Mums in medicine

Could you study medicine and be a parent, all at the same time? Anna Down and Kirsty Le Doare even find time to research and write about it

"OK, whose idea was this? I'm old (well I'm 30 or thereabouts), and I'm female. Worse, I'm married and I have children. I've also just left a reasonably successful career elsewhere. Is this really the right time to start a medical course?"

It was September 2002 and my first day at St George's Medical School. These thoughts just wouldn't go away.

Desperate mothers

Fortunately, they have proved unfounded-it most certainly was a good time, and I wasn't the only one there with kids. Within minutes, we had magically migrated towards each other and discovered that we weren't alone in these thoughts. But there were only two of us. Perhaps naively, both of us had assumed that a course aimed at graduates would be more geared up to dealing with people with families.

By definition, graduates are older than your standard medical student. Nationally, acceptances of mature students, defined as students over the age of 25, have increased from 2.8% in 1996 to 8.2% in 2003 (see www.ucas.org). At St George's, about a quarter of student admissions in 2003 were mature students, compared with 5% in 1996. About two thirds are women. Increasingly, at St George's anyway, many of these students have, or would like to start, families.

In countries such as Australia, where graduate entry courses have been running for several years, students with children account for over 5% of the student population (www.flinders.edu.au). Medical schools have worked to develop relevant welfare strategies. It was quite a surprise to realise that we were the first two mothers to follow the graduate entry programme-we were part of the third intake. We were soon asking questions that had never been raised before and didn't have easy solutions.

The course dealt with us admirably and is still doing so. Having tracked down people on other courses that had children-at the time of the questionnaire, students at St George's with children accounted for 12% of the four year course and 5% of the five year course students, and this is increasing-we soon set up a student parent's association. When the opportunity arose to do some more research, we leapt at the chance to better understand what life was like for this group of students, and what their needs really were.

Number crunch

In between school runs, play dates, and even some academic work, we tried a literature search (unsuccessfully; there is no research on this subject) and devised a questionnaire for all the students at St George's with children. We then used the results to create a questionnaire for all the other medical schools in the UK. We made the survey available anonymously to all students at St George's and looked for responses from students who already had, or were expecting, children. Seventy eligible replies were received from 1000 students sampled.

Sixty five per cent of eligible respondents were women; two thirds were 31-35 years of age. Half of these students have at least one child of 4-16 school age (more than a third have at least one primary school aged child), with a further 15% of children being over 16 years. Seventy per cent of the respondents live more than 20 minutes commute from St George's. Many students commute by car to combine the school run with their own travel. The average commute time was an hour each way. The longest commute was more than two hours each way: "My children are settled in school in Hertfordshire, and so I am unable to move closer. This is both costly and involves a huge commute."

More than four fifths of the respondents studied at home or while commuting. They study in the evenings and at weekends, to fit around their childcare and spend more time with their children either to help them with their homework or as leisure time.

A costly affair

Half of the respondents indicated that a nursery, childminder, or nanny was their child's main carer. Of the remainder, most indicated that they were the main carer or that childcare was shared between parents. Two thirds pay in excess of £400 (€600; $750) a month for childcare with half paying more than £1000. This is a massive financial burden.

Sixty five per cent preferred child care closer to home. Actual childcare arrangements were varied: nannies, nurseries, crèches, after school clubs, friends, and family were all included. No student had a place at an NHS nursery, and many pointed out that to get a place in one was almost impossible, as well as expensive (student places were unsubsidised). Most students indicated that they would use a cheap crèche as an emergency childcare facility if it were available. They also indicated a heavy reliance on family and friends for childcare support: "I would like to point out the extent I also rely upon the good will of family and friends for fairly substantial childcare favours."

What we also found was that there was difficulty in organising after-school care, when hours of attendance do not fit with normal working hours. Some institutions were better than others at meeting the most basic need of students with children for timetables set out in advance so that they could arrange childcare in advance of the beginning of term. Shift work is particularly problematic and this is a problem that will soon apply more generally to junior doctors too.

bubbles photo library/alamy
Have a good day at school, mum

The most important areas here were financial advice and help applying for funding. Most students were not aware of what funding they could apply for or how-for example, to help with childcare costs. Bursary students were especially confused because of the need to swap from Department for Education funding to NHS funding towards the end of their course.

Help with transport costs if the student was travelling long distances because of their family was ranked as highly important.

Support is essential

A need was expressed for areas of workspace, especially during school holidays when library access was needed. This was also ranked highly for students living close to the school who required access to the library at evenings or weekends. Web based material was indicated as vital, particularly if students were unable to attend because either their child or childminder was sick.

Students gave a high priority to flexibility of clinical attachments in terms of timing and location. Many students indicated the desire to start or complete their family while they were studying. Therefore, the ability to have "maternity leave" without having to miss a full year was highlighted. Location, especially during the final years when placements tend to be away from the main teaching hospitals was very important-further distance would stretch the already tight resources. Most of these students attempt the school run at least a couple of times per week and this became impossible if their commute times were lengthened.

The medical school questionnaire was sent out to 27 medical schools with 14 replies. The schools were asked to indicate which services they provided and which were prioritised for parents. Some schools seemed to be in a better position to provide services, thanks to the size of their student population, but it was the same schools that offered all services.

The schools that provided flexibility of attachment location all indicated that requests from students with children were dealt with on an individual basis. These same eight schools also indicated that they provided web based lecture notes and handouts.

On the subject of flexibility of attachment timing, all the schools that indicated that they provided this facility would offer a gap year as the usual solution to those becoming pregnant whilst studying. Seven schools offered information about future years of their course and provided careers advice and information. Despite the indicated need for financial advice this was only offered by six of the schools.

Only two of the schools had a formalised support network for student parents.

Making sense of it all

Childcare costs and cost of travel are high. Most students therefore tend to study once they have collected their children from childcare and are at home with them. Discussions with parents during focus group sessions also revealed confusion over what grants and bursaries they were entitled to apply for.

Students need support when their long-term childcare arrangements break down. The students and their families and friends are currently handling this. Some trusts now employ nannies to cover such emergencies for their staff that might be of use to medical students.

Most students with children have long commutes. Moving closer to the school is not practical for many reasons, not least of which is the fact that many have school age children who are settled at a school close to their existing home, and the financial implications of moving into London to study. Flexibility of clinical attachments is needed so that they do not spend prolonged periods of time away from their families.

Students who would like to complete or start a family while studying indicated the need for flexibility of clinical attachment timing, so that they would not necessarily need to take a gap year, which adds substantially to financial worries. It would be interesting to see how this trend develops as the number of older students enters medicine.

Family commitments mean that it is necessary to work at home in the evenings, or bring children into the medical school after hours. Most students need to deal with their children's homework and school life in addition to their own studies. Added pressure occurs at certain times of the year, such as school entry, examinations, holidays and carer illness. Students have indicated that they would benefit from having a workspace they could bring their children into, as well as web based lecture notes and handouts. These are especially important if the student is unable to attend for prolonged periods due to their child or carer's illness.

Most medical schools do not seem to have begun to address the issues raised in this research. Of those that have, some have strategies in place to deal with a few requests each year.

What now?

This limited piece of student research can only give a snapshot of the current situation and further research is needed. There is a small student population with children and a lack of data from medical schools about students with children.

Just as we discovered three years ago, a different type of student is now entering medical school and students with children are just one of these. It would be interesting to see how medical schools can support these students and what type of safety net is needed to ensure they are supported before crisis arrives. There is no evidence these students are less able than their contemporaries. They do, however, have added potential for stressful situations that they need to manage and which medical schools could seek to tackle in order for the student to achieve as well as possible. It is possible, as student demographics change, that student parent numbers begin to rise to a point where dealing with their needs on an ad hoc basis is no longer a workable solution.

It sounds dreadful, but it's not. Some of the issues we found that needed dealing with are really not that different to those of working parents. However, financial constraints often add to student's problems. There is no age where it is easier for a student to combine family responsibilities and career, whatever that may be. Traditionally women may have waited, or have been expected to wait before returning to study or work until their children were older. Others put off having children until their careers were established, anecdotally, some doctors wait until they have completed specialist training before trying for a family (this becomes less of an option for older students, though).

In a study for the Elizabeth Nuffield Education Fund, 80% of successful applicants had one or more children.¹ Over half of these women returned to study whilst their children were still pre-school age. The results indicated that women would rather incur extra childcare costs, than wait even longer to start a career path. Most also indicated regret at the amount of time they spent with their children but still felt that it was beneficial to the family for them to study earlier, both financially and logistically.

Would we advise someone else with a young family to take the plunge? Definitely, especially if they can put the right logistics into place early on. It's rather like a house of cards, and if the logistics go wrong, it all goes wrong for a while. It's hard work, you need to be organised and in an ideal world your family need to be on your side, but it can happen. We've felt rather like pioneers at times, but hopefully those following through are getting past that. Roll on our foundation years-and a whole new set of organisational challenges.

St George's Hospital Medical School, London SW17 0TE c/o Graduate Entry Programme Office Anna Down, medical student,
Email: m0100519@sghms.ac.uk
Kirsty Le Doare, medical student,
Email: m0100519@sghms.ac.uk


studentBMJ 2006;14:441-484 December ISSN 0966-6494

1. Land H. Childcare matters: lessons from the Elizabeth Nuffield Educational Fund School for Policy Studies Research. Bristol: 2001.

   

           

	Responses published this month

Articles	Responses
CAREERS Mums in medicine       Anna Down and Kirsty Le Doare (December 2006)	Pragna Rao (November 30th, 2006) Read this response

	CAREERS Mums in medicine        Anna Down and Kirsty Le Doare (December 2006)
	Pragna Rao (November 30th, 2006)        Professor of Biochemistry, Kamineni Institute of Medical Sciences, Narketpally, AP, India mnaprag@hotmail.com
	Anna Down and Kirsty Le Doare's well written article is pertinent and correctly timed. Several women medical students face similar situations around the world. Childcare facility, if it were available on campus, would go a long way in allowing mums to peacefully pursue their academic goals. Combining family responsibilities and careers especially one as demanding and exacting as medicine is a challenge by itself. With increasing number of mums as students, medical schools need to ponder over providing child care facilities for such student mums (and dads!) . It is time to acknowledge , salute and encourage in every way, these mums for their sheer grit and commitment to study medicine in the face of logistic, financial and emotional ups and downs.