Student loan debt, or why I'm going to go cry now.

So I was requested for my last blog at hospitaldr.co.uk to write about tuition fees and student debt. If you're interested, go read it there! :-)

Writing that got me thinking about how much I owe the Student Loans Company/Government/whoever it is now. They pay my tuition (about £3200 each year) and my maintenance loan (about £4000 each year). And at some point started charging me interest on all of that (I swear that wasn't part of the deal when this started?).

And I got curious about how much I currently owed. And tried to find that out.

It hasn't proved easy. I dug through all my paperwork and I only have statements of interest from my Local Authority for 2007-08 and 2008-09 (my first two years at uni). Then it seems the Local Authority switched to a central student loans thing (Student Finance England) and I stopped getting these.
I tried to log in to their website and find out, with no such luck. Firstly I can't remember the password and secret answer for something I use once a year. Secondly when I managed to reset all that and log in, the website was all aimed at "APPLY FOR NEXT YEAR" and had nothing about what I had already been given.
I eventually found a list of payments they sent me, but no interest total. (I added it up myself to get a rough total of £32,300.00 in payments).

I'd pretty much given up on finding this figure without a freedom of information request or something, but my friend managed to find it on a completely different website- Student Finance Repayments. I logged in and here it is:



Bear in mind that that's only with interest up until June 2010, nearly two years ago. I will be getting more payments until next year, and more interest until I'm about 80 by the look of things.


It's obvious that the government/student loans people are trying to keep this information away from us. We don't even see half the money- the tuition goes straight to my university with not even a passing wave at me.
It's better for them that we silently rack up a huge debt without realising, with no reminder of what's actually happening, until we get presented with a huge bill when we graduate! "Oh don't worry about it, you can just pay it off for the rest of your life."
Not really a great start to the world of employment, is it? No wonder we have a recession when people are entering the workplace already very firmly in the red.
(Mind you, we couldn't exactly choose to do without the loans anyway).

And this is why tuition fees piss me off, people. Let me remind you all, I'm training to be a doctor. I'm not going for money, I'm going for good. I intend to work mainly in the NHS (what's left of it) when I qualify, I intend to help people... My job is going to be to make people healthy.
If I wanted to get rich, I would have done Law or Economics or something. Sure some doctors get paid well, but that's not my aim (and nor would I be able to do that until about 10 years after I graduate).

One of my big questions is why the government hasn't realised the problem with doing this to Medics and Dentists in particular? Our degrees are twice as long as other degrees, with accompanying living costs (and much more time to burn through any potential savings). We also have near full-time courses with little time to fit in part-time work. And now that tuition fees have gone up again... People are going to end up £100,000.00 in debt before they've even started work. At a time when we're trying to widen access to medicine and dentistry, I think you're going to put off just about everyone from applying.

RSH, get over yourself!

So I'm currently on my RSH (reproductive and sexual health) rotation. As a long-standing member of a Sex Education society (KCL Sexpression) who is considering a career in GUM, I was *really* looking forward to this rotation. I have been since last year. I wanted to have it as my first rotation this year, but I got second.

Unfortunately, the reality has proved somewhat different to my dream. My minor fear of dropping babies aside, this rotation isn't well set up and I'm not seeing things that interest me. So far I've had the obligatory introductory week of lectures (fine), a week of GUM lectures (loved it), a week of breast teaching (very good teaching), and then...
I've been sitting in the corner of Gynae clinics for the last month and a bit. Mostly being ignored by the doctors. Seeing a lot of quite upsetting things, like patients being diagnosed with cancer or struggling with their fertility. And not really learning much from it, either.

I'm not enjoying it. I have also managed to have basically no obstetrics teaching yet (despite the rotation surely needing to be 50/50 split), and I still don't know what obstetricians are talking about. It's all primips and liquor and 35+6 and honestly, I don't know what monkeys, alcohol and maths have in common, but it's certainly not letting me know what's going on. Why none of this was never covered in pre-clinical lectures, I have no idea. (I have my obstetrics weeks at the end of the rotation, hopefully it will become clear!)

Not only are the doctors often ignoring us, we've also had a few experiences of being told off for not knowing things... something I find incredibly useless and a waste of time. And I'm not talking being grilled on your knowledge by a doctor who will make you keep guessing and thinking about something until you get the answer, I'm talking being asked a question you haven't been taught about, so don't know the answer to, and then the doctor just gets angry that you don't know it. Not productive, doesn't teach me anything, generally a waste of time.
Quotes from a recent lecture have included "Do you even understand these lectures?!" (just going to leave that one there). Even the gynaecology lecture we had in second year was by an incredibly angry person- I have a vivid memory of him asking us what the epithelium lining the vagina was, and when someone suggested "mucosal" he shouted:
"NO! IT IS SKIN!! THERE IS A PENIS GOING IN AND OUT OF IT!!"


And on top of all this, the bosses of RSH are hassling us extremely about attendance and getting us to all sign up and come to things and are trying so hard to MAKE SURE WE ARE LEARNING. It's all a bit patronising to be honest, especially seeing as this is happening halfway through our penultimate year. We've worked out how to come to clinics, thanks.
Getting a doctor to sign my book every morning and afternoon often results in incredulous looks from the doctor- cue me saying "Yes, please just sign it to show I've been here". And try getting a book signed in theatre... not easy :-p

The clincher for me, was the morning of contraception teaching that I unfortunately, so unluckily, managed to sleep in and turn up an hour late for. It was a genuine mistake, and I was gutted myself as I really wanted to refresh what I was teaching in Sex Ed. But I turned up and went to the other 3 sessions.
I worked out that I'd only missed a simple talk on barrier methods of contraception and how to demonstrate using a condom. But apparently because I'd missed part of the session, I had to come back in a few months time, on a different day, to be taught this again. The RSH people had even emailed us to say that if we missed the session and didn't attend the make-up session, we would not be allowed to take our end-of-year exams.

Now, as I have already mentioned, I am a Sex Education teacher. I have been in a Sex Education society for FIVE YEARS. I have personally taught literally hundreds of schoolchildren to use a condom safely. I have attended conferences, organised lectures from GUM doctors on contraception and STI's. I wrote our lesson plan for contraception teaching. In summary, I can put on a damn condom.

I tried to explain this to the organiser of the session, and asked if I could demonstrate my knowledge to avoid having to spend another day (just before exams too) doing this session again. She said she couldn't let me. I went and found the person teaching barrier methods in the break, and asked if she'd quickly go through it with me now, and she was happy to. But the organiser wouldn't let me. I simply must go to this condom session in a few months time. I'm going to turn up and put the condom on blindfolded (another activity Sexpression do).

Now, I understand that some people don't like RSH and may not turn up to sessions without encouragement such as attendance sign-ins. But don't you think you're taking it a bit far?? When I was taught Advanced Life Support, really important stuff that could save a patient's life such as CPR and using a defibrillator, they saw it as sufficient to have it as a log-book sign-up for students to attend and get. Do RSH really think that their precious condom session is somehow more important than that?!

Sorry RSH, but you're going about this all the wrong way. I love your subject and even I'm getting annoyed at all this. How about you put a bit of obstetrics in your introductory lectures, get your doctors to relax and be more inclusive, and then you won't need to obsessively document our every moment for 3 months. No love, Me.

Learning to hold a baby.

So I find very often that in medicine, no-one bothers to explain to you the simplest things, including:
"where to get a patient a glass of water" (rather difficult on a brand-new ward, often with a coded door to the kitchen that I then have to find a nurse and ask for)
"how to help a patient move from a chair to their bed" (I have been told off for potentially injuring myself, but no-one has offered me manual handling training)
or my latest one- "how to hold a baby".

Racking my brain, the last baby I really remember holding was my sister, who is now 18. I have a memory of being about 5 and being given a very small, wrapped up thing and my mum being very nervous- "SUPPORT THE HEAD!" Which left with a semi-serious fear that should I be handed a baby, if I didn't hold it properly I would probably snap it's neck, killing the baby and being forever shunned from normal society for being unable to perform such a basic task.

When you're on an Obs and Gynae rotation, however, you can't really avoid holding babies. Despite having lived in Central London for the last 5 years and not really even *seen* any babies, you also can't make it obvious that you have absolutely no idea what you're doing, because if you look genuinely terrified of a patient's baby, the patient probably won't then trust you to look after their/their baby's health.

(Another thing we don't get taught is nappy changing... my friend on Paeds got handed a baby to examine who needed one... the parents, assuming that we do this all the time, said they'd "leave it to the experts". Not wanting to ruin a rapport, my friend said "Sure thing"... thus then changing his first-ever nappy.)


So, being the overly-academic person I am, I've been actively trying to learn how to hold babies. I started with some of my young cousins at a family party, where I discovered that for some reason, babies genuinely enjoy being rocked or bounced up and down. This would annoy the crap out of me, but apparently babies like it, something I've managed to put into practise in hospital by rocking a baby to sleep. (Alternatively, perhaps this merely proves my soporific effect on fellow humans.)

My next success was being given a baby by a fellow student who is a mother and had her (very well-behaved!) baby with her in a lecture. I held the baby and it was very cute and I am pleased to report that no major disasters occurred and the baby is fine. (Thanks baby mummy!)

Which meant that yesterday I was confident enough to hold a baby for a mum in clinic. I got to hold a cute baby, she got a few minutes respite to do something. I then learned my next thing about babies... it turns out that they like to pull my hair and put their saliva-covered hands in my face. Well, I already knew they were gross, but perhaps I'll remember to tie my hair back next time :-p

The SJT, or, why I shouldn’t have bothered.

Our careers advisor filled us in a few weeks ago on the new process of applying to the Foundation schools, as I will be in the first batch of applicants. The new scheme has eliminated the white space questions, replacing them with a "Situational Judgement Test” of multiple-choice questions based on dilemmas we may face as an F1. The SJT counts for 50% of the points, with the other 50% based on academic performance and papers published, etc.

The few example questions for the SJT seem fairly difficult, which I guess it is designed to be. It’s very hard to know exactly which of several relevant answers are the most ideal- possibly it will be down to luck?! I find it a bit odd being asked questions about my behaviour as an F1 which feature things such as problems with handover and paperwork, something I clearly have very little experience of as a student, as I spend my time in hospital trying to see patients, and doctors with paperwork tend to ignore us in order to get it done. However I will say that at least the SJT rewards those who get themselves into clinics- those students who have a general experience of the hospital will do much better than those who only go in when they have to.

But only half the test actually takes my achievements into account. So everything I have worked for so far in medical school- my ranking in my year and SSC marks- contributes to less than 50% of my overall points. The rest of this 50% comes from additional degrees (marks vary depending), and then a maximum of two marks from having a paper published, and/or presenting at a national conference, and/or winning a national prize (e.g for an essay). (And if you don’t have any of these already, it’s pretty much too late to get something published before the deadline).

Nothing else I have done counts. Not the audit I worked on, not my diploma that I did alongside my studies, not being president of an award-winning volunteering society, not raising hundreds of pounds for RAG. Not my BSL or first aid qualifications. I can’t even mention these on the form, because there is nowhere to put them. It’s especially annoying that I have thought these things would help my application for the last few years, but suddenly I’m getting the message that I shouldn’t have wasted my time; I should have spent the last 4 years in the library, getting myself into the top decile of the year, because that’s what the marks are for. I don’t think that is right. The most intelligent doctor isn’t necessarily the best doctor- we need to be good all-round, we need to have some life experience. I’m aware that people manipulated the white space questions (a lot of societies got started just for someone to become president of it) but are hypothetical scenarios really a better measure? Surely consistent, honest effort should be rewarded somehow.


(This entry also posted at hospitaldr.co.uk)

The importance of feeling stupid.

I know a lot of people dislike feeling stupid, but I think it's a fairly useful emotion- feeling stupid about something almost certainly means you just learnt something, in a way you're not likely to forget.

It's hard to get used to. Many of us are used to being high/over-achievers... When I first got to med school I had to get my head round the shift from being one of the top students in a fairly crappy comprehensive, to being decidedly average in comparison to my peers. (Unluckily for me, I also get compared with my super-smart brother being one of the top people in his year in medical school... Thanks for making me look bad!)

Feeling stupid means you've realised there's something you didn't know. Often that's the spur for me to open my books... you just have to sit through one lecture/clinic session, not understanding half of the terminology used, and the urge to do your reading rises dramatically!
Of course, reading around the subject before you go in is valuable and should be commended. But if you're not being challenged, if you don't see anything you didn't know about, if you didn't ask any questions or get asked something you couldn't answer straight away, what did you gain from it?

Similiarly, making a gut-wrenchingly embarassing mistake I think is a sure-fire way of ensuring you don't do the same thing again! I find this especially important for clinical skills- you can read about them all you like, but it's the first time you struggle to ask a patient to undress that you realise what you *really* need to practise.
(History taking too- during a GUM history I accidentally on autopilot asked an MSM if the sex was "oral, vaginal or anal"... I won't be doing that again!)

We all cope with it in different ways; be it laughing it off, silently wishing for the ground to swallow you up, or ranting about the circumstances that led to it happening, as long as you find a way to accept what happened!

It's a good thing to get used to though- everyone will make mistakes (hopefully not too many) in the course of their career, and it's a truly valuable skill to be able to admit that you've made an error, apologise and deal with the consequences.

So I say embrace feeling stupid. No-one's going to make it through life without the feeling, so you may as well take what you can from it!

Sh*t medical students say

So probably by now all of you have heard of the viral videos of "Sh*t X says". I had the idea of making a "sh*t medical students say" video, but a quick sweep of youtube informs me I've been beaten to it, 5 times!

And I *love* these:












My particular favourites are the guys thinking they have primary amenorrhea and endometriosis :-)

I still think there might be room for a "sh*t UK/London med students say" if anyone wants to help out?

Breakout sessions

So, I don't know how it is for other universities/courses, but for me very few teaching sessions are well-defined. I don't really know what these "seminars" or "tutorials" are supposed to be, as it's never consistent.
I just turn up and take what I get... sometimes it is essentially a lecture, or sometimes if it's genuinely a "tutorial", we'll be going through a piece of work we are supposed to have already completed. Sometimes "seminars" are interactive-style lectures, which can range from a teacher talking at us with the odd question thrown in, to a teacher grilling you over a subject in detail (painful, but it makes you learn it) or if you're really unlucky, a teacher playing "guess what I'm thinking" and asking you vague questions repeatedly until you finally say what they want to hear.

Even though I never know what a teaching session on my timetable is going to be, this doesn't really bother me. A good teacher will make it work in the way that suits them and us... if they prefer to wax lyrical on a subject for an hour, as long as it's relevant I'm happy to listen.


However there's a new breed of teaching style emerging that is becoming more and more prevalent within the medical school, and so infuriating me more and more often. And that is the "break-out session".

Firstly, what does that even mean? Break out of what? Break out of where? Break-out, as far as I'm concerned, means "escape"... what are we escaping?

As far as I can gather, modern teaching ideals say that sitting us all in a lecture to be fed information is bad and wrong, and everything should be interactive and have feedback and involve discussions of how we feel about the subject.
So instead of say, sitting 400 people in a lecture theatre to listen to an expert explain a subject to us, they split us into small groups, put us into a variety of junk-filled classrooms and make us spend an hour with a chirpy "medical educator" who spends the first 10 minutes asking us to brainstorm what we already know about catheters. NOTHING. THAT'S WHY I'M HERE.

Don't get me wrong, I'm not opposed to group discussion/communication practise. There's some instances where the medical school does it really well- I love it when we get the chance to talk to the actor patients, or "expert patients" (usually someone living with a long-term condition), because we get clear, personal feedback on how we are doing, and useful insight from an outside person.

But often I feel that it is forced unnecessarily, or with no clear guidelines to what we're doing and why. Earlier this year I found myself sitting with 4 other people looking at a Freda Kahlo painting and discussing the answers to a list of questions about how this reflected her feelings about her medical conditions. "I guess she feels... sad?" Sorry, but without someone with some kind of arts or humanities background to help me in this, I'm not really going to have a clue. And what does it matter what I think actually? Unless the medical school is worried that I'm incapable of feeling and empathy (and don't worry, I always cry at the end of Gladiator) I find it highly unlikely that a patient is going to present to me with an abstract self-portrait of her body for me to interpret. "Hmmm, there's a lot of heavy brush-strokes in this... perhaps she's got MS".
(I actually did take a Self-Selected Module in Medicine and Art, and found it really interesting... WHEN I WAS BEING TAUGHT BY AN ART LECTURER.)

I struggle with Ethics lessons in a similiar fashion. The teachers have an infuriating habit of bringing up a case study of a previous real-life ethical dilemma, making us put forward our opinions on it, and then moving on. Why not tell us what happened? What would be wrong with letting us know what the outcome of the court case was? I wish they'd give us a general idea of what happens. It gets to the point that I'm worrying that everyone in the class will just reach some terrible conclusion without being challenged: "I think we should kill the baby. Killing the baby everyone? Yeah? Sounds good to us all then..."


My final problem with break-out sessions is less about teaching and more about fellow students: there's always a risk with group work, that you'll end up with one of the several overly self-important people in our year. They dominate every session they are in- interrupting to ask difficult questions to highlight their own intelligence, trying to debate lecturers over irrelevant technicalities, and often completely missing the point of the session in their attempt to make themselves look as impressive as possible. Most awkwardly for me, I have witnessed fellow students act more rudely with a session leader who wasn't a doctor- correcting them on medical points unnecessarily, and irritatingly for me wasting the only time we got to listen to how their role in the treatment worked.
Still, I'm sure I will end up working with doctors who are just like that, so I guess if nothing else, I'll gain the skill of putting up with annoying people!


So yeah. Call me old-fashioned, but I don't think that scientific fact needs to be taught in any way radically different to a lecture- an expert telling me what I need to know. All this discussion business achieves nothing, wastes time, and generally makes me want to fulfil the name of the session and break out of it :-p

(This entry also posted at hospitaldr.co.uk)