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Emma Espiner: Entitled little pricks

Newsroom columnist and medical student Emma Espiner hopes a rort at the University of Otago over a final-year overseas elective won't end up punishing all aspiring young doctors.

You could see the train wreck coming from a mile away. I was in Nelson for work, having just finished my 5th year exams. It was a sunny morning and I glanced at the news before walking out the door. The headline read “University of Otago investigating claims med students faked work placement records.”

I checked my phone and the Messenger chats were strobing like crazy. Speculation about who the whistleblower was, what their motivations were, who was going to get caught out, how it was going to affect us, what’s the TEA, sis.

Sometimes I feel like I’m two separate people. There’s the medical student version of me that I wear like a suit when I’m on clinical placement. Eager, affable, nothing is too much trouble, yes I’d love to do that, thank you for the opportunity. One of my friends describes being a medical student as ‘presenting the least annoying version of yourself at all times.’

Then there’s the real me - a mum of a six-year-old, a grown-up with a mortgage and unpaid debt from the first time I went to university more than ten years ago, two part-time jobs and regular fights with my husband about how to correctly pack the dishwasher.

The medical student in me wants to defend us. #notallmedstudents! I want to explain how the final year student grant really works - it’s not there to pay for the overseas elective! Most of us actually attend our elective placements!

I want to point out the gruelling hours over the course of the six-year degree, the assessments and exams and constant fear of failure, the rates of mental illness and suicide among my colleagues. I want to communicate my love for these people who are doing their best, who suffer through the ignominy of either being invisible or being mercilessly grilled by impatient consultants on ward rounds, who shake with anxiety through their first encounter with a patient, mess up their first cannulation, get yelled at by a scrub nurse for de-sterilising the equipment table in theatre and have a cry about it on the bus home wondering why med school ever seemed like a good idea.

The former political staffer and communications specialist in me winces when someone does any of the above, aware that ‘medical student’ is synonymous with ‘entitlement’ for most people. In the goodies and baddies dichotomy of our discourse there’s no room for light and shade and we’re all just a bunch of entitled pricks. Explaining is losing, bitches.

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A small number of people really f...ed up. Whether it was common practice or not, bribing your way out of attending your elective by paying someone to falsely sign off your placement is an open and shut case of bad judgment.

The mystery was how the saga expanded beyond the 15 students who really messed up, to the 53 now junior doctors who are allowed to start working but can’t graduate with their peers. After asking around I understand that the university asked the entire year-group of students if they could honestly stand by the elective reports that they had written. The extra 38 students were those who owned up and said no, they couldn’t.

Doctors have gone on the record to say they did those things too when they were medical students. Someone’s parents talked to RNZ arguing that their child was being scapegoated for a practice that’s been going on forever. These interventions have confused the whole thing further by implicating every medical student who has ever gone on an overseas elective, reinforcing the idea that ‘having a holiday’ for a large amount of the time you're on placement is tacitly approved. The scathing response of the public to these attempts to reframe the narrative has shown that nobody is interested in our deservedness nor the importance of the overseas elective experience for our training and future practice. I can see ‘Decades-old Culture of Entitlement’ as the title of the next think piece eviscerating us. The blood lust in the comments sections of articles and on social media shows that, fairly or not, no one is with us on this except ourselves.

I’ve seen people calling for the final year medical student grant to be abolished as a result of these revelations. ‘Taxpayer-funded rort’ is an old favourite that I remember from my time working at Parliament. I wish those people would think about what they’re really asking for. It’s a bit like the army back in the day. Officers received less pay than the soldiers beneath them. It seems counter-intuitive until you realise that it’s a method of reinforcing class power structures. Only the wealthy could afford to have sons in the officer class. It’s the same in medicine. When we classify all medical students as undeserving of any financial support because of ‘entitlement’ we erase the efforts of our social justice schemes which are attempting to diversify the medical workforce to better serve our population.

I remember talking to investigative journalist Kirsty Johnston at The Herald after she wrote her piece last year titled ‘Want to be a doctor, lawyer or engineer? Don't grow up poor.’ Her investigation highlighted the astonishingly low rates of entry to ‘elite’ university courses by students from low-decile schools. A companion investigation showed that half of university scholarships went to students from the wealthiest families. Kirsty wanted to know if her findings were representative of my cohort. Coming through the Māori and Pacific Admissions Scheme (MAPAS) like I did, I was automatically more likely to be friends with students from less privileged backgrounds, because of the ethnic inequities in our country. Of course, not all brown kids are poor, and so the number of students in my cohort overall who struggle financially is still a minority but it is instructive.

You get to see how the differences play out over time. People who have to work part time to support themselves are less likely to be using that time to study - there are only so many hours in the day. This affects their grades. Before the EFTS cap was lifted - allowing students to borrow for more than seven years of full time study costs in some courses - several of my colleagues who had used up their student loan entitlement doing an undergraduate degree were forced to fundraise to pay their fees, or to consider dropping out of medical school entirely. Simply having to pay their own bills has prevented other friends of mine from taking up valuable - but poorly paid - research opportunities in favour of part time work in hospitality or retail. All these small advantages accumulate over time in favour of those who have more resources and connections. Taking away the final year grant would be punitive and vengeful and would disproportionately punish those who can least afford it, skewing our health workforce back in the wrong direction.

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So, I returned from chairing a panel at the Nelson Arts Festival to find the scandal unresolved. The Messenger chats had moved on to speculation about the response from our university, and whether our elective reports in the coming year would be more intensely scrutinised. “I guess Bosnia’s definitely off the cards. Lol.”

The topic of the panel discussion had been ‘doctors who write’ and it’s one of those things that is perennially interesting to audiences. The sessions always sell out. There’s been a trend towards celebrating doctors who have these eureka moments when they discover their patients are actually people too. I think this might be more of an indictment of the practice of medicine, than a celebration of these enlightened doctor/writers. Should we really worship these outlier doctors just for having a soul?

We have been hungry for compassion and empathy yet, until relatively recently, those things haven’t been considered essential traits for practising doctors. They’re now a core part of the curriculum at medical school. I can honestly say that my colleagues have no need for the revelations shared by the doctors on these panels at arts festivals, because we’re taught to care for the whole person and to think more broadly about the causes of the causes of their health problems from day one. It's for this reason that I’m not in despair about the future of our medical workforce as some people are, off the back of this scandal. Everything is going to be okay.

Disclaimer: Emma will be a final year medical student at the University of Auckland in 2020, she is a regular contributor to Newsroom.co.nz and works part-time as Communications Lead at Hāpai Te Hauora.

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