Deciles: The Hunger Games of Medical School
No one said Medical School would be easy. We were prepared for this when we decided to come here. All those exams, interviews and work experiences have allowed us to be differentiated from the rest. As a result, we are here. There was a lot of competiton to get into medical school, but success makes us feel like we are ready for what awaits ahead of us. Yet a question that often springs to mind: Are we really ready?
It would be naive to think there would be no competition at all in medical schools. You get the highest achieving and the most ambitious kids from school and place them in the same environment. The maths here seems simple. However, I think the pressures exceed that of what we expected. Let’s take decision to intercalate or not as an example. This ceases to be a question but a must to secure those 4 extra Foundation Programme Application System (FPAS) points. What if you can’t intercalate? This can be due to anything beyond your control. To finance living costs in London for an extra year is not an easy decision. We compete for the top deciles to get the highest FPAS points. We hope all this will be worth it because we will get the best jobs in the end. I do agree that a certain level of competition enhances motivation to do well. This stimulates a hardworking environment that allows the process of molding medical students into good doctors. But doesn’t ranking mean no matter how well you do your success is always determined in comparison to others’ merits?
This relentless comparison of ourselves to our peers has greater impact on our careers and future patient care than we think. We learn - via unspoken rules- in medical school in order to do better than others in a test, we have to work staying up late compromising our sleep. We go over and over things until we are burnt out. In the end we fall ill, or become fatigued. Do we ever think about taking that much needed break? The answer is no for most of the students. If it is a yes, there is usually guilt attached to it. We are building a culture where taking time off is seen as a sign of weakness. Now think about this scenario as a doctor. The fear of appearing weak, jeprodisring future career options or asking a colleague for help will lead to presenteeism. This will lead to poor patient care. Therefore it is crucial that we learn “smart” working and not just hardworking during our degree. This way we can take good care of both our patients and ourselves in the future.
We won’t be taking care of our patients alone. We will be working together with a team which will also have people who we are studying with now. Who wants to work with incompetent colleagues? No one- especially if what you are dealing with is human life. So we better work not just to become good doctors ourselves, but encourage those who we are on the same journey with. Right now not all of us can be in the top deciles. Therefore it is not unreasonable to think: “Why should I share the knowledge I spent time learning with someone else?” Yet 5 years down the line as doctors, we’ll be winning together and we’ll also be losing together when things go wrong. Therefore if only one individual learns from a mistake it cannot make them a better doctor. In order for this to work, a doctor’s job should be in isolation of others. However healthcare is teamwork. The team has to learn. For this we have to share our knowledge and our opinions. Our communication will helps us make each other better. So why don’t we start doing this at medical school? Surely it must be easier to do as we start as FY1s if we already have 5 years of practice under our belts.
No matter what, medical school will be a competitive environment due to the nature of students it picks. This can be good in a way. Being raised in a high-pressure environment will prepare us for the high-pressure healthcare environment. However in order to shape our culture in the best way possible we should all learn to not lose perspective. Having recently started clinical years I am even more aware that the 5 years is so much more than just getting good grades or being the best. So I propose that we think of our time in medical school as a bowl of ice cream. Being at the top of the class can be the cherry on top. Yet we shouldn’t forget that a bowl of ice cream is still wonderful regardless of the cherry on the top.
