Dear Editor

Steven Ford's response to my r.r. seems to misrepresent my comments. Maybe it would have been clearer if I had said 'some women', but it seemed fairly obvious that I was pointing out that the examination is difficult and sensitive for some, and I would say more women than Steven Ford seems to assume. The bottom line is choice - including obviously of any gender.

I would disagree that using the words 'intimate' and 'sexual conotations' raises any misunderstandings for most medics, women or men. The reason a chaperone is used for what are intimate examinations is exactly that - there is no need to be squeamish about saying so. They can be handled sensitively by male or female nurses or doctors. It is not a problem to ask a woman her choice - bearing in mind all will not be confident enough to state that without being asked. (I have co-ordinated discussions about intimate examinations with mixed groups; more women than men have had distressing experiences.)

Dear Editor

This is an interesting and informative article that provides a great deal of information and new analysis. However, the authors themselves identify a number of limitations with the study and data gaps. From the perspective on an NGO working with education staff, we would like to flag up the following points:

1. During this period many teachers were either isolating or teaching online which would remove/reduce the risks of infection

2. There remain major issues in schools about ventilation, building design, class sizes, masks in primary schools, physical distancing and pupil numbers and as we have seen now since the return of children to schools after the summer break infection rates will increase if these are not addressed

3. There is a lack of reference to a Zero-Covid solution to the spread of the virus, one that reduces and controls transmission

4. It does not acknowledge that there is a lack of data about how effective ventilation is in all Scottish educational establishments

5. We also know now that many people have been left with long term ill health and disabilities resulting from Covid-19 infections and some that did not require hospitalisation

6. There is also a lack of investigation about the consequences of infections of teachers and the spread of the virus to their family members

7. Vaccination is just another mitigation in the fight against the virus but many people have been double vaccinated and are still infected and infectious and of course children have not been vaccinated and many young people still only had one vaccination

8. The headline of the press release is misleading - 'BMJ Press Release: Teachers not at increased risk of hospital admission or severe covid-19 during 2020-21 academic year'

9. The SAGE SMI-M-O warning and the subsequent significant increase of cases in schools since Scottish schools returned, is a major concern to teaching and school staff, pupils and parents and this article does not address those issues.

With best wishes

Janet Newsham

Dear Editor,

As undergraduate medical students, we enjoyed the perspectives recounted in the article ‘Should I take an F3 year?’ and found them helpful in considering the future of our own professional careers. The article highlights the absence of opportunities provided during both foundation and undergraduate training, including the chance to experience different specialities in their day-to-day unfiltered state. The accounts of F3 training documented by Rimmer mention the benefits of taking an F3 year.[1] However, we felt the editorial doesn’t address some of the perceived disadvantages, as well as the reasons for reduced appeal of taking up specialty training posts following foundation training.

As the article mentions, many medical students leave university undecided on their future career. The UK foundation programme itself provides only a short snapshot of life as a doctor in an even more limited pool of specialties. As students due to graduate in under a year, this comes as a disheartening prospect.

Opportunities for realistic experiences, in addition to ‘observing on the side’ for the ‘interesting’ events, would give students an insight into how different specialities function. For example, students taking on job roles as healthcare assistants found that they were able to witness a new perspective; not only allowing themselves to gain a better understanding of the department that they were working in, but also providing them with enhanced learning opportunities[2].

Furthermore, the popularity of F3 programmes is in part due to the increasing discontent with specialty training posts within the UK. The number of foundation doctors entering specialty training immediately after F2 has declined since 2011, hitting a low of 34.9% in 2019. [3] Many doctors in these posts feel undervalued and overworked compared to those in F3 positions.[4] Training programmes may be able to learn from these “F3” programmes to provide doctors with the support and autonomy highlighted in this editorial.

Despite recounting ample reasons in favour of taking an F3 year, the article does not highlight many specific disadvantages. Some training pathways may look unfavourably upon an F3 year if one has not provided evidence of personal or professional development during their time out of formal training. This puts pressure on individuals who may wish to be taking an F3 year to pursue personal milestones, or simply to explore other endeavours.

References:

1. Rimmer, A. Should I take an “F3” year?, bmj. 2021, 374.
2. Nolan H, O. K. Qualitative exploration of medical student experiences during the Covid-19 pandemic: implications for medical education, BMC Medical Education. 2021, 21, 1-11.
3. Programme, U. F. 2019 F2 Career Destinations Survey Report See https://foundationprogramme.nhs.uk/resources/reports/ for further details. Accessed September 01 2019.
4. AC Hollis, J. S., Van CV, Milburn L, Alberti H The new cultural norm: reasons why UK foundation doctors are choosing not to go straight into speciality training, BMC Medical Education. 2020, 20, 1-9.

Dear Editor,

Thank you for this article, and to the BMA for conducting such an important study.

As female medical students, it does not surprise us that nine out of ten female doctors have experienced sexism at work. It would also not be surprising if similar statistics were found among female medical students. In this year (2021) alone our experiences include, but are not limited to, being told not to pursue certain specialties because they are too difficult, being signposted to specialties more appropriate for women, receiving comments that our uniform is too tight, and having clinicians speak only to our male counterparts and not to us.

If medical students, at the start of their career, are being educated in an environment which is already discriminating against women, then is it surprising that new generations of male doctors are adopting the behaviours of their seniors? Or that their female equivalents are learning that sexism is just part of the job?

We are often told that sexism will phase out as older generations retire. However, some forms of discrimination come directly from our male student colleagues, this can be even more upsetting as it comes from our peers. How is the NHS meant to limit the spread of sexism within the workplace if medical students are already discriminating against their female counterparts?

By incorporating education on sexism into medical school curriculums, and creating an environment of equality in clinical placements, the amount of discrimination experienced by female doctors could be reduced. This could impact both today and the future. This is a difficult battle to fight, but one which we are prepared to take on, aided by our future employer - the NHS.

At the end of the day, we all go through the same training, there is nothing that separates us other than the attitude and education of our peers.