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Don't Patronise Novices

Updated: Aug 6, 2021


Being a novice is not the same as being a child.


I recently saw a tweet from an American medical school graduate who was starting her first year as an intern (FY1/house officer in the UK). It really got me thinking.


“I am not a baby doctor.

I am not a child

Please stop infantalizing us. Especially women get it enough from patients already, always deferring to our taller male colleagues.

We are first year resident interns. But babies we are not.”

- @londyloo


What an obvious statement, of course she isn’t a child! However, I think we all recognise that this is a cultural problem that exists within healthcare training. We understand exactly where her frustration comes from and we are probably all guilty of perpetuating it…especially at this time of year when so many rotate around unfamiliar hospitals and specialities.

Nobody who is working in healthcare should be patronised. Nobody working as a doctor is a child. Medical school attracts some of the brightest and most enthusiastic adults (they were adults when they were studying too!!). By failing to recognise this we stifle them…and they may as well take their brains and enthusiasm elsewhere (in fact a worryingly large number are).

There is a hierarchy within healthcare that includes and surpasses clinicians. Sometimes it is toxic. The most junior team member will typically be given the most mundane tasks, they will be tasked with fulfilling roles that often have little training value, their inexperience puts them at greater risk of manipulation out of a sense of duty/to please senior members and they have the least agency when it comes to decision making around their training needs and career aspirations.

I think most people’s recollection of foundation jobs was treading water to keep afloat, perfecting time management, secretarial responsibilities and finding the shortest routes in hospital between any two given points.

It’s beholden to all of us with training roles (I.e all of us) to train each other and support junior team members…But really support them…not simply say “call me if you need me”.

We should be supporting our colleagues by training them to do the job they want to be able to do to a standard we expect them to achieve. Finding out their interests, helping them to achieve the skills they want to achieve and guide them in a career that we know more about. Nobody can be expected to do something professionally until they are trained. We certainly shouldn’t be leaving their development to self-directed learning…what bad habits might they develop? - Practice makes persistence...not perfection

So I would ask everybody to think of medicine as an apprenticeship. To look on the novices as adults who are there to improve and progress. To share the opportunities that arise. Agree some goals for the day and help them reflect at the end on what they did.

The patients are our responsibility until we hand that responsibility over to someone we feel is competent…our trainees want to be more than that, they want to be proficient.

Motivated staff make better clinicians and better colleagues. Better colleagues are more enjoyable to work with. Better clinicians improve patient care. An enjoyable department with great patient care does not have staff retention problems.


So..

If we are resting because our junior is flat out doing the work, we could be developing them better

If we use the excuse “well that’s what I had to do at their stage”, we are perpetuating an unnecessary hierarchy.

If we look on novices as incompetent or feel we were better at their stage or telling them off, then we are infantilising them

We aren't treating them as professional adults. We certainly aren’t training them.


They won’t want to come back.

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