Once upon a time medical school class sizes numbered about 40 people. The student : consultant and student : patient ratios were low. Everyone had an equal opportunity to see and touch and hear things. Future doctors had to know all the things, had to write essays, had only a handful of textbooks and a ward full of patients. All was right in the world.
Then came the surge in tertiary education accessibility and this strange idea that everyone who was bright had to do science i.e. medicine. What followed was a welcome blossoming of the medical field. Now we had extra doctors to fill in the gaps previously patched up by family nurse practitioners and old doctors long past retirement. All was even better with the world.
But the numbers kept climbing. What started as a welcome trickle soon became an unstoppable torrent and the volume of graduates was starting to spill over the buckets we had to catch them. It’s been going on for a while, but in the last three years it’s been getting a lot more noticeable.
It’s not just the numbers that are the problem, either. Historically, UWI doctors have a reputation for being unparalleled clinicians because of the overwhelming amount of exposure we’re supposed to get on the wards. Our consultants tell us stories about being in final year and getting a stipend for acting as interns. They’re full of back in the day type stories but to us they’re just that: stories.
Our reality is lecturers who are a hundred miles away, histology specimens on LCD screens and anatomy labs where we balance precariously on high stools praying we don’t fall face-first into the formalin. Our reality is two junior students plus one senior student assigned to one patient in addition to the team that’s actually taking care of them.
Our reality is the super clever students answering all the questions meanwhile those of us who are not so clever mill around at the back of a ward round with 20-odd people without quite following the discussion. Our reality is a million different textbooks and the indefatigable expanse of the internet and consultants who constantly contradict themselves. Sometimes medical school is also a negotiation of egos.
Older consultants complain that the quality of the UWI medical student is declining. It’s true. When female med students show up in rompers to the hospital, or when a med student back-chats a consultant in exams, or when they can quote Bailey and Love’s back at you but don’t know the first thing about their patient’s procedures. These all represent a shift from previous standards, a downward shift.
But between the student and the consultant lies the administration. And the administration seems somehow disconnected from the goings on of the very people they administer to. Class sizes are uncomfortably large and the university responds by building basic sciences buildings big enough to fit everyone in. But the clinical spaces are the same size as they were five, ten, fifteen years ago.
There are not enough hospitals, not enough consultants who volunteer to be associate lecturers (I have to say volunteer because one common complaint about UWI is that they never pay anyone), and most importantly not enough patients.
We overwhelm everyone when we step onto the wards, every single time. There are only so many variations on ‘There are so many of you!’ that one can hear before one gets fed up.
‘You won’t all fit’,
‘You can’t all go at once’,
‘Some of you have to stay outside’,
‘Decide which one of you gets to do it’.
Please. It’s not our fault our class is this big. None of us have dropped out yet.
Yet despite the glut of doctors on the market and the increasing difficulties faced by medical students on the wards and in clinic the UWI doesn’t think to cut back on medical school entrants. They’re rolling out the red carpet for everyone. Everyone who can afford it, that is.
Grades aren’t a good enough criteria any more: everyone has Grade Is and IIs in CAPE, and co-curricular activities, and higher than 3.3 GPAs so now it’s the ability to actually afford medical school that separates the wheat from the chaff.
And once you can afford to get in, the long ago shift from essay questions to MCQs makes it infinitely easier to keep passing exams and make it to final year, MBBS and graduation. The standard of medical student isn’t the only standard that’s dropping here.
I wish our university would realize that trying to fit 500 medical students into a system with nowhere near that kind of capacity is like trying to pour 160lbs into size 2 jeans. The non-stretch kind. There is no stretch in this cotton, UWI.
We are the adipose pushing at your waistband, and one day the seams will burst.