governments portray healthcare professionals as heroes who never tire, sustained by their sole “calling” and freed from the banalities of rest. Caught up in this fanciful rhetoric, it’s no wonder so many of us don’t feel good enough.

We can show compassion to our patients and our peers—aware that productivity doesn’t quantify value—so why is it so hard to direct those same feelings to ourselves?

Harder, better, faster, stronger

The medical recruitment process is notorious for selecting “Type A” personalities, but medical school’s unsustainable work culture doesn’t stem solely from our perfectionist tendencies. Medical school reflects our productivity-obsessed society. It’s a relentless treadmill of lectures and reviews, along with pressures to publish, audit, complete quality improvement projects, and teach. We try to maintain that elusive work-life balance amid the “be kind to yourself” reminders of the same faculties that rank us against our friends.

Our value is quantified by so-called meritocratic point systems, which arguably have little correlation with our clinical skills. Phrases such as “borderline” instead of “clinically safe” are used to describe future practicing physicians. In the NHS Core Curriculum, the highest praise a trainee can receive at the annual skills progression review is ‘no problem’. Why not “good”? Our education and training systems are failing to instill self-esteem in the next generation of doctors, and as bottlenecks in training programs increase1, the pressure to outperform our peers will also increase.

Many articles urge medical students to take the lead in everything from seeking sustainable health care to fighting for reproductive justice.23 It’s true that we all need to take action, but messages like this are approved by people in power who abdicate their responsibilities. Defining the challenges for our generation cannot be tackled by individuals alone, and governments and NHS governing bodies must implement the system-level changes that are urgently needed. Medical education should incorporate ideas of social justice and equity into teaching, but simply adding even more tick-box lectures when exams still prioritize memorization of the coagulation cascade is symbolic.

Far from equal

The burdens of this culture are unevenly distributed and perpetuate existing inequalities. The expectation to go beyond the medical school curriculum disproportionately harms those who already face barriers and discrimination, widening the disadvantage gap. The #LiveableNHSBursary campaign is highlighting the financial pressures some medical students face, more than ever.56 While these students are working part-time, their peers with less financial constraints can brush up on their resumes or take a well-deserved break. We know that the bar is higher for physicians who have not historically had access to medical education, whose voice is least often heard. Indeed, one doctor shared that “[ethnic] minority doctors must be more “exceptional” in their work than their white colleagues. »7

The idolatry of productivity runs deep in our capitalist society, but that shouldn’t stop us from thinking about our role in embracing these beliefs and how we can slowly dismantle them. Change is needed to make the expectations of medical students more realistic and compassionate – we cannot be everything, every day, all the time, and we should not aim to be. Employers and educators must take responsibility for how they reinforce these pressures.

less is more

The medical culture must favor collaboration and not competition. We must recognize that continuous grading perpetuates grading, is unfair, and can harm people’s mental health. Our identities should be celebrated for their inherent value, rather than endlessly shaped to best fit application systems. No one should wonder if their free time is “high-return” enough. The relentless pursuit of success can be mitigated by increasing the number of jobs, so that we can leave behind the bizarre paradox where patients cannot find doctors while doctors cannot train.89

As you wait to become more than a number, remember that if you’re struggling to balance everything, in a system that keeps asking for more, you’re not alone. The treadmill of medicine might superficially reward those for whom deciles and portfolio points take precedence over their own needs, but burnout is much harder to recover from.

Recognizing the implicit hypocrisy, privilege and irony in our writing, our message remains: please allow yourself to stop being productive. Metrics do not define your value. Watch Netflix at 1.0 speed, turn off your alarm, go for a walk listening to Dua Lipa instead of Zero to Finals. Do not do anything. The richness of our lives will never be measured solely by the densities of our resumes.

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