Wednesday, 23 July 2008

Not a Lot About Very Little

Not a great deal to blog about at the moment. The last week has been taken up mostly with packing. The big move is this weekend so fingers crossed everything goes well, our stuff is going into storage for 2 weeks before we move in to our new flat.

It is now less than 2 weeks until I start work, I daren't think about it too much. Shadowing begins in a week, I'm hoping there is some kind of secret initiation during this period that turns you into a fairly competent doctor as I'm struggling to remember even the basics, never mind all the complicated rubbish I learnt for finals. I guess that gives me 1 more week of freedom, 1 more week before I finally become a grown-up? Best of luck to all the other bloggers out there starting work in 2 weeks, any plans for your last weeks of freedom, or any tips for our first week?

Will hopefully keep you posted on events over the next few days.

Monday, 14 July 2008

Reflections On 5 Years

This post is so long it needs a contents page so you can skip to the relevant part if you can't be bothered with all of it.
Part 1 - Introduction
Part 2 - The first few years
Part 3 - The Preston fiasco
Part 4 - Other complaints
Part 5 - Graduation disaster
Part 6 - Disclaimer to potential students
Part 7 - Conclusion

If I'd learnt anywhere near as much about medicine as I have about life in the past 5 years I'd be a genius. Had I coasted through medical school without a single problem I'd still be as naive as I was 5 years ago. Maybe I should be grateful then that Manchester have 'taught' me so well. Ha. I am bitter about my time at medical school, but by being so I believe I'm far more prepared to be disappointed in the real world. It might not make much sense as I write about it but believe me, I'm a much harder person now, and hopefully, based on my experience will be far more able to accept the incompetencies of other institutions and organisations (*cough* NHS *cough*)

Just one worry, what will I have left to blog about?


I was 16 when I started looking at medical schools and only just 17 when I submitted my application. I was young and naive, perhaps even bordering on stupid. I based my university choices mainly on where I thought I was most likely to get in, that was my first, and probably biggest mistake. The first thing I always tell potential applicants is to apply to where they want to go, not to where they think they're most likely to be offered a place. The second thing I tell them is not to touch Manchester with a barge pole!

The first time I visited Manchester was for my interview and even though it was raining torrentially, it was the city, rather than the medical school that inspired me. Although I now harbor a passionate hatred towards the university, the city itself is move vibrant than ever and inspires me even more than it did 5 years ago. Maybe it was my expectations of what to expect from the whole university experience that were wrong to begin with. Maybe I would have been just as unhappy elsewhere, grass is always greener and all that. I've heard plenty about problems with other medical schools too so I don't expect that Manchester is unique in its inadequacy.

Had I been blogging in first year I would have had very little to write about, it went by with very little fuss. There were always rumblings of administrative incompetency from others but I was happy in my own little world. Without warning, problem based learning was thrust upon us. Fresh from spoon-fed A-Levels it was quite a shock to have to learn everything yourself. There were of course 6 or so supplementary lectures, although these were often irrelevant or cancelled, It was clear early on that PBL is little more than a synonym for DIY.

I made some great friends from all over the world in my first year and on the whole I really enjoyed myself. Despite the learning style, I even enjoyed the work, I found it interesting and was reassured I'd made the right choice of course, if not university. All that was about to change in what was a pivotal moment in my university years. I've written about this before and it may be a little bit boring so apologies if you're falling asleep already.


It was time to choose our hospitals for clinical years. I never imagined how important this would be. This process seems to vary from school to school, At Manchester, for the last 3 years, you're based at one of 5 hospitals, 3 of which are in Manchester, one being Keele (40 miles away) and the other being 40 miles in the opposite direction in a wonderful city called Preston often referred to as depreston. At the end of first year we ranked in order of preference those 5 hospitals and we were assured that the allocation process would be random and fair. If you don't know, I'm sure you can guess what happened next. I fell foul of this 'random' allocation and was allocated to Preston. The day after finding out, I handed my appeal letter in personally. Naively again, I didn't for one minute think my appeal would be unsuccessful and spent the rest of the summer safe in the knowledge that of course I wouldn't actually end in Preston, unfortunately the other 40 students allocated to Preston had exactly the same idea.

If my biggest mistake was choosing Manchester then my second biggest mistake was not having a clinical partner for this allocation process, i.e. a friend with whom you made a joint application to a hospital preference. At first I did have one but we wanted different first choices so in the end we applied alone. In my appeal letter I clearly stated that the process had been unfair. We had been told that whether or not you had a clinical partner you were equally as likely to be allocated a place at your first choice. When the allocation results were published this was clearly not the case. As sad as I am I used my basic knowledge of statistics to analyse the results and it was clearly skewed in favour of those who had clinical partners. To put this simply the algorithm used had clearly given a group of two students the same priority as a single student which is obviously unfair on the single student.

I complained and complained but to no avail. I know of at least one person who had their allocation altered on the strength of a falsified official letter. The vast majority of appeals were unsuccessful, after all, they can't just have an empty hospital. It wasn't until the end of second year that I even met another person going to Preston. Needless to say, none of the friends I'd originally made were. Fantastic. From that point onwards I decided that I was no longer there to enjoy university, I was there to endure it to gain my qualification. I met one of the senior staff (albeit not that senior, they're completely off limits) I cried, I shouted, I pleaded, I exclaimed how unfair the supposed random allocation had been why could they not see it? In the end, I was told just to deal with it. Gee thanks for all the support.

As second year went by, my disdain evolved to hate but I kept plugging away and had no troubles academically. By this stage, the glimmer of student support we'd been given in first year had disintegrated and we were left to fend for ourselves. Most of my emails and letters were now being ignored. Why I don't know, I was persistent, but had never been anything but polite in my requests.

One thing is for sure, I certainly wasn't moving to Preston. It might be 40 miles away, an hour's drive at the best of times but having fallen for the city of Manchester and expecting to be there for 5 years I wasn't about to upsticks to a city I already hated.

For reference, it was at this point, at the end of second year that I met missbliss. I decided to continue living in Manchester and commute to Preston, a few others followed suit but it was almost impossible to share lifts as everyone was doing things at different places at different times. Commuting, combined with visits to missbliss in Cambridge soon meant that I was often driving almost 1000 miles a week at a cost of about £100 per week. In January of third year I was forced to move to Preston for the rest of the year, it was every bit as bad as I thought.

You might think that by now I had accepted being in Preston and moved on and I just about had when I heard that a mistake had been made in the allocations for the next batch of students and the medical school were offering students £2000 if they would swap an allocation in Manchester for one in under subscribed Preston. In other words, they were offering £2000 to students who could be persuaded to go to Preston. WHAT THE HELL?!? Where was the £2000 for student who had to go against their will? What on Earth were the medical school thinking when they decided they could offer some students money and not others, had this happened in my year I would have taken legal action. Because it wasn't my year it just made me even more angry! It was at this point I submitted a freedom of information request so that I might see the algorithm or process used in the allocation of hospitals. They didn't even refuse because nobody ever actually got back to me, I should have reported them to the information commissioner at that stage for breaking the FOI act.

I let the subject drop again but worse was yet to come. The following year during the allocation for the new cohort of students the process had to be declared null and void. Can you guess why? It had finally been exposed as unfair, can you guess how? The process was biased against students without clinical partners, exactly as I had told them in my appeal letter 2 years previously! Now I was livid, I had always known the allocation process had been unfair, if I'd been allocated Preston by a completely fair system, I mightn't have liked it but I would have put up with it. I demanded a meeting with the dean of the medical school of course I was ignored, but this time, I'd been proved right and wasn't about to let it drop so easily. I had to make do with a meeting with someone else. I went to the meeting to ask if the allocation process that had been abandoned that year was the same one used in previous years. Unfortunately I was met with a very defensive woman who wouldn't tell me anything and if anything, wanted to intimidate me rather than explain things to me. The meeting didn't go well, I was polite but was clearly not being listened to. It was clear that the medical school wasn't about to admit that they were wrong, after all, hundreds of students had appealed against this procedure, to admit a mistake at this stage would have been a disaster. I asked if I could at least have an apology since my appeal was based on a claim the process was unfair just as it had now been exposed to be. I was told, in no uncertain terms that I could definitely NOT have an apology and, already having been deceived, ignored and lied to, was threatened that taking this topic any further could be detrimental to my place within the medical school. I was taken aback, this was a threat in all but words that if I carried on with this issue I could face being kicked out of medical school - on what grounds I'm not quite sure. At that point I realised I was fighting a losing battle and started blogging instead.

Before I draw a big black line under this topic, I need to cover a few of the potential counters to what I've said. Some of you might think I have a point, others might think I'm just a bitter individual, some might say 'it's only Preston' and most of you probably don't even care. You're all entitled to your opinion just as I am but let me explain a little about why this is such a big thing. I applied to Manchester University because I loved the city, having been sent 40 miles away to Preston there is very little chance to do anything in Manchester and you have very little access to the university facilities or support. It is my belief that you also miss out on educational opportunities by being in Preston although it is a good hospital which may make up for this in some respects. I decided to stay in Manchester, that decision cost me the best part of £5000 in fuel and £3000 in lost free accommodation in final year - despite the travelling it was worth it. You could say 'life is just unfair' - maybe you're right but at least now I'm much more prepared for it. You could say 'you're going to be a doctor, you need to be prepared to move wherever', again, I'm much more aware of this and willing to accept it but at the same time I would hope that where such a system is used to allocate jobs, it would be fair and at least in part based on input on my part, whether that be an application form or interview. Finally, I hear that in future, applicants are going to be told if they've been allocated to Preston when they apply to Manchester through UCAS. I suggested to them 3 years ago this was the only fair way of doing things. Preying on the desperate there Manchester - I'm sure there are plenty of people without offers who'd love a place at Preston.


Now we've got that beast out of the way we can go back over a few other things that have happened in the last 5 years. Honestly, I know I'm bitter about the whole Preston issue but that isn't the only reason that I despise Manchester.

Almost more important than the Preston issue is something which came to light recently. Apparently the medical school had, in the past, restricted learning opportunities at particular hospitals because they couldn't ensure that similar opportunities could be provided at other hospitals. In one example where changes to the third year curriculum were implemented (whilst we were in fifth year) so that all third years would be taught suturing, the opportunity was denied to the fifth years on the grounds that it was for third years only. We had never been taught it despite it being a potential finals station, after pressing for it we did eventually get the same opportunity. Firstly, you should be doing everything you can to maximise learning opportunities and secondly where do you get off telling people who and what they can teach? Ridiculous. I know you don't care about your students but that is a whole new level.

That leads me nicely onto another issue. It was often said that Preston missed out on some of the opportunities in Manchester but in one case students at one hospital were given access to 14 questions on one of our exam. I'm pleased to say that after much complaining this issue was rectified in that these questions were excluded from the marking but it should never have happened in the first place. It was discovered this once but who is to say how many times it has gone unnoticed in the past?

This is just one of myriad issues that people have had with the examination system. I'm sure you all remember my OSCE fiasco. I'm not going to complain about that here because that is an academic issue and I'm bound to be biased against it. What I can say, having seen OSCEs (practical exams) from both both sides (being an examinee and a volunteer) is that in their current state at Manchester (and to be fair, at most places) they are a lottery. The exam cannot be run objectively at 4 different sites at the same time and the marking is so subjective it makes the whole thing almost pointless.

Next we have student support - or lack thereof. Manchester should be ashamed of itself in terms of this. There was some limited support in the first year but after that you may as well not even exist, nobody at the university cares about you. At Preston the support was good as the hospital staff were willing to listen, but centrally support is non-existent. I'm pleased to see this is something they're trying to address, whether it will be or not remains to be seen.

I'm sure you all know what I think of PBHell. I hate it. They may as well give you a list of things to learn on day 1, send you away and bring you back 5 years later to examine you on it. Conceptually PBL isn't bad, but it doesn't work when it is relied upon to be a substantial method of learning. You can't learn all you need to know without some sort of input. There isn't a lot of evidence out there comparing graduates of PBL courses against traditional courses but this is slightly concerning given that Manchester and Liverpool were 2 of the pioneers of PBL in the UK. PBL does give you the flexibility to learn what you want when you want but I'm gravely concerned about some of the graduates this course has produced. A much better approach would be a combined course featuring comprehensive lectures and PBL.

PBL can be effective if every required element is there, unfortunately where medical students are concerned this is almost impossible. Yes I might be bitter and angry but at least I'm not a bully. I've met some really great people in the last 5 years but I've also met some particuarly mean and nasty pieces of work.


Finally I want to talk about graduation. A day where you are supposed to celebrate your achievement. As I've said before, for me it was less about the achievement and more about being free from this incompetent institution. The ceremony itself was so cringeworthy it was awful. The worst part for me was the main speech, it was given by a senior staff member who didn't introduce himself, we should probably have already known who he was but such is communication within the medical school, few people had a clue who he was. I'm still not entirely sure and I don't understand his nu-speak title anyway. I'm sure he is very good at what he usually does but he was definitely off that day. He launched straight into a completely irrelevant speech delivered with all the charisma of a dead aphid. If we're supposed to be proud of our achievement I would hope that the staff would be proud too, but the speech was delivered with such monotony that it was clear that the speaker didn't care and probably didn't want to even be there. Worse than the style of delivery was the content. The opening motif was introduced as we were told, "Although the University is rather old, it continues to benefit greatly from being new". The rest of the speech contained contrived examples of many old and new things, but we were graciously informed that we hadn't managed to deplete the knowledge stores of the university ("Is not knowledge the property of humankind?"). I could not engage with anything that he said. In another speech, the pinnacle had to be the mention of Harold Shipman (well I suppose at least he is a former graduate of Manchester) - what a fantastic way to celebrate a new generation of doctors! Perhaps I misread the atmosphere but everyone I've since spoken to felt the same about the whole thing - I didn't even notice the Shipman reference until later. At least when the names were read out by the Medical School Dean (again, I think it was him but I'm not too sure, having never seen him in the last 5 years) he delivered them with a bit of passion, as though he was proud of us all. The Dean also read well when it came to the affirmation, a modern day version of the Hippocratic Oath which we all affirmed in turn. When we finally got out, fittingly it was pissing it down and there were shouts telling us to "leave the building as quickly as possible".


As a disclaimer - to prospective students, I should say that other opinions are available. At least a couple of (maybe even 3) people are very happy at Manchester, although I'm really interested to see how they do in the national student survey - 3 guesses for what I gave them. I'm afraid I won't be recommending Manchester medical school to anyone, in fact, where possible, I will actively discourage students who might be considering it. For anyone who is already at Manchester or who, despite my advice still insists on applying, the course has changed significantly in the past 5 years, and seems to have improved a lot. I hear they even 'teach' you anatomy these days. The faculty even have a new blog and I must say that this chap looks to going in the right direction so it might not all that bad if you do end up stuck there.

And that, ladies and gentlemen, is that. The end of a long journey, one that I'm very glad is over. I'm looking forward to a completley new chapter in my life, one with less bitterness and fewer grudges. To those of you that I like, you know who you are, the very best of luck. To those of you that don't like me, it has been a pleasure, I'm honoured to have had such an impact. Finally to Manchester Medical School, a good riddance for all.

If you read all that you deserve a pat on the back, for those of you from Manchester, I'm sorry but I've not said anything that isn't true.

edit: seems Shipman was indeed a Leeds graduate not a Manchester graduate, oh well.

Thursday, 10 July 2008

I'm Free

Graduation was just as ridiculous as I expected it to be! It wasn't just me who wasn't looking forward to it, many other people didn't want to be there but to keep their families happy obviously they had to be. For me, it was just as much about celebrating the end of being tied to an incompetent institution as it was officially finishing my degree. I suppose it is a bit sad that it had to end that way but I take solace in the fact I'm wasn't alone in my feelings.

The ceremony itself was awful, but more on that in a later post. Yes folks, I'm afraid you're going to have endure just one more exceedingly bitter post from me on my time at university. Whilst you might not be interested and some of you may entirely disagree with what I have to say it is important for me in terms of closure, at least from a blog point of view. It will only be one more post, I promise. I've have learnt some medicine in the last 5 years (I hope) but I've learnt more about life and people which will probably be a lot more useful in the future.

As I told the alumni association, I want nothing more to do with you, as far as I'm concerned I'm not a University of Manchester graduate, I'm a medicine graduate.

Watch this space...

Tuesday, 8 July 2008


Graduation tomorrow, couldn't be less excited if I tried. Lack of posts at the moment because although i'm quite busy, most of my time is being taken up by important but spectacularly boring stuff.

Wednesday, 2 July 2008

Are You Proud of the NHS?

It was only relatively recently, at some point during medical school, that I learnt the NHS has only been around for 60 years. I was rather surprised, I had never particularly thought about it but if I had, I would've imagined it being around far longer than that.

In the press, rather than concentrating on the NHS's achievements to celebrate 60 years, much has been made about the future. Is the NHS still viable? Can and will the NHS survive and of course the 10 year NHS plan. I was recently asked if I was proud of the NHS, in reality this is a rather stupid question, after all, it isn't like I had anything to do with setting it up, nevertheless, some of the answers I've seen have been interesting.

I guess the main factor here is probably political affiliation, I suspect most labour voters would say they are proud, and most conservatives would say the opposite, if for no other reason than they are currently the opposition. This position is perhaps compromised if you're somehow involved in the NHS. I would hope that most healthworkers would be proud of the organisation they work for although I recognise that many have reason not to be. In this case, I would hope that they are proud of the idea of the NHS if not its current state.

Personally, as someone who is about to embark on a career in the NHS, I'm not sure where I fit in. I'm certainly proud of the foundations and ideas of the NHS and I find myself vigorously defending it to anyone who isn't. I don't know much about politics, to me, they're all as bad as each other, I don't think it makes a great deal of difference who is in charge. I don't think the Conservatives would necessarily do a better job with the NHS than Labour have, yes things might be different, but will they really be better? The conservatives will win the next election, of that I'm sure, and frankly that doesn't bother me. I have voted labour in the past but am quite willing to see what the conservatives can offer, so much so that I might even vote for them *shudder*.

So am I proud of the NHS? Yes, I am, regardless of what I think about its current state. I think many that aren't have been swayed by the media who tend to focus on the negative aspects after all its scandal that sells papers.

Are you proud?

Happy 60th!
what will you wish for?