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Rise of the doctorbots

Young English doctors and medical students are tragically homogenous.

Although an Irish res isn’t exactly a hotbed of eccentricity, radicalism and non-conformity, there certainly seems to be a lot more colour to be found there than there is here.

One of the duties I have in our department is being the lead for teaching. I enjoy teaching but similar to my experiences in teaching in Ireland, I find myself getting bored once I’ve given the same spiel five or six times. There are no words to express how much I admire primary school teachers facing into their 30th year of Ann and Barry or the like. At least if you were teaching a group of Irish medical students though, you could knock some sort of craic out of trying to make out who still had the fading imprint of Copperface Jack’s stamped on their wrist or enjoy the contrast between the south county Dublin high-flyers and the rural savages.

Here, they are all the same. The accents, the look, everything. There are certain inalienable truths. You are never more than six feet away from a tall guy called Ben. Ben likes to bake and cycle. So do all the others, even the ones not called Ben, who are usually called Dan or Tom or in a rare outburst of bisyllabic otherworldliness, Toby.

The girls also like to bake and cycle but are distinguishable from the boys by the fact that they’ve all done an elective in bloody Belize.

Every single one of them looks at the idea of American medicine with a mixture of fear and disgust and consider me an exotic deviant for having practised there. Deep down, although post-colonial politeness forbids them saying it aloud, they have no idea why America left the Empire. They would feel the same about Ireland if they knew we had left the Empire, but they don’t.

They know lots of medicine and precious little else. They are usually white or Asian (but still called Ben), but almost never black. Nobody ever seems to wonder aloud why. Only 6 per cent of applicants to UK medical schools are black, and just 3 per cent of those accepted are.

At at time when the pressures, demands and expectations on doctors seem varied and often contradictory and our work lives become more and more interdependent, there seems for me to be an acute need for a diverse array of personalities and experiences within medicine. To that end, I cannot understand the persistence with standardised aptitude testing as a means of entry to medical courses.

‘Every single one of them looks at the idea of American medicine with a mixture of fear and disgust and consider me an exotic deviant for having practised there’

In Ireland that test is the HPAT; in the UK it is the MCAT, both of which are designed to be predictors of ‘suitability’ for medicine, and ones that cannot be effected by intense test preparation.

However, this argument was fatally undermined by the publication of a report on entry to medical school in Ireland 2014, which found that over one-third of successful applicants were repeating the HPAT.

The test examines logical and non-verbal reasoning and inter-personal understanding and a review of the first few years of its use found that candidates repeating the exam tended to improve their performance in all three domains, presumably with coaching. The aptitude test therefore has unintentionally become another brick in the edifice of the stultifying homogenisation of doctors and with 21,000 results from a Google search of ‘HPAT preparation courses Ireland’, a means of the better-off flexing their financial muscle to again ‘game’ the system in their favour.

The conceit that there is a single set of characteristics and aptitudes that are appropriate for as diverse a profession as medicine is false and misguided and conceived of a conviction that medical students in Ireland are inhuman, emotionally unintelligent automatons, incapable of relating to their fellow man. Rather than asking for evidence of this, we accepted the anecdote. Accepted the theory that it is possible to design a person who is supposed to be fully human, while eschewing all negative human instincts and reactions, while working in what are often inhuman conditions and being their absolute best selves 24 hours a day.

Isn’t it time we abandoned this nonsense?

Nothing against Ben, but there has to be some better way of selecting the hard-working, diligent, yet creative cohort that reflect accurately the communities from which they emerge and will serve.

  1. Roisin on September 23, 2016 at 11:41 pm

    Thank you Anthony for do eloquently expressing my firm opinion re HPAT joke. Working in Canada and currently at a conference. Women are so well supported, represented and encouraged here. If you are looking at gender balance, as well as a wide range of community involvement, as a measure of a healthy medical workforce, then Canada is the place to be. They don’t even recommend the mirena to trainees as mentioned to a colleague on my training scheme. Here women with family are also highly valued.
    HPAT is a money spinner, my class had all types of characters that have (nearly) all become wonderful doctors.

  2. Roisin on September 23, 2016 at 11:41 pm

    Thank you Anthony for do eloquently expressing my firm opinion re HPAT joke. Working in Canada and currently at a conference. Women are so well supported, represented and encouraged here. If you are looking at gender balance, as well as a wide range of community involvement, as a measure of a healthy medical workforce, then Canada is the place to be. They don’t even recommend the mirena to trainees as mentioned to a colleague on my training scheme. Here women with family are also highly valued.
    HPAT is a money spinner, my class had all types of characters that have (nearly) all become wonderful doctors.

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