Jumping through hoops
Last November I attended a science and medicine conference,
held by the Royal College of Physicians, as a representative of my
medical school. Listening to speakers at the forefront of their
research fields was highly informative, as was reading many of the high
quality poster presentations. It was a welcome change to be immersed
back in the world of research. Before my four years of undergraduate
teaching, I was a post-doctoral researcher at Berkeley university in
the United States.
Some students read the conference posters with interest but did not
feel confident enough to speak to the author. I know from past
experience, however, that speaking with the author directly is often
the most informative way to digest research findings. In my former life
as a scientist, I had the chance to ask questions of some of the most
eminent researchers in the world about their findings, and they always
welcomed this.
One poster caught my eye. The hypothesis and conclusions drawn were
interesting, but the presentation of results and choice of statistical
analyses were not clear to me. I quizzed the author over coffee to
clarify some points. I was informally dressed for the occasion, and the
author asked me if I was a medical student. When he heard my reply, his
attitude changed to that of the cynical veteran lecturing the new
recruit. I was given a brief and unconvincing explanation of his choice
of method, and it was clear to me that this author did not welcome
probing from mere undergraduates. I left feeling educated in more ways
than the author could have known.
I have encountered a number of situations at medical school where
attitudes effectively state: "Do not question your senior." One
consultant was visibly annoyed during clinical teaching when I asked a
question about the evidence supporting one choice of treatment over
another. His junior doctor has told me that I should not ask such
thought provoking questions of consultant X. "Just stick to asking
about straightforward textbook stuff, and you will be fine", the
senior house officer told me. Fine? I think he meant that this way I
would score "brownie points" to secure a better grade at the end of
the attachment. The fact that my question would remain unanswered was
not the point. The result was that his teaching sessions ended up like
courtship displays among animals. Students displayed their meagre
feathers of knowledge during the ritual but left it with their minds as
unfertilised as before they began.
Perhaps I am naive and should tailor my approach to asking questions in
future. Some of my student colleagues wisely keep their heads low
during teaching. They speak only if they know the answer, rarely ask
questions if they don't, and learn their lists of facts to regurgitate
during examinations. This offers low exposure to ridicule and a safe
route through clinical attachments. One of my older friends describes
his strategy for surviving medical education as "jumping through
hoops and running through tunnels" that are placed before us, in the
style of an obedience class for dogs. I have come to the conclusion
that he may have the right approach. One of my fellow students said I
should send this article anonymously, to prevent it harming my future
chances of getting a good position as a house officer with certain
consultants. This is the extent of some people's fear of "rocking
the boat". Perhaps it will harm my chances. Although, if that were
really the case, I suspect that the educational value of working in
those posts would be questionable. If I'm unemployed in 18 months
time, I guess my friend will have been right.
Of course I have come across many clinicians who are fine educators.
Many welcome questions that may have no answers but generate more
interesting questions, and enjoy debating with their juniors. I have
learnt much and I thank them. But there is still a small minority of
those who enjoy the power accorded by senior status. They encourage
their students to become unquestioning conformists in their own
clinical image. So for now, I will continue to run at the sound of the
whistle and get my doggie reward at the end of the obstacle course
placed before me. But I will secretly look forward to the time when I
can teach again and learn as much from the questions of my students as
they do from me.
Alan Woodall, fourth year medical student, University of Leeds
studentBMJ 2000;08:175-216 June ISSN 0966-6494
