Letters

When medical students go off the rails

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7376.1364 (Published 07 December 2002) Cite this as: BMJ 2002;325:1364

Lack of continuity from admission to postgraduate career is a problem

  1. Jonathan H S Fuller, senior lecturer (jonathan.fuller{at}btinternet.com)
  1. Department of Primary Health Care and General Practice, Faculty of Medicine, Imperial College, London W6 8RP
  2. Albany Medical College, MC 153, 47 New Scotland Avenue, Albany, NY 12206, USA

    EDITOR—The editorial by Rubin highlights a difficult and complex subject, not least because a medical student can go off the rails in many ways and for many reasons.1

    Our experience at Imperial College with students who have failed their exams is that many of them have had major problems in their non-academic lives and need help coping with them. What is sad,but probably not surprising, is how few have tried to obtain help when the difficulties started or their work became affected. Of course these are not the students that Rubin was considering, although those who misbehave often, although not always, do badly academically.

    The fitness to practice procedures that most medical schools are setting up are an important step forward. Obtaining evidence that is defensible will be more of a challenge. Often it is a number of small events that should set the alarm bells ringing. Ensuring that these events are recordedmay be difficult.

    What about students with health problems? I am aware of students with depression who suddenly disappear. Having depression should not disqualify students from becoming doctors, but disappearingmight, even if it is linked to a treatable illness.

    A major problem is the lack of continuity from admission to medical school and postgraduate career. Not only should information be passed forward but feedback should be given to the school. This should be an area for research. If at all possible we should learn more about the student careerof doctors who perform poorly. Even with all possible precautions in place, some students will still surprise us. There is much to learn, and given the few students about whom this is an issue in each school, much to be gained by sharing information.

    References

    In New York standards are set and tools for help given at start of medical school

    1. Sheila Otto, instructor (ottos{at}mail.amc.edu)
    1. Department of Primary Health Care and General Practice, Faculty of Medicine, Imperial College, London W6 8RP
    2. Albany Medical College, MC 153, 47 New Scotland Avenue, Albany, NY 12206, USA

      EDITOR—With reference to the editorial by Rubin,1 in the first week of the first year of medical school we attempt to set a standard of professionalism. We ask students to reflect on why they came here, what they expect of fellow doctors, and what makes joining the medical profession different from other occupations.

      Substance abuse affects about 10% of those in the medical profession at one time or another. Toenforce this awareness, we invite a doctor in recovery to speak to students first hand about his or her experience.

      Finally, we give new medical students tools for help and reporting (New York state has very strict and specific guidelines). Our message is that this is important, a priority, and must be recognised from the start.

      References

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