Do medical schools care? Rethinking compassion within medical training
BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2693 (Published 10 November 2022) Cite this as: BMJ 2022;379:o2693
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Dear Editor
Dr Breen recommends screening potential medical students for predisposition to mental health issues such as PTSD, citing such screening in the military as a useful precedent. However he provides no evidence that psychological screening is beneficial.
I am unaware of any research on pre-employment psychological screening in the health field. However a systematic review of psychological screening in disaster relief work concluded "At best, this sort of screening can only weakly suggest vulnerability and at worst may result in discrimination. Until better evidence about its usefulness becomes available, employers should exercise caution over its use" (1)
I dread to think how my 17-year old self would have scored on tests of psychological resilience!
References
1. Opie E, Brooks S, Greenberg N, Rubin GJ. The usefulness of pre-employment and pre-deployment psychological screening for disaster relief workers: a systematic review. BMC Psychiatry. 2020 May 11;20(1):211. doi: 10.1186/s12888-020-02593-1. PMID: 32393208; PMCID: PMC7216600.
Competing interests: No competing interests
Dear Editor,
Medical students, junior doctors and senior doctors are highly motivated conscientious and intelligent. The health systems are underfunded, under-resourced and litigious. People are now more knowledgeable demanding and fast to complain? This is a potent cocktail of stress, burnout and demoralisation. Increased mental illness in the profession is no surprise.
Really the solution is to fix the system issues - but it is unlikely this will ever happen, however it should be constantly tried. The other part is to screen candidates for medicine. In the army those more likely to get PTSD are screened out if possible. Students need to know what they are getting into - a life of serious demands, risks and long hours, but also a very rewarding career for those who enjoy patient contact and scientific and clinical endeavours and team work.
Selecting people on academic results alone is flawed. Having a group of highly intelligent doctors in substandard hospitals with overcrowding and ambulance queues, won't work. What may work is having a group of good enough doctors with people skills, team skills and a sense of humour. However the most suitable doctors will burn-out in prolonged stressful thankless and demanding work environments. The humanity of the student and doctor should be a good fit for the work involved and so student selection needs to be much broader and academic results should be just a part of a wrap-around assessment of suitability for a life in medicine.
The NHS needs to look after its most valuable resource - the young students and doctors and training bodies need to really take the widespread unrest among students and doctors to heart and "do something about it."
Competing interests: I work in psychiatry and see professional and student burn-out up close.
Dear Editor,
Thank you for describing lack of compassion in medical schools.
This lack of compassion starts well before admission to medical schools i.e at the application stage. My understanding is several hundred applicants apply for a limited number of medical school places, with a typical ratio around 1:10. All applicants who are rejected do not get detailed feedback for reasons of failure, information of lacunae in the application or any advice for improvement. Similarly, after interviews for medical school places the applicants get a generic feedback without any specific advice.
Surely, 17 and 18 year olds need more and, frankly, the medical schools owe them this.
If we need compassionate doctors, medical schools should set the bar by demonstrating it to their students but also extend it to young teenage applicants. We need this as a society.
Competing interests: No competing interests
Handbook of Military Psychology - of Medical Psychology?
Dear Editor,
Dr Summers makes a valid point about the evidence base and usefulness of screening tools for entry into medical school. The short answer could be "follow your passion" and in the absence of obvious impediments (serious substance abuse, serious mental or medical incapacitating illness, etc) these candidates should do very well and brook no obstacle in achieving their goal.
However I would say the majority of medical people are not so motivated/passionate and are good professionals and students who weather the present medical world with varying success. I have not found a specific interview or screening tool for medical school entry but there are many structured interview methods for checking suitability for various job types.
In medical litigation people complain because they had unmet expectations, had unrealistic expectations, were not listened to, did not receive courteous communication or were charged too much among other reasons. At least let students have realistic expectations, know what life in the medical trenches is like and the demands and risks they will face. Suicide rates in female physicians are six times that of peers in other jobs, addiction rates are 25-30% higher in physicians, marriage breakdown is also increased. There is an urgent need to educate students about this not to scare them but forewarn them. The five things I wish I knew before I became a consultant are all about work life balance and taking care of mental physical and social health, and forging a sustainable life style with accessible supports for when the going gets tough. I did find "The Oxford Handbook of Military Psychology" which could well be read as medical instead of military. Medicine is now a high risk profession that requires mandatory pre-entry assessment (a mandatory training course should be introduced and developed) and constant vigilance and support for all staff. Every soccer player has his support team and every doctor should also have one too.
Competing interests: No competing interests