We had a medical student in the practice last week. The job I did before this was in a part of the country devoid of medical schools, and, as it happens, this is the first student who’s had an attachment at this practice since I arrived here myself. So, the last time I had any medical students around was in my paediatrics job, five years ago.
It’s something I’ve really missed – teaching was always a part of my job that I loved. One reason for this, of course, is that it feeds my ego. One disadvantage of general practice is that you do spend a huge proportion of your life as the most junior person around. Since your training is directed at making you a jack of all trades rather than a master of one, you never move up the ladder in any specialty because you’re always moving straight on to the next specialty to start from scratch. When there were students on the ward, at least I could revel in the satisfaction of knowing there was someone further down the totem pole than me. Not that I would ever have abused my position, you understand. I just enjoyed the warm feeling of smugness.
Another thing I liked about having medical students around is that people who are totally new to a particular area and see it through fresh eyes play a vital role in stopping everyone else from getting into a rut. One of the great things about teaching, I found, was that explaining what I was doing to other people reminded me vividly of how little I actually knew about it myself. It made me realise that just because I’d learned to fake my way through did not mean that I actually had a clue about anything important. (Much of hospital medicine at the junior doctor level consists of asking a bunch of standard questions, doing a standard examination, and choosing some standard tests from a mix-and-match set, and so faking your way through without knowing why you’re doing what you’re doing is scarily easy.) It confronted me with uncomfortable questions about why I did things the way I did and whether, indeed, I should be doing them any differently.
(Incidentally, the absence of students was only one part of a huge difference that I noticed when moving from my hospital training into long-term general practice – namely, the absence of any sort of regular influx of new people. In hospital, not only are there medical students around to fulfil this role, but there is also a constant turnover of junior doctors and student nurses. In general practice, it’s a rare event for anyone new to be employed. The same people are there year in, year out, with no new faces and, more importantly, no new viewpoints. It was something I found quite difficult to get used to, and often stifling.)
But the most important reason I missed teaching is simply that I love it. The reason I chose to have children is because they help you see the world through new and fresh eyes. Medical students do the same thing on a smaller scale and without the sleep deprivation. Explaining what I do, and why, to someone who’s new on the scene reminds me of something I do sometimes lose sight of when snowed under with paperwork, time limits, and a surgery full of people with inexplicable pains and insoluble problems – namely, that medicine is absolutely fascinating.
So, all things considered, when I found out that the job I’d thrown together a last-minute application for ("Oh, what the heck, it’s in <area of country we were trying to move to> and it looks like it’ll do and if I touch up my CV a bit tonight and bung it in the post tomorrow it’ll just make the deadline") was actually a teaching and training practice (a fact they omitted from their practice prospectus), I was overjoyed. (As were the trainers in the practice, who were extremely pleased at the thought of having a keen young would-be teacher around to take on some of the teaching-associated duties.) When one of the practice partners announced the imminent arrival of a medical student on the scene and asked for volunteers to take him for a session or two, I jumped at the chance. I did feel a little nervous – after all, wasn’t this the point where I realised I’d merely been faking my way through all this time and didn’t have a clue what I was doing?
Apparently not. In the distant days of my hospital training, I’d moved on every six months, apart from the paediatrics post that I stayed in for a whopping year. I’d stayed in each place just long enough to get a good grasp of the basics, and since ‘the basics’ for a junior doctor unfortunately consists in large part of where to find the Venflons, what the procedure is for discharge summaries, and what time you’re expected to turn up for a ward round pretending to look intelligent, there somehow didn’t often seem to be much that I could usefully pass on to students. But now, not only have I been in this career for four years since qualifying (plus the trainee year), but I’ve actually gone out of my way to get some relevant qualifications – not just the necessary ones, but also the above-and-beyond-the-call-of-duty ones. Which, in turn, got me into the habit of trying to keep vaguely up to date and actually reading all the journals people keep sending me. In short, it seems that along the way I’ve actually managed to learn rather a lot about my job.
This did not come as a complete surprise to me, because one of the other good things about this job is that it’s a medium-sized practice with a large spread of people of different ages and levels of experience. After three years in a practice with only two other doctors, both middle-aged men, I found this refreshing, and one of the most refreshing things about it was that – after a mere decade as a doctor – I was suddenly not the most inexperienced person around any more. That honour fell to the other doctor who was employed at the same time as me, a woman about my age but in her first general practice job post-training. All of a sudden, I was the one being approached for advice. What was more, I generally had some. I listened, in a distantly amazed sort of way, to my voice saying things like "Well, if she’s got angina and CCF I’d definitely want to start one of the cardioselective beta-blockers. Lowest dose to start with and titrate up slowly. But do check her Hb as well," and thought that, blimey, that actually all sounded quite intelligent.
However, this is the first chance I’ve had to unload all this knowledge on a medical student. I’m not sure the poor chap knew what had hit him – I talked my way solidly through afternoon surgery, with brief breaks to allow patients to make mention of symptoms that I could talk some more about. Fortunately, he was the keen variety of student – interested in a career in general practice, in fact. I do hope that’s still the case.
And me? I loved it. I can hardly wait until we have another student around. And it’s made me think about where I go from here in the field of teaching. In case you were wondering about my previous mention of ‘teaching and training’ as separate entities, ‘teaching’ in this context, refers to undergraduate medical students, and ‘training’ refers to postgraduate GP trainees. (I shall skip discussion of the somewhat worrying implications in that terminology.) Now, being in a teaching and training practice means I can get involved in both in the sort of peripheral way that I did last week (taking the student for a session without having to do any of the organisational work involved). But should I get more involved than that? In short, should I, at some stage, go through the training to become an official trainer myself?
Previously, I’ve always rejected suggestions of so doing. Yes, the teaching part sounds wonderful – but surely doing it officially, rather than just helping out with the odd session here and there, involves all sorts of boring stuff like buzzwords and paperwork mountains? Well, yes. But anything really worth doing is going to have its difficulties and drawbacks to deal with. And I’m starting to rethink my previous embargo on trainership. As someone employed by an officially accredited training practice in which the existing trainers have started to make noises indicative of a general desire to pass the torch on at some not-terribly-distant point in the future, I’m in the ideal position to become a trainer in due course. Somehow, the idea of taking advantage of that is sounding rather more attractive to me than it once did.
Of course, we’re talking long-term plan here – the obvious way to go is to continue to be as involved as possible in the teaching and training here as more students and registrars arrive for their attachments in the practice, and make further decisions about my own training in the fullness of time. But I have an increasing feeling that I wouldn’t be totally surprised if being a trainer was in my future. Whether I’ll then live up to the title of this post is, of course, something we’ll just have to wait to see.
Good Enough Mum 