Life after University

I came across this video produced by Linguistics here in Edinburgh. I liked it for a number of reasons.

First, it is simple and straightforward in design and purpose. Thea Graham (an ex-student) speaks well, and invites interest. It is an example where what a student says, is likely to be more useful than what staff say. (I remain deeply troubled by many peer-based learning and teaching approaches, and have seen groups of students propagate errors. All that we know about teaching — in terms of domain knowledge; expertise in problems students have within that domain; and general knowledge of pedagogy — suggests that they can make learning worse. The problem of course, is that peer-to-peer learning can work brilliantly in some situations. I just remain uncertain how to define those situations. OK, rant over.). Anyway, I think this video was terrific.

The other issue is how good a job we do of preparing students for life after university and what meaningful advice we can give. And I don’t mean visiting the careers office.

Medicine has problems in this regard, although at one time I would have pooh-poohed this statement. At one time, the answer was quite simple:  you either worked in the NHS in hospital, or in the NHS (as a contractor) as a GP. A small proportion would work in universities, and a small proportion would leave medicine or work within pharma, or go overseas (not such a small proportion, perhaps). If you stayed in the UK, you enjoyed great job security, and careers paths were fairly clear, and largely based on what your peers thought. Things have moved on in the UK, and some of what we see has happened overseas is going to apply here, soon.

There are a number of memes to consider

Job security is diminishing. Perhaps most doctors graduating will work for different employers in their careers, and most will not work for the NHS for all of their career. It may be NHS branded, but it is not the same creature the NHS once was. I cannot see the NHS surviving another 20 years — and, in one sense, it hasn’t survived my career ( the current NHS has a different ethos to the NHS when I qualified).

Professionalism. The rule is that once people start talking up something and wishing to formalise it, you know it has disappeared and will continue to be killed off. So, with professionalism, resilience, leadership, ethics, and the like. Those who ran Enron came top of their ethics classes at the Harvard Business school.  Orwell got all of this right a long time back. Bureaucracies and many corporations (including the UK government) detest professionalism, it is why disability assessments, and much of health care, has to be hived off to non-medical widgets, who do not have the cheek to work to a different value set. I learned something about professionalism from the two neonatologists, Ed Hay and Mike Parkin, who ran the Northern region SCBU. This is a world that sadly has gone. One would have used more colourful language than the other, to describe the current state of affairs.

Specialty choice. It think this is really hard, and I wonder if we do a really good job of informing our students. When I was a student, many wanted to be surgeons, but many of those fell off the ladder, quite quickly. Many ‘physicians’ wanted to be consultant physicians in a teaching hospital, but that is now a post that essentially does not exist, and many still doing it wish they had chosen otherwise. Subspecialism, shift work, and the crazy destruction of the Senior Registrar grade, have all made work in many specialties less enjoyable. People will leave, given the choice.

It is very hard to get an idea of whether you will be happy in a specialty based on very limited undergraduate exposure. There also tends to be a feeling that students need ‘pushing’ into areas because the NHS ‘needs’ people in that area. This is putting the cart before the horse. Or perhaps I should say it more forcibly: the job of universities is not to conflate enthusiasm for propaganda, nor to act in anybody else’s interests, except those of our students.

Specialties also change within lifetimes. At one time ’surgeons’ did things with their hands, and non-surgeons, didn’t. This distinction not longer holds, and some non-surgical specialists, work for longer with their hands than many surgeons I know. Take dermatology. When I came into it was very much ‘physician like’ with little surgery. However, in Vienna there was clearly a different tradition, and in Newcastle where I then trained, surgical dermatology was being pioneered (from a UK perspective, along with Cardiff and London). Now there are dermatologists who do no ‘general dermatology’ and who operate for 50% of their time ( I am married to one), having pinched back a lot of work from plastic surgeons (everybody is pinching work from plastic surgeons: ENT, max-fax etc). Anybody looking to train in dermatology now, would be mad not to consider surgery as a key component of the subject.

So, technical advance, and changes in the pattern of care, have big effects over a lifetime. The catch is that much clinical expertise, is developed on the background of being terminally differentiated. As we know, ‘pluripotency’ and ‘generic skills’ are trendy, and easier to bullshit in, simply because they are so superficial  — just look at managers.

Lifestyle. I get nervous here, because the word vocation was one used. And I have never considered my job and my non-job life to be very far apart. I think many academics feel the same way. But I used to be puzzled by observing that in the US, dermatology was one of the most popular specialties. Now the UK is the same, and the quality of our trainees is terrific. Once again, I think the young see further than their elders: they probably don’t need my advice. Virchow said it best: ‘not the first, nor the last time, youth was right.’