So You’d Like to be a Doctor?

In the film Dead Poets Society, John Keating, a charismatic and inspirational English teacher, returns to the school where he was a pupil, a US boys’ academy hothousing the future doctors, lawyers, bankers, and captains of industry bound for the Ivy League.  Here he offers his students an alternative and perhaps subversive educational experience.  He invites one of them to read to the class the introduction to a poetry anthology, Understanding Poetry by one J. Evans Pritchard.  This expounds a literary theory which evaluates a poem according to two criteria, perfection and importance.  These can be graphed on an x and y axis such that the overall worth of a poem is represented by an area on the graph.  Mr Keating draws the graph on the board and the class dutifully copy it down.  But they are brought to a sudden halt by his comment.

“Excrement.”

In Waterstone’s the other day I paused to look at the medical section.  I like to keep my finger on the pulse.  I noticed there was an entire shelf given over to a variety of textbooks more or less bearing the same title, “How to get into Medical School”.  I thumbed through a few of them, with a sickly fascination.  They mostly followed the same format and dealt with the same issues, in largely the same way.  Getting good grades at school is de rigueur.  In addition, you need to do well at one of the Clinical Aptitude Tests now required by most universities – UKCAT or BMAT or GAMSAT.  This needs rehearsal.  Then you would be wise to accrue some work experience relevant to the health sector, perhaps a holiday job in a care home, a hospice, or hospital.  Try to shadow a general practitioner and spend some time observing at outpatient clinics.  If you are taking a gap year, it would be good to spend time in a developing country, doing voluntary work.

With respect to your application, visit the med schools that attract you and find out what they have to offer.   Take the greatest care to hone a beautifully crafted Personal Statement, and rehearse endlessly for the interview, fielding all the standard questions as well as a few unpredictable googlies.  You get the picture.

If I were mentoring a prospective medical student, I would certainly encourage all of the above.  I would even suggest they read some of the “How to get into Med School” books.  I’ve just finished reading “Get into UK Medical School for Dummies” (Wiley, 2013) – rather an oxymoronic title considering how difficult it is to get in.  Maybe it refers to a specific institution – “I won a place at UKMSD.”  Anyway it contains lots of sound advice and I would happily recommend it.

What I would hesitate to do is tell that prospective medical student what I really think, namely, that  the whole of that particular bookshelf, the whole project, is a steaming pile of… well, what was that word Mr Keating used?

There’s a piece of medical propaganda that it suits the universities, and the profession, to peddle.  It is that, in order to study medicine, you need to be a cross between Albert Einstein and Mother Theresa.  And it would be helpful if you spent your summer holidays solving the Ebola crisis.  It’s a myth.  If you have enough native wit to gain a sound knowledge of pathophysiology, and if you are kindly, caring, and conscientious, then you can be a good doctor, perhaps even a great one.  There are plenty of young people out there with solid, if not exceptional, exam grades, who would love to study medicine, but who never get the chance.

I found myself wondering whether, if I were applying for medical school now, I would have any chance of getting in.  I was a graduate student, and I gather some of the med schools attach more weight to graduates’ UKCAT performance.  So out of curiosity I got some practice questions and had a go.  UKCAT is a psychometric test, measuring your thought processes.  It’s in five parts: verbal, quantitative, and abstract reasoning, decision analysis, and situational judgment.  No special knowledge is required to sit the test, and indeed any person who had done reasonably well academically at school could, given plenty of time, walk in off the street and make a pretty good fist of it.  What makes the test difficult is the time constraint.  To complete the test, you need to answer 231 questions in two hours.  That averages just over half a minute per question, and most of the questions are quite lengthy.

With my confidence lately boosted by imminent publication of my novel, I thought I might try the verbal reasoning subset.  You read 11 passages of prose and mark 4 statements on each passage as being “true”, “false” or, on the information given, “can’t tell”.  You have 22 minutes to complete the subtest.

The first piece of prose was 250 words long, and contained a lot of detailed information.  I read it in a minute.  That left me a minute to answer the questions, but it took me two minutes, and then I got one wrong.  Then I started to pick a fight with the examiners.  “No no no.  That’s not right!”

The quantitative reasoning subset was worse.

With abstract reasoning and decision analysis, UKCAT becomes surreal.  You enter the realm of Bletchley Park and decipher hieroglyphics.  Oddly enough I did quite well at that, and that puzzled me.  Then it twigged.  I’m a crossword addict.  It’s really all about practice.

I was amused to find myself looking, as a prospective medical student would, for the tricks of the trade that would allow me to perform better in the tests.  Clearly, you can’t sit down with a cup of coffee and read these 11 segments of prose in a “normal” way.  Probably best to skim read them, then read the questions and cherry-pick the answers.  If in doubt, write “can’t tell”.  There’s no negative marking so you have nothing to lose.

Ridiculously, I found myself considering practising a bit to improve my performance.  It’s my own personal Myth of Sisyphus.  Having completed a career in medicine, I’m obliged to go back to med school and start rolling that boulder up the hill again.

But really, who makes this stuff up?  And why?  All prospective medical students have already been educated, excruciatingly, to breaking point.  Why subject them to this?  It’s a form of abuse really.  Prospective medical students are talented people.  Put a hurdle in front of them and they will probably surmount it.  It doesn’t really matter how ridiculous the hurdle is, it will be hurdled.  It’s like a concert pianist playing The Minute Waltz in 31 seconds.  You marvel at it.  Yet something is missing.  Like… Chopin.

The real irony is, while our universities are going to immense trouble to select and train these pedigree racehorses, you can’t find a doctor when you need one for love nor money.  (Well, maybe for money.)  Two weeks to see a GP, six months to see a neurologist…  All the doctors in their 20s are leaving for Australia, and all the doctors in their 50s are just leaving.  It’s enough to make you roll up to the med school interview in jeans and T-shirt and without a care in the world.

“Mr Campbell, why should we offer you a place ahead of the other interviewees?”

“Well, I don’t know any of them.  You decide!”

“You tell us about your strengths in your Personal Statement.  What would you say is your weakness?”

“I’ve got a bit of a drink problem.”

Of course it’s just a fantasy.  Like everybody else, I would present a strength disguised as a weakness.  “I’m terribly impatient.”  This can be translated as, “I’m clear headed, decisive, and dynamic.”  Sounds a bit arrogant, so needs to be tempered.  “I need to take time to listen, and to understand an opposing point of view.  I’ve been working at this, and have found the satisfaction of learning to be a team player immensely rewarding.”

Makes you want to throw up.

But if there’s one thing you learn in medicine, it’s to play the game.  So you turn up in your charcoal suit, exchange some charcoal blandishments, and recycle some charcoal ideas.  But make sure you throw in something a bit different that will make them remember you.   Like your burgundy tie, nothing off the planet.

I once went for an interview and didn’t give a damn.  I sat the Civil Service graduates’ entrance exam (in a freezing building on St Vincent St Glasgow during a power cut) and passed it, and got invited down to Whitehall for one of these intense two day goldfish bowl experiences where psychologists watch you chair board meetings.  My fellow candidates all seemed to have gone to Haberdashers and Eton.  I must have looked, and sounded, like a Martian.  And at the interview:

“What is it that attracts you to the Civil Service?”

“Nothing much.  I’m thinking of applying to med school.”

Oddly enough, they didn’t throw me out on my ear.  Well, not right away.

If you stay in medicine for long enough, eventually you cease to be an interviewee and become an interviewer, when remarkably talented people say to you, “I’ll give the job 110%.”

“Oh don’t do that.  You’ll be burned out in 2 years.”

“I’m not afraid of hard work.”

“Oh yeah?  Well I am.  I’m absolutely terrified of it!”

I thought these thoughts, but I never actually voiced them.  The fact is that, as a teacher and mentor, you have to be very careful about introducing your students to the attractions of being maverick.  There’s a subtle, barely articulated implication in Dead Poets Society, that Mr Keating, for all his remarkable inspirational gifts, was a bit naïve.  Of course it is quite right to say that when a tragedy occurs in the school, he is scapegoated and hung out to dry.  A colleague of Keating, Mr McAllister, very nice, empathetic, old-fashioned Scottish dominie tries, in the gentlest fashion, to warn him.  And just before the school lets Keating go, he and the Scotsman catch sight of one another, through a window and across a quad, and exchange a friendly wave.

Neil Perry is the boy who plays Puck in A Midsummer’s Night Dream, who wants to act, but whose overbearing father is forcing him to be, of all things, a medical student.  Neil says to Mr Keating, “I’m trapped.”  And Mr Keating says, “No you’re not.”  Within that simple exchange lies the whole beauty of the medical consultation.  UKCAT doesn’t know anything about that.

Mr Keating’s students find a copy of their teacher’s year book.  “John Keating.  Keats.  Man most likely to do anything.”  I co-edited our medical class final year book.  No, that will never do.  Far too uppity.  Rework it for the Personal Statement.  “I was lucky to have the chance to contribute to the editing of our final year book.  I was terribly impressed, and rather humbled, by the range and depth of my colleagues’ extracurricular activities…”  Well, that’s true.  One woman boosted the finances by driving a heavy goods artic down the M1, and another by shouting the odds at the dogs at Powderhall in Edinburgh.  But they didn’t do it to enhance the CV; they just had an instinctive notion of how to get a life.  Maybe Wiley and Sons could commission them to write, “How to get a life for dummies.”  It would be the absolute antithesis of “How to get into Med School”.  I think it would resemble a letter of advice I feel inclined to write to my young pre-med self:

“Relax; calm down; chill.”

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