Dear editor,

As medical students, our experience of the NHS is a unique one. We interact with all staff in all departments at all times of day and night and this provides us with a particular insight ‘behind the scenes’ of clinical medicine. Of course, this unique position comes with responsibility; namely, that we are obliged to reflect on what we observe. We are also obliged to share things that might harm our future patients. Because of this duty, we feel we must tell the public about a problem, little discussed, that may damage the future of the NHS.

For many students there has been an insidious decline in the quality of our experience of clinical medicine both on the wards and in general practice, predating any recent controversy. This has had a profound effect on morale and left some of us wondering if a career in medicine is really worth it.

Time after time, we are told by senior doctors to ‘get out while you can’. Some final year students are doing exactly that, or moving abroad to practice. On GP placements, students are told, simply and unequivocally, ‘don’t do this’ – therefore it is not surprising to us that one in five GP trainee posts remained unfilled after two rounds of applications in 2015, and that additional benefits need to be offered to attract graduates to some of the country’s most undersubscribed regions (1). Nor is it surprising that in 2014/15, 21% of respondents to a census of consultant physicians reported significant rota gaps in hospitals, with worries that ‘they cause significant problems for patient safety’(2). The demoralisation present in the doctors responsible for our teaching is deeply disheartening.

Coupled with the concerns surrounding patient safety, rota gaps threaten the level of education medical students receive. ‘No medical students tonight, we already have 13 patients that have been here past the 4 hour waiting time’ one student was told at the start of a mandatory A&E night shift. ‘Everyone was rushed off their feet and didn’t have 10 minutes for a break, never mind to teach us’, he reflected. Consequently, medical students are being placed in an increasingly difficult position if they want to seize on the opportunities to learn. Their education increasingly feels like it is competing with patient care. A London-based junior doctor adds that: ‘we are regularly emailed and called to fill in on-call shifts. I feel knackered most of the time and although I love teaching, find that I use that time to catch up with my own workload rather than share my knowledge and skill with students. It is a real pity that the next generation of doctors are not nurtured, in hospital, the way I was as a medical student.’

Research by our medical school, born out of the 2015 BMJ survey, finding that 30% of polled medical students had experienced or received treatment for a mental health condition whilst at medical school (3), suggests a link between financial concerns and the mental and physical health of medical students (4). With the financial cost of doing a medical degree becoming prohibitive (5), there is growing evidence that ‘doctors from underprivileged backgrounds are poorly represented in medicine’(6); with overall applications falling by 13.5% in the past two years (7), this is a growing concern.

We want to care for patients and make the world a better place – many of us have dreamed of being a doctor for years. However, our experience of perpetual staffing shortages, worsening financial difficulty and rising workloads is sapping our enthusiasm. The deteriorating learning environment and a demoralised workforce struggling under the tension these conditions produce, is gradually subverting our dreams.

It is difficult to care for others if you are in a bad place yourself. The morale of medical staff is important to us, but it should also be very important to you.


London Medical Students

References
1 - GP National Recruitment Office. (2016). ST1 Recruitment. Available: https://gprecruitment.hee.nhs.uk/Recruitment#panelOne. Last accessed 8th March 2016.
2 - Joint Royal Colleges of Physicians Training Board. (2016). One fifth of consultants state that rota gaps are causing ‘significant problems for patient safety’. Available: http://www.jrcptb.org.uk/news/one-fifth-consultants-state-rota-gaps-are-causing-‘significant-problems-patient-safety’. Last accessed 8th March 2016.
3 - Billingsley, M. (2015). More than 80% of medical students with mental health issues feel under-supported, says Student BMJ survey. Available: http://student.bmj.com/student/view-article.html?id=sbmj.h4521. Last accessed 8th Match 2016.
4 - Watson J, Wheeler T (2015). A report on clinical year student funding for MBBS Medicine.
5 - Ercolani MG, Vohra RS, Carmichael F, Mangat K, Alderson D. The lifetime cost to English students of borrowing to invest in a medical degree: a gender comparison using data from the Office for National Statistics. BMJ Open, 21 Apr 2015. Available: http://dx.doi.org/10.1136/bmjopen-2014-007335 
6 - General Medical Council. National training survey 2013: socioeconomic status questions. Oct 2013. Available: http://www.gmc-uk.org/Report___NTS_Socioeconomic_Status_Questions.pdf_53743451.pdf 
7 - UCAS Analysis and Research. Deadline Applications Statistics: October. Oct 2015. Available: https://www.ucas.com/sites/default/files/mr_october_151015_medicine.pdf