Abstract
Many people are prepared to work as doctors. It's a job that exudes status, excitement and competence. Doctors themselves often think otherwise. Try explaining to a misty-eyed sixth form student that a medical career doesn't suit everybody – and even those it might suit experience difficult moments that question their conviction. Many other professions look to medicine as a shining example of equal opportunities. Women and ethnic minorities are well represented. Medicine from the outside seems fair and desirable.
Voices from the inside tell a different story. Previous research shows that some 50% of doctors do not believe that medical school is an adequate preparation for work. This isn't uniquely a UK phenomenon. In a survey of German doctors, 60% felt ill-prepared for work. 1 Dig deeper in this month's analysis of UK data and you discover that a further 25–30% of doctors do not believe that a lack of preparedness is a problem. 2
These data are surprising for at least two reasons. First, almost every doctor I've spoken to on the subject has never pretended that medical school is an adequate preparation to begin work as a doctor. Either younger doctors, those in this study qualified in 2008 and 2009, are a better prepared bunch, they felt unable to tell the truth, or I keep strange company. Second, how is it possible to be ill-prepared for work, a job that immediately involves life or death situations, and not consider your lack of preparation to be a problem?
The point of this particular study is to look for differences in preparedness between sexes and ethnic groups. In short, women feel less prepared for work than men, although not to the same extent that non-whites feel less prepared than white doctors. This latter finding seems unlikely to be related to language or ‘culture' shock but may be a consequence of differing expectations of work life. These differences merit further exploration, although the dominant factor in level of preparedness is medical school.
That does make sense. Medical schools vary in their preparation of doctors but all must be failing to some degree. The pressure point, as shown by this month's research paper, isn't necessarily clinical skills; it is in the ‘job' of doctoring – clinical procedures, administrative tasks, interpersonal skills and physical and emotional demands. These issues are familiar to deans of medical schools and educators but is the current undergraduate medical education system doing enough to tackle these failings? It would be complacent to say yes.