It’s time for medical training to shed off colonial mentality

During our medical school days, a story was told of how a young doctor, one of the first to graduates from Moi University School of Medicine, had proceeded to do his internship in a provincial hospital, back in the day when they were only eight of those in the country. The young man sure had a huge chip on his shoulder, but, worked hard.

He was thorough and committed. He spent an ungodly number of hours in the ward looking over his patients, adjusting treatments, getting the patient labs done on time and generally being an all-out obsessive, over-the-top rookie on the job with too much gas up his nozzle. Despite challenging his very senior specialist consultants and getting them all riled up most days, he was the model young doctor. He was well read, he knew all his patients and knew everything about them. He followed up on their test results, made sure the scheduled surgeries were well prepared for and the ward ran like a well-oiled machine. His patients loved him because he clearly demonstrated his dedication to their well-being.

However, the fellow did have one thing; his Achilles heel was that he could get a little cocky. Now if you went to medical school when your faculty were the full stiff-upper-lip types who studied the craft under the Brits, you know what I am talking about when I say, they were never going to stand for the cockiness. The young man was brilliant, he challenged his consultants all the time and it drove them crazy.

On his third rotation, he met his match. Word had certainly gotten around the hospital about the young doctor that he was impossible but amazing. And he had survived the past rotations just fine. But that was not going to be the case this time round. He met one who believed that respect for authority and not talking back to authority sure trumped that.

Long story short, on his third week of the rotation, the young doctor had been neatly packed up, complete with a bow and was enroute to sender. The consultant interpreted the cockiness as belligerence and figured that he would be better off interning under the professors who let him out of medical school with that attitude.

Let’s just say that the young man excelled at his craft and his stubbornness led him to do amazing things in transforming rural healthcare in the most remote parts of the country. He raised it up a notch and went on to do amazing things on the global health platform and pick up a whole new diplomatic persona while at it.

Well, to us, he was a hero. We never knew him in person, but we loved his spunk, and the fact that it stemmed from a place of deep belief in oneself, driven by excellence, with the patient at the centre. We loved it even more that our professors looked past his cockiness and appreciated the rough diamond that he was. They knew he was meant for greatness.

That may not be the case everywhere. This was the amazing attitude of a young medical school, working hard to break from the mold, setting new traditions, new practices and a brand new culture while at it. These are doctors who had trained under an extremely rigid regime and wanted to change this. This led to the birth of the second medical school in Kenya.

Well, it has been two decades since and a dozen more schools have come up. What is sad to see is the attitude of some of the doctors who are faculty, still portraying the very colonial attitude that has no place in this age. Medical training is hard. It encompasses long hours of cramming, many examinable subjects in the early years that make the end of year exam period an absolute terror.

The clinical years’ journey doesn’t get easier. As a student, you are riddled with self-doubt when you face real patients, scared of making mistakes. Even more intimidating are the comments made by those entrusted to teach. The horror stories told when doctors walk down memory lane will leave one dazed. Nothing beats the clinical exams.

One doctor told us how he had to duck under the patient’s bed when he saw the pair of examiners headed his way. 

The professor was known to intimidate students so bad, no one ever expected to pass the exam with her. Another regaled us with stories of how this one professor would ridicule the students in front of patients for wrong answers given during the ward rounds.

For many, the horror stories built the doctors that they became. For others, not so much. Some were just not built for that level of abuse, and though they turned out to be amazing doctors, something was irreparably broken. The culture carried on to specialist training level, where it stung worse because many of the doctors in advanced training were no longer young, carefree persons but were now mature adults, with families.

Hurt people hurt people. Some of these specialists who survived the militant training are now in the same position of power. The negative and toxic energy is no way to build the profession. It is time to shed off these habits and embrace a true culture of professional engagement, inspiration and mentorship. This is because medicine is an apprenticeship, hence we learn by working closely together.

No amount of amazing clinical skills is going to make one a good teacher if he does not inspire those coming behind him to want to learn. Further, in this era of technology, the younger people are more likely to learn faster, innovate more and literally drive us all into oblivion. We have to embrace shared learning and understand that imparting skills and knowledge is going to flow both ways.

It is time to put a stop to the bullying, abuse of power and intimidation that characterised the past engagement in the profession. The generational discordance we have to exist in is remarkable. In the past four decades, we have had four different generations that are completely removed from those who currently hold authority. The need to adjust to these changing faces is urgent. The old tricks won’t do the job for this lot. Yet, we are all potential patients, and as we age, we must be cognizant that these will be our doctors. Let’s train them to serve us!

Dr Bosire is an obstetrician/ gynaecologist