BJGP Back pages-Master[1]


British Journal of General Practice, November 2009 877

Viewpoint

Much of the detail of what I learned at
medical school I have subsequently
forgotten. I suspect this is not a unique
observation. The useful stuff is gradually
synthesised, reinforced and one day
applied to the patient in front of you. The
rest falls away with time. However, there is
another more subtle yet powerful influence
that remains to this day.

One of the biggest influences on my
career has been and continues to be, the
role model. Often, it must be said, these
experiences were negative — the surgeon
who swore and threw implements around
the theatre or the punctilious consultant
who deliberately tried to catch out
students. Yet a few were positive and these
left a lasting impression with me. On rare
occasions, these were the people who
made you go home at night thinking ‘this is
the kind of thing I want to do’ or perhaps
‘this is the kind of person I want to be’.
There is some evidence that such
encounters may affect others career
intentions too.1,2

Medical education is at the mercy of the
same trends, idiosyncrasies, and fashions
as any other academic activity.
Nevertheless, in general practice at least,
the role of mentorship as the cornerstone
of teaching and learning remains
unchanged over several generations.
Students may now have e-portfolios and
PDPs to worry about but much of their
learning is still the result of sitting in with a
doctor or a nurse; watching, listening,
practising and debating with each clinical
encounter. Much of this learning is never
written down and is part of the ‘hidden
curriculum’ that may either challenge or
affirm students’ attitudes, prejudices, and
perceptions.

For me, role models aren’t necessarily
people. They could be a type of job, the
way a group works together or even the
wider environment where work takes
place. Any of these could inspire or deter a
trainee on a particular path. The diversity of
general practice is perhaps one of its
greatest strengths. Whereas the

Role models, radicals, and
reactionaries

experience of a student in a hospital may
be relatively homogenous, general
practices and the communities of which
they are a part, are comprised of very
different kinds of people responding to
different problems in different ways.

We are used to being self-aware in
considering how we appear to patients and
staff — the communication skills we
deploy and the ‘games we play’. But
consider for a moment how we may seem
to students watching our every move as an
impressionable observer. Do they see
someone who is preoccupied with targets,
data collection and impenetrable funding
streams? Do they see someone who is
emotionally neutral? Or tired? Or angry? Or
cynical? Or perhaps they see someone
who is inquisitive? Or compassionate? Or
perhaps even serene? Do they see
someone who still retains some of the
passion that they took with them to
medical school?

One wonders just how radical or
confrontational the student experience in
general practice is today. The delivery of
care, the medical workforce, and medical
training have all become increasingly
micromanaged. Does this mean that
students are less likely to be challenged to
question what may now be accepted
norms? As a profession, do we have an
obligation to produce a cohort of
graduates who can passively fit in with the
values of modern service provision or one
that should question and challenge those
values?

It is inevitable that the experience of
studying medicine in a leafy college town is
different from studying in a metropolis. Yet
there may be other role models out there in
the community that students could learn
from. We should consider how imaginative
we can be in terms of the people, places,
and situations that we direct students
towards. This should include exposure to
the neglected, chaotic, and the
disenfranchised among our society as well
as to those sectors which are easier to
engage with.3

Perhaps above all, we should recall the
enthusiasm and passion that we had at the
outset and which we hopefully still retain
despite the mortgage and the politics. We
should remember what it was like to watch
others at work and remember that one day
they will be sitting in the other seat with
someone watching them. And we should
look forward too. There is always the
potential to be inspired by someone or
something which is one step ahead of you
on your own journey.

Keith Taylor

Author’s Note
A student’s viewpoint follows on page 878 (DOI:
10.3399/bjgp09X473024).

REFERENCES
1. Sinclair HK, Ritchie LD, Lee AJ. A future career in

general practice? A longitudinal study of medical
students and pre-registration house officers. Eur J
Gen Pract 2006; 12(3): 120–127.

2. Howe A, Ives G. Does community-based experience
alter career preference? New evidence from a
prospective longitudinal cohort study of
undergraduate medical students. Med Educ 2001; 35:
391–397.

3. Littlewood S, Ypinazar V, Margolis SA, et al. Early
practical experience and the social responsiveness of
clinical education: systematic review. BMJ 2005; 331:
387–391.

DOI: 10.3399/bjgp09X473015