Di stress / Distress / De-stress

Please enjoy this post I wrote 2 years ago while struggling to survive my intern year. The level of optimism is truly remarkable considering I was on my Paediatric rotation at the time.

The shift from medical school to internship is the shift from dipping one’s toes in the swimming pool to diving in the deep end. When you’re a medical student, duty ends at 10pm. If you can’t get an intravenous access, you call the intern. 12 o’clock is always lunchtime.

Suddenly, it’s July 1 and the minutes don’t roll over. Free paper has been burnt. You have passed the dreaded MBBS and received, in return for your labours, more hard work. Harder work, in fact. Your duties extend for 24 and 48 and 56 hours. Sleep becomes a concept. Lunchtime, a luxury. You become the person the medical student calls when they’ve destroyed all the veins in their quest for an IV access.

Why am I here again?

If you haven’t asked yourself that question at least once in the last six months, consider yourself lucky. You might actually want to try your hand at the Lotto.

If there was a buzzword for internship, disillusionment would be it. When asked what lessons have been gleaned from the “Internship Experience”, one intern from a hospital which shall remain nameless (we’ll call it the Really Tall One) responded with an outburst,

“Old doctors want our experience to be as frustrating as theirs to ‘build character’.”

You know it’s time for a paradigm shift when you point out workplace inadequacies and your boss responds with,

“You merely adopted high patient loads and low resources. I was born in it, molded by it. I didn’t have the luxury of readily available investigations until I was already a SR and by then it was an insult to my clinical acumen.”

It’s admirable to want your interns to be the best they can be but there are practices in medicine that in any other profession would spark the ire of an entire HR department. But I digress. This isn’t meant to be a call to arms.

Sometimes the answer to that ever-present question is positive. Real life patient care (as opposed to the dabbling that’s done in medical school) can be and has been rewarding and invigorating. The General Surgery rotation is particularly satisfying in this regard: patients enter the hospital bleeding, broken, dying and with the flick of a scalpel, the swish of a stitch (and some strong pain meds) they survive to maim themselves (or someone else) another day.

Lest this turn into a clichéd trope about the satisfaction of a job well done, I do have some misgivings about the surgical field. Once a patient expressed their profuse gratitude for having their infected digit amputated. You’re . . . welcome?

As uplifting as those moments are, they seem to be outweighed by the downsides of working in the public system. Like McGyver and Miss Lou, you has to tun yuh hand mek fashion. Whether it’s performing an entire sepsis screen (including lumbar puncture) on a neonate without assistance or manoeuvring a 250lb patient with bilateral skeletal traction off their stretcher and onto the CT machine, provided the CT machine is working. One disadvantage faced by every public hospital is inadequate funding, but necessity is the mother of invention. If you haven’t made an IV drip stand out of a curtain hook or a chest tube out of a Foley catheter, you haven’t really lived.

There is a certain satisfaction to seeing patients managed conscientiously despite low resource settings, but can medicine be equally reward and punishment? Ours is the lot of sleepless nights, thankless hours and the constant threat of occupational exposure (latent TB, anyone?). Is the smile of a mother when you tell her yes her baby can go home really worth the stress of q4hrly bilirubins?

As the most junior member of the medical team that stress of ‘getting it done’ rests squarely on the intern’s shoulders. It often feels like we’ve been left in the deep end of the pool to sink or swim, complete with Yoda-like figure declaring “do or do not, there is no try”. Coping mechanisms become currency as we try to stay afloat despite the setbacks. Periodic nervous breakdowns, the impenetrable veneer of cynicism and a strong tendency toward smoking and alcohol are only a few of the methods employed.

If you are stranded amidst the sea of disillusionment, clinging to the battered lifeboat of responsibility it helps, I think, to remember the reason you started out on this journey in the first place. Sankofa, my friends. It is okay to look back for that which you have forgotten. Whether it was the personal fulfilment you get from helping other people or the determination to be consultant someday, internship is decidedly BYOM. Bring Your Own Motivation.

At six months in we’ve already committed to this gestation period, for better or for worse. And when we are delivered in another six months, freshly registered and happy to be out of the frying pan of internship, we’ll look back from the fires of Senior House Officer year with the same clouded nostalgia as the consultants who believe that their internship experience was the only one worthwhile.

The more things change, the more they remain the same.

 

Should you go to Med School? Probably not.

Medicine has long enjoyed its reputation as a distinguished and well-respected profession with an assortment of perks. Not just in Jamaica but worldwide, doctors rank up there with lawyers and politicians in the hierarchy of  ‘jobs you want your kids to have’. Children with even a mediocre aptitude for science get pushed into medicine and often for the wrong reasons. If you want to be a doctor because you “like helping people” or just so you can put that “Dr” in front of your name you probably shouldn’t go to medical school.

If you like helping people that’s awesome, but you have to be realistic about what exactly you’re working toward and what that work involves. (If you just want the fancy title, get out now). I’m not trying to discourage anyone from becoming a doctor but I do think it needs to be said that being a doctor isn’t for everyone. Similarly, being a garbage collector or plumber isn’t for everyone. And yet someone has to do it. You can appreciate this comparison once you understand that the way we ascribe meaning to jobs is totally arbitrary and ultimately pointless.

People who create immense joy and inspiration like musicians or writers are not revered or compensated equivalent to the value of the work they produce. Conversely our government leaders who exist to serve the tax-payers who elected them are revered and compensated entirely out of proportion to the work they don’t produce.

The bottom line is this: If you could be guaranteed the same amount of wealth and respect by working as a grass cutter (or any other underpaid job), would you still want to be a doctor?

If you said yes, be prepared for a lifetime of hard fucking work. Getting accepted to medical school is only the first hurdle, and it’s a pretty big one. You need the right grades and a decent collection of co-curricular activities. In today’s society it helps if you know the right people. The sheer number of applicants to medical schools annually is staggering; competition is fierce and it will be like this for most of your career.

Aside: If you don’t get into medical school it isn’t the end of the world. If after reading this article and doing your research you decide that you 110% want to do medicine there are ways and means. And you’re young, you have so much time. If after the soul-searching and the research you decide it isn’t for you then congratulations! Go do something that makes your heart sing.

Let’s say you get accepted to medical school here at the University of the West Indies. If your parents can’t afford to, you now have to figure out how to finance all five years of your education. A part-time job is out of the question because you won’t have the time, scholarships are hard to come by and student loans are expensive to repay. Where do you turn then?

Let’s say you decide to take out a student loan. Now you have to hit the ground running with your studies. Medical school is essentially a brain dump of information, most of which has to be memorized until you can understand it enough to apply it. There is constant competition among your peers in tutorials and exams and a stifling atmosphere of one-upmanship. The pressure to continuously outperform your colleagues rarely lets up. Starting here and continuing for a good half of your career, sleep will become a hypothetical concept.

Once you graduate, you’re staring down the barrel of what will probably be the worst year of your life. Internship is a grueling marathon of stamina and skill with the added weight of being responsible for people’s lives. And halfway through the year, if you took out loans, the Student Loan Bureau will come knocking.

If you decide to pursue postgraduate studies, you’re looking at another 3-5 years of school, loans and now trying to balance your family life (probably) with your career and education. If you don’t pursue postgraduate studies, your marketability plummets and your pay grade stagnates. Either way you will probably go prematurely gray from the stress of it all.

If you’re still not re-considering, you’re likely thinking one of the following thoughts:

But doctors are rich!

Unless they inherited wealth (which admittedly, a good many doctors do) doctors aren’t rich. For an average Joe from a lower to middle income family, it takes several hours of overtime to maintain the lifestyle the public usually associates with doctors, especially in the early years of a career. In the grand scheme of income rates, Jamaican doctors get paid very poorly compared to our international counterparts (even South African doctors get more money than we do). But there a lot of different factors influencing how much money you make, most importantly post-graduate study.

But doctors are well-liked/respected!

This is true to some extent. Certainly doctors have special privileges: people smile at you more (people smile at puppies a lot too), you can stand as a character reference (so can ministers of religion) and banks tend to want to lend you money (it’s a trap, Jim). But like Uncle Ben said, with great power comes great responsibility. And if you slip up even once it’s a long way down.

But doctors are _______!

It doesn’t make sense to generalize. The experience of the doctors you have so far been in contact with will not be your experience. The field of medicine is constantly changing and rapidly evolving. It isn’t now what it was fifty or even ten years ago. Technology makes things easier and harder, popularity and accessibility make competition a hundred times fiercer, and regulatory bodies have turned medicine into a business, always looking at the bottom line.

The volatile landscape of the medical profession demands a special kind of adventurous spirit who does their research beforehand. Map your territory. Talk to a medical student, talk to a young doctor, talk to an older doctor, shadow them at work, flip through a medical journal, visit a hospital. Get a feel for the shoes you’ll be walking in.

And after you’ve done all that, talk to yourself. If you have a keen interest in helping people, if you love challenges and relish hard work (and care very little for sleep), if you’re naturally competitive and have a good head for business with a passable understanding of the human body then medicine might be the career for you. Otherwise, set your sights elsewhere. Preferably something in line with your natural inclinations.

Might I suggest Banking and Finance?

More Advice You Don’t Need: Textbooks

Hello troopers! Condolences on getting into med school, if you have. Don’t give up on your dream, if you haven’t (but maybe consider an easier dream).

Today we’re talking tomes. Med textbooks cost several arms and legs, and the reality is you won’t be needing every single one of them. In this post I will attempt to dispense advice on which ones I think are absolutely crucial, and which ones you can borrow or rent or even do without.

Without further ado,

Crucial Basics

Anatomy. Here we use Netter’s Atlas of Human Anatomy for the pictures (internationally renowned) in conjunction with Last’s Anatomy for the descriptions. You will need these for the rest of your life.

*Just FYI – those homemade textbooks the Anatomy department sells you in first and second year are actually useful for passing anatomy, but utterly useless for the rest of your live.

Physiology. The Guyton and Hall Textbook of Medical Physiology is recommended, but there are other like the Ganong that are probably just as good. If I’m being honest, I have to admit that I didn’t spend much time reading Physiology textbooks, because they’re pretty much all long-winded and boring (f you know of one that isn’t, please leave a recommendation in the comments!) but you absolutely have to know how systems work and these texts are the way to do that.

Pathology. Here we use the Robbins and Cotran Pathological Basis of Disease. It’s long-winded, but you should get it because after you learn how systems work you have to learn how they fail, which helps you figure out how to fix them.

Crucial basics only get more relevant as you advance in your career, and you will constant be using them as references. Yes, the editions will constantly be updated but the core material will remain the same. Think of these books as investments in your future.

Clinical Necessities

Textbook of Clinical Practice. Such as the McLeod’s. Highly indispensable book, full of instructions and techniques for histories and examinations. You will use this from third to final year. Even once you’re confident in your skill set, the McLeod’s is still a book you turn to from time to time.

Oxford Handbook of Clinical Medicine. I love small books that pack a punch. The OHCM is first class for information dispensed in bite sized portions that still cover all the necessary basics. I see residents walking around with this book (it’s pocket-sized too). Nuff said.

Textbooks of Surgery, Obstetrics/Gynaecology and Paediatrics. Yes, all three. Because when you’re in school they’re incredibly valuable.

For surgery, we use the Bailey and Love’s Short Practice of Surgery as a reference text (have a love/hate relationship with this book – it is huge and long-winded but surprisingly fun to read). A pocket-sized textbook for surgery is also useful. I prefer the Surgical Recall (and Advanced Surgical Recall), but some think it’s inadequate. I found it extremely adequate for my senior surgery rotation and remarkably easy to read.

For OB/GYN we use locally published textbooks. The Textbook of Obstetrics by Roopnarinesingh is perfectly tailored to our exams and clinical setting, despite being several years old. Similarly the Textbook of Gynaecology by Bharat Bassaw was written by most of the people who teach and test us. Basically? Get these books.

For paediatrics, we use Nelson’s Textbook of Pediatrics, but I think any well-respected textbook would do for paeds. Just make sure to pick one that you’re comfortable with because you will most likely end up teaching yourself this subject.

Nice Knowing You

Your first and second year textbooks of Histology, Embryology and Pharmacology don’t get much use later in your clinical years. Or maybe it was just me? Once you’ve learned the material and passed the exams anything else you need to know can be answered with a quick Google.

These books can be rented or bought and resold to junior students: DiFiore’s Histology, Langman’s Embryology, the Rang and Dale pharmacology text. Don’t get too attached to those names.

Fluffers

Any specialty textbook: Ophthalmology, ENT, Dermatology, Rheumatology, Orthopedics etc etc.

You can borrow all of these for the duration of your rotation. Even if you’re planning a career in the field, five years down the line (when you actually start your residency) you’re going to need an updated edition anyway.

That concludes our session, I think. Questions? Disagreements? Leave ’em in the comments. Good luck my friends. And happy studying.

For Shari, who asked about WJC

What are some other things you liked that Mona Western had to offer, that Mona didn’t? (pro/cons of both campuses).

You guys, this is my absolute favourite topic (barring Doctor Who, Jane Austen, The Bloggess, and also right now Hozier).

The Western Jamaica Campus was like a second home to me. I loved the people, the campus and the atmosphere; I am hopelessly biased. But I will try to give you some amount of objective information (don’t take my word as gospel, guys).

Starfish
That time we found a starfish at the beach.

Disclaimer: This post is written based on my rose-coloured memories of life at WJC some 3+ years ago. The Todd just reminded me that life at WJC was actually not all that awesome.

We had to fight for some basic requirements (good sized classroom, proper streaming, actual anatomy specimens), and a lot of the time we were doing the best we could with what we had. What made it easier to bear was the relaxed, ready-to-help atmosphere of the western campus and the gorgeous, gorgeous surroundings.

wave goodbye

Additionally, things might have changed for better or for worse. You can get up to date information on WJC happenings from their Facebook page or on their blog, The WJC Insider.

Let’s get into that pro/con list.

WJC vs Mona

WJC Mona
Class sizes small – 20-30 people Class sizes HUGE – 200-400 people
Student:specimen and student:teacher ratio relatively good Brand new anatomy lab with lots of space and small group sessions
Tutors are (usually) readily available Lecturers have dedicated office hours, more students to compete with
Lectures are all streamed via network that might not work Lectures live or streamed depending on lecture theatre
Consultants teach anatomy Mostly residents and anatomists teach anatomy
Have to travel to Kingston for major labs No travelling required
Small, close-knit group of people Sprawling campus; easy to disappear
Breathtaking view of the Bay/beach/airport Mountains. Sometimes cold.
Hall of residence has a pool Campus pool that is currently out of service
Some clubs, some diversity of students Wide variety of clubs, wide range of nationalities etc.
The beach is RIGHT THERE. Liguanea is right there?
Less social events, almost no night life (except Hip Strip) Everything happens in Kingston. No, seriously.

WJC actually seems to come off worse in the comparison (sadface) but again I’m not exactly a valid or reliable judge (I’m actually a notoriously unreliable judge – ask anyone). If there are other specific concerns you have about either campus, feel free to post them in the comments or even call the campus of interest (I don’t have all the answers, guys, sorry) and share their response here.

Much love,

Robyn

For Christiane, who asked a Really Big Question

Dear Robyn,

I am from Trinidad and I got accepted into medical school at Mona. Could you tell me all that I need to know concerning medical school and how to care for myself while I am in Jamaica? Tell me how you managed because this is a new experience for me and I could use all the help and advice I can get.

Dear Christiane,

First off, congratulations on getting into medical school! (Or condolences, depending on how long you’ve been following this blog).

I want you to know that there is no simple answer to your questions. Five years into medical school and twenty-odd years of living in Jamaica and I’m still figuring most of this stuff out. A lot of your experiences here will be trial- and trial- and trial-and-error because they will likely be very unique experiences. (It is best to embrace this fact from now).

The best I can do is give you a few sweeping generalizations. (If you would like more specific answers, please leave specific questions in the comments)

I don’t know where to begin so I’m giving you your very own blog post (yay!) for people to comment on and share their own bits of advice. My hope is that this will turn into a giant crowd-sourced repository of advice for surviving and thriving medical school at UWI Mona (your place to shine!) much like my other (massively supported, I love you guys) post on medical school. (I will love you guys even if there is no support on this post).

I’ll kick-start the discussion with what I’m hoping are the starts of answers to your very valid, questions and share the links to some posts where I’ve gone in depth on a few topics.

New experiences are scary! And exciting! There’s so much potential, so much could go wrong; you want to run towards it with your arms wide open or hide with your teddy bear in a blanket fort (the teddy does not judge). I understand your need to feel prepared, but there’s no possible way to prepare for everything. What follows is my (hopeful) guide to keeping you alive and reasonably sane.

Medical School

See my (mostly) comprehensive post here: What is UWI medical school like?

Generally speaking, medical school = university + dead bodies and loads of studying.

Aside from the dead bodies, it’s pretty much like any other science major. Get used to the smell of formalin, and studying all the time. If studying all the time is your bag, congrats! If not, you will need to do some degree of adjusting.

First year med students hit the ground running with the sheer volume of information they’re expected to absorb and regurgitate, and the sad part is you will forget most of it. Later on in your 4th and final years some of it will actually start to make sense. Accept this fact from now.

Keep yourself healthy. This means physically, emotionally and mentally. Eat right and get some kind of exercise – foster the good habits early, or you will end up being the intern with a stomach ulcer who collapses on the job (true story).

Have appropriate outlets for your emotions; suicide is a very real danger for people in this career. Some/most med students study hard and party harder as a way of stress-relief. Find your stress-reliever and hold on to it with both hands (and feet, and your teeth too. Don’t let that fucker go).

Medical school is very self-directed; what you put in is what you get out. You should have a reasonable idea of what you want and what kind of doctor you want to be. The guiding light in med school is not passing exams, it’s being a clinician. You’re going to need to prioritize your activities (academic and co-curricular) according to the type of person you want to be when you graduate.

That sounds a little heavy.

My point is, when you’re confronted with decisions that seem hard or information that seems pointless (a lot of it will seem pointless in first and second year, it’s hard to tell the difference) the choices you make now will influence what kind of doctor you are five years down the line.

I’m not telling you to stay in the anatomy lab until midnight every night (unless that’s what you want to do – no judgment there), just be aware of the difference between your short-term wants and your long-term wants.

And make friends. Making friends in medical school is awesome. You need people to get your weird med school jokes, and to commiserate about how horrible this all is and why didn’t you just do business.

Taking Care in Jamaica

Jamaica is pretty much the same as everywhere else, except slightly scary and dirty and people harass you if you’re not from here. So, pretty much the same as everywhere else.

Stay clean, keep hydrated and don’t be an obvious target*. If you need to eat, bear in mind that food is expensive here (blame the IMF and our sliding dollar). If you need somewhere to live, you can read my post on student housing.

Hang out with people who don’t do medicine (you will need the break). Living on hall is a good way to meet those people. Get involved! University is a much more fulfilling experience when you’re involved in things you’re passionate about with people who are similarly passionate.

Something I wish I had known – you can do whatever you want as a medical student, especially in first and second year. Med school is not an amputation of your life outside of medicine. You can write songs, start a charity, go to Literature classes, join a professional dance company. If it’s your passion – go for it!

I hope I managed to answer at least some small part of your questions.

Much love,

Robyn

**

*Not being an obvious target = keep your wits about you, read all the campus security bulletins/advice, trust your instincts (unless you have bad instincts, in which case I would suggest not trusting your instincts). 

**

Advice from my classmates include:

First, would be not to worry about getting all the books that are required. The library is reliable and you will meet fellow students that will help you, so travel light if you can. Always have a working phone with credit. Take time to enjoy what the island has to offer, and be balanced with work, family and friends.

And of course. . .

Don’t. Go. 

Run as far away as possible.

Advice Across the Board

(No more classes, no more books / No more teacher’s dirty looks. In celebration of the end of my training, I’m sharing tidbits of advice from the last six years of my life. Because there’s no advice like unsolicited advice).

What I Wish Someone had Told Me

Before I started Medicine . . .

Stay in the Arts, create yourself, establish boundaries and priorities, travel, push through the fear and conquer the unknown. Own the unknowable. Get advice from as many people as possible about how to do what you want to do, not just about the best thing for you to do. Stick to your guns.

In first and second year . . .

Pay more attention in Anatomy class. Actually, forget that. You were probably better off break dancing at the back of the room when no one was paying attention. Study just enough to pass your exams, real medicine won’t start for another two years. Anatomists and physiologists are not real doctors, but they can still fail you. It gets better. It does.

In third year . . .

Read the small books and commit them to memory – the OHCM is going to follow you for the rest of your life. Do not ever trust the administration to get things right. Have at least five white jackets to start with, add more as necessary. Spend your time on Paediatrics learning Paediatrics, not feeding and consoling fussy babies. Switch consultants if you have to. Don’t lose your enthusiasm for participating in clinical duties; pace yourself. Don’t assume it’s always going to be this exciting because it. won’t. be.

In fourth year . . .

Leave UHWI every chance you get. Deliver your elective assessment to the Dean’s office yourself; no one is going to do it for you. Give up on ENT classes from early (you’ll only sleep through them); spend all your time reading instead. Pay more attention to ECGs on Emergency Medicine. Pick the rural places for community health; the people are nicer. Do not start the habit of calling ‘Empathy point!’ every time a student says something supportive during a history/counselling station. Read more Radiology than you think is necessary.

Start MBBS prep from now – find a study group you’re comfortable with, who moves at your pace. Get organized with PPQs and lectures and notes from the graduating class. Do it now so you don’t have so much to do later.

In fifth year . . .

Prepare for each clerkship like it’s the final exam. Take really good notes on everything – that way you can revise your notes and not the whole textbook. Ignore the consultant who tells the third years not to end up like you. No guilt-tripping about your study habits. As early as possible, ensure the Dean’s office has all your elective forms. Spend less time in the classroom and more time assisting at procedures or reading on your own.  Keep a tight hold on the small books (Surgical Recall, OHCM, Toronto Notes).

Medical school drags its feet when you’re stuck in the middle or at the beginning, but when you look back from the end of the road you fully appreciate the whirlwind/ thunderstorm/ cacophony of experiences you’ve lived through. It is a lot to live through but you can survive it; you can even do it well, if you try hard enough.

Dear UWI: Please Wear Your Size

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.

The good old days.

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.

Everyone knows one of these people.

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.

Actually, one does.

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.