Resident doctors synicsl strike again

Yes, @mumsneedwine .
The sentence you found ‘utterly revolting’ at 19.45 yesterday was

A place to centre their studies with like minded peers is invaluable.

It never occurred to me that anyone could see this is socioeconomic terms. Eventually I realised that my rather lovely experience of this centre was formative for me as I explained earlier today.

Obviously you had no knowledge of that. As someone who works with YP from lower POLAR 4 quintiles, I thought you might be interested in things that work for them. The details would be different in the UK, but uni student volunteers can offer unique strengths.

When someone jumps to the worst possible interpretation of my statements and fails to acknowledge subsequent communication, I do feel free to make the full story extremely clear.

Thanks very much, @Scotiasdarling

I’ll have a great Easter now. Best wishes to everyone for the same, or a good day otherwise.

Have you heard the phrase 'try to be civil'?

I would have thought that someone who purports to be keen on widening participation would take seriously any intervention which might help.

To put it very kindly simply getting as many people as possible in to universities with the lowest possible entry requirements doesn't seem to be working in the longer term (the hope obviously was that they would catch up. The reality is they don't)

Still going ? Have you ever heard the phrase stop digging ?

Happy Easter

@mumsneedwine

I will finish my explanation to you with a piece of my own background, which informed my thinking.

In my home country UG education in many subjects is more flexible than in the UK (also cheaper). Talented final year high school pupils sometimes enrol in introductory modules, if they are lucky enough to live near a university. There is very little socioeconomic differentiation amongst them, as teachers recommend for enrolment, although possibly MC parents have sharper elbows.

It can be a bit daunting for the pupils, especially first term. I participated in a voluntary service to help them. We had a congenial study centre, provided snacks, tutoring, a certain amount of basic equipment, etc. This centre became a desirable place for some of the top pupils from all socioeconomic strata in our city to hang after school, each probably for several hours 2-3 days/wk, doing their schoolwork.

DC of doctors and lawyers and DC of dockworkers and cleaners. No one was thinking about that. They were happy to have an intellectual peer group, embedded in a university environment. Seeing with their own eyes lots of people being happily productive because they were intelligent was invaluable.

Another time, another country.

And in my view also can’t take as good a history and synthesise a case as well as an experienced clinician. I expect it’s pretty good already at interpreting investigations. But history taking involves subtle skills that aren’t easily programmed, such as critically interpreting things that a patient does say, but also picking up the things they don’t say.

AI can't take blood or insert central lines. It can't see a patient's tremor/ jaundice/palor it can't auscultate a chest or heart, it can't palpate an abdomen or if it come to it intubate or perform CPR- most resident drs will do these tasks multiple times every shift ( except for the central line/ intubation tbf). It is very difficult to see how AI is going to replace that.

Not a chance! Hopefully AI will take away some of the grunt work for juniors, and some specialties like radiology may be greatly affected, but we will still need human doctors.

And BTW these human doctors will need to have a wee but they can always do during a shift. I’m getting irritated by the trope of the busy resident doctor who has no time for a wee or food. Ridiculous. There is always time for a few minutes, even when working in A&E or doing the on call overnight in an acute hospital. Hyperbole doesn’t help the cause.

Anyway this was an interesting thread until the usual suspects got involved again. There probably needs to be a subforum as these threads always end up going down the same path.

I have nothing against doctors, they do an important job. But some people raise them to such a ridiculously exalted status, like religious ministers used to be held in such high esteem.

Somewhat ironic, to discuss my children's education, the funding of state education, private schools, NHS "underfunding" and PAs and then complain that the thread has lost its focus, don't you think?

The point about Cambridge, and the increased chances of privately educated students getting firsts, is that it occurred purely because Cambridge decided not to select on the basis of prior attainment, in an attempt to increase the proportion of a discrete subgroup of applicants - to "level the playing field" as you put it. When admission decisions were made on academic criteria, students from state schools and private schools had identical outcomes.

The problem with state education, as far as Oxbridge is concerned, is that pupils in the top quintile of nominally unselective state schools are 25x more likely to be accepted than children in the bottom quintile. I am not aware of comparable figures for medicine, but they are probably similar. This is clearly not related to funding, and does not have anything to do with private schools.

If WP applicants were "attaining excellent grades despite facing challenges along the way", medical schools would have been able to skew their intake in their favour without deprioritising academic attainment. But they were not reaching the high bar set by medical schools. So what has happened is that non-academic requirements replaced the academic. Medical school admission became substantially more complex, disadvantaging the pupils it was meant to help. UCAT is one example of this, it was intended to "level the playing field", instead it gives an advantage to applicants who have access to guidance, resources to practice, and if need be, to try again.

You may prefer to theorise about what makes a good doctor but prior attainment is the best predictor of postgraduate performance, without which career progression is not possible, and as McManus et al. concluded: "Passing examinations such as those discussed here is important for being a good doctor, and those who have difficulty in attaining such clinical knowledge will probably be less good doctors. Knowledge is generally preferable to ignorance, and clinical knowledge underpins clinical practice."

@OonaStubbs posts are very unpleasant and ignorant about doctors. It is so sad to see someone carrying that around.

The NHS is hardly "done on the cheap". It costs hundreds of billions a year.

If they had good working conditions they would be less inclined to strike; and the rise is PAs is an insult to all the training doctors have done ... it would really stick in my craw if I was a medic. NHS trying to get a service on the cheap while leaving the real medics fighting for jobs.

Lots of working people saves lives. Being a doctor is just a job, like any other. You don't see plumbers or electricians or greengrocers constantly threatening to go on strike because they are unhappy with their lot.

To continue, @mumsneedwine ,

I am not suggesting that independent schools offer an inherently superior education. I do think selectivity frees them up to do more teaching, because less behaviour management - old MSc and even PhD students who have taken jobs in the independent sector really enjoy teaching the subject matter, whereas our graduates who teach in state schools are more focused on the pupils. That can be good for the pupils as people but it isn’t necessarily best for attainment. A delicate balance.

Again, this is not about peasants being stupid or any such nonsense.

Anyone could benefit from the self confidence of a school that brings out their talents, gives them the confidence to feel comfortable at Oxbridge, etc. The pupils in these schools may be lucky, which they may mistake for being superior.

I wonder how this plays into the issue of dissatisfied doctors? All academics are familiar with students whom we admitted because they overperformed at A level and interviewed well. When their peers catch up, they flounder. It is plausible that they stress more and more as medical training continues.

People are complex and it is impossible to generalise.

@OonaStubbs LOL, apart from saving lives. As my daughter did today, picking up a grossly abnormal PH on a blood test and getting the patient to intensive care and dialysis.

Doctors set up so much mystique around what they do. It's just a job. There's nothing special about it.

@Marchesman Your grandfathers and father may have been working class but your DCs attended pre prep, prep, private boarding schools from age 3 to 18, didn't they?

Do you not think the problem lies with a failure of the education system in this country? All children should have equal access to educational opportunities. Then there wouldn't need to be as many contextual schemes seeking to address inequality by trying to level the playing field for those not as fortunate as your DCs? For those who can't afford to or don't want to send their DCs to private schools, the budget in state education whether DCs are in state grammar or comprehensive school don't stretch to afford DCs that level of support. The widening participation schemes exist to address the problem by seeking to level the playing field. It's great that they exist but it would have been better if all children had equal access to these opportunities from the early years of attending school than trying to fix things at age 18.

It has been mentioned here that there are larger numbers of privately educated students going on to achieve firsts at Oxbridge or other elite universities. Maybe not surprising after all that investment in their education. It doesn't mean however that state school or WP students are not as able as the privately educated students. Many are but they are let down by the the educational budgets within the system. It's fantastic that these schemes exist to help WP students access the degrees and universities they want after attaining excellent grades despite facing challenges along the way.

Some posters have suggested that WP doctors are perhaps, in the case of speciality training, not good enough and that's why they haven't qualified for training opportunities and therefore they shouldn't have been doctors in the first place. It's like someone saying doctors from wealthy backgrounds who went to elite universities who are leaving medicine shouldn't have been offered those medical school places if they then leave medicine because they are disappointed they aren't earning as much as their friends who did finance.

The thread has lost focus and little is mentioned about the issues of severe underfunding and replacement of doctor jobs with PAs, etc which is a driver of these strikes.

Also what is happening to locally employed doctor posts that were removed from the NHS to make way for the training places that appear now not to be materialising? There appears to be little concern that future NHS care may be delivered by non-doctors.

I guess just like education, how wealthy you are may determine the healthcare you receive. The patients that can go private will be treated by doctors and those that can't afford to may be treated by PAs and others without medical degrees within the NHS with just a few supervising senior doctors. Without the government expanding speciality training and consultant posts, the future of medical care looks grim. It's absolutely insane that training places are being withheld because strikes are going ahead.

I note there has been discussion on which medical schools make the best doctors. There's no guarantee that doctors who went to Oxbridge or what are viewed to be elite universities deliver the best medical care. Even if the top performers in these medical schools do really well in postgraduate medical exams as you have said, ultimately how good a doctor is depends on many factors including how they deal with patients. Having the best in depth knowledge but a failure to communicate it or being too arrogant to recognise when they have made a mistake or delivered a poor standard of care would be unacceptable to patients. I am sure you would agree that many of the top doctors in the UK, even in the most competitive specialities, have attended medical schools other than Oxbridge.

I think there is a big misunderstanding but in order to clear it up I would like to know more about what you think I mean.

To give it a go: I think high attaining students benefit from a like minded peer group, who value education. Emphatically, this statement has nothing to do with socioeconomic status. My DF was seconded to a very expensive American city for my high school years. We lived in an upscale suburb and i saw first hand that being rich or having high achieving (or pressurising) parents need have nothing to do with valuing education.

So yes, students with talent and ambitions need peers. Also mentors. Where do they get them? Perhaps school can provide this, perhaps not - the needs of the many rightly come before the needs of the few. And the state school teachers and staff I know are doing everything they can already.

I was thinking of the relatively small number of uni outreach experiences in the UK, open to all but at very small scale, or the Sutton Trust and Oxbridge outreach which do focus on pupils from disadvantaged backgrounds but IMO too little, too late. Still a big step in the right direction, however.

A number of independent schools articulate the ideal, but it doesn’t seem to translate to reality: talented, aspiring pupils from different backgrounds have a lot to offer each other . Some could impart confidence and optimism, others tenacity and grit. Different learning styles. Etc. Pupils from different backgrounds should be banding together. I hate that this ideal has deteriorated into a cynical PR exercise.

How can this ideal be achieved? Because state school teachers and staff are so overstretched, my thoughts went to an extracurricular structure. Should or should not independent school pupils be eligible? They may need less help, but socioeconomic segregation is undesirable.

For that matter, one could make a case for focusing enrichment resources on Q1-Q2, because their medical school entry statistics lag so badly, or this could seem wrong on the grounds that it segregates them.

Which would you prefer?

Now I would like to know what you meant in your post?

BTW I was educated abroad in a completely different system.

Haven’t read this whole thread, so apologies but l’ve read very many similar. Personally, having a doctor daughter who is 4 yrs qualified I know the struggle. The pay is crap for the responsibility and role. Junior doctors get paid similar to nurses and it’s not right - I speak as a nurse of over 40 yrs. Doctors’ pay in the 80s was nearly twice what I was paid and quite rightly too. That’s taking into account the upshift of what nurses do now.
The biggest shocker is the inability of many foundation doctors to get onto training so they are in limbo or unemployed. This is a big reason for striking, not pay. It’s a disgrace. The govt have now said that they withdrawing the extra 1000 training places as docs are going on strike. My DD said today they weren’t going to be available anyway. They are being made to jump through hoops to apply for limited training places including having to compile a portfolio of published articles, inc teacher training etc - at a big financial cost. Most consultants wouldn’t even have this. I’m furious on their behalf. My daughter is brilliant in her job - caring, dedicated and very competent but she wishes she had done Maths at Uni and would not recommend Medicine as a career. I think the BMA have seriously let junior doctors down over the years to allow the pay to be very much eroded. It’s a case of too little, too late. Those people that think they are being greedy couldn’t be further from the truth.

Unfortunately I don't think you have read it wrong - everyone should keep in their lane. It is like time travelling into the 1950s.

Your last sentence is utterly revolting. So you think the peasants shouldn't mix with the gentry ? Just wow. (Or have I somehow read that wrong - please tell me I have ????)

🫩 no, many many people live in council housing, not just refugees. I really do despair. We send about 10+ students a year to med/dentistry (we are a v large local academy chain). Many are PP and/or FSM. It's really not that uncommon in some parts of the country. Bright kids can come from any background, gone are the days you could buy yourself into Uni.

I'm serious if you want to come visit. 'Working class' and poverty are totally different things.

That’s too late. Students need to enter medical school - let’s go further and stipulate strong medical degree programmes - on an equal footing.

For this they need the same study skills, self confidence and A levels. Work experience is realistically not so important, at a guess - we could ask the consultants on this thread. However many YP find it motivating, enjoy discussing it, and may use it as a form if competition amongst themselves. So YP from disadvantaged backgrounds need the same access to WE, academic enrichment, etc.

The whole package that helps the MC succeed at university. @Marchesman posted a shocking statistical advantage that privately educated students have when it comes to gaining a First. If their secondary education is excellent, they will begin university with an advantage but any explicit knowledge from sixth form will only go so far. The biggest advantages will be in the realms of study skills and self confidence. YP from disadvantaged, disorganised backgrounds can barely imagine much of what they are missing.

A place to centre their education with like minded peers is invaluable.

@poetryandwine What does dearth of opportunity look like? If medial schools bend over backwards to recruit from under represented groups, you could say they are getting opportunities. It’s whether this is producing better Doctors is surely what we as tax payers and patients want to know.

For clarity, and I am addressing this generally, I do not think I suggested that diversity is more important than attainment. I do think society has an obligation to cultivate talent where it is often easier not to look and wants only a chance, and for a variety of reasons we make only a patchy effort.

I want doctors to be high attaining; however this increases the moral obligation to provide the opportunities to make attainment possible. My understanding is that the dearth of opportunity makes this question very difficult to sort at present.

The very high percentage of unsatisfied doctors does suggest that something has gone badly wrong. But just who are these unsatisfied doctors? Is it known, for example, that they come from PBL programmes or medical schools with lower entrance requirements? It seems logical that a strong education would help one to withstand the resident doctor years. (Certainly better prepared PG students tend to be more successful at doctoral studies, although there are confounding factors and the analogy is not perfect)

If dissatisfaction is statistically linked to the same factors that create weaker doctors, is there any chance that this will be an impetus for change?

I don’t care about those who don’t belong in medical school; but in light of the fact that only 14% of those with a place are from Q1, how many of the concessions for coping with weaker students are being driven by DEI?

Thanks very much