Medical school does not prepare new physicians for the real world, doctor warns

OXFORD, United Kingdom — Medical school does not adequately prepare new doctors for the realities of their profession, a junior doctor warns. The new book, “The Bleep Test,” explores how factors such as burnout and overwork can compromise patient safety, with junior doctors being particularly susceptible to these issues.

Dr. Luke Austen’s book discusses the phenomenon known as “Black Wednesday,” the first Wednesday in August when freshly minted doctors start their hospital duties. There have been studies suggesting that patient safety could be in severe jeopardy during this period, but the evidence remains inconclusive.

“It’s not a good feeling to be told that after years of expensive training and dedicated study you might be a ready-made disaster for your first patients,” says Dr. Austen in a media release. “But the reality is that even if Black Wednesday does exist, which is far from certain, the reasons behind it are likely to be complex and multifactorial. It is systems rather than individuals that truly create safety for patients.”

In his book, Dr. Austen aspires to communicate that understanding the thoughts and emotions of young doctors is vital to the welfare of both patients and physicians. He also outlines strategies to assist new doctors in acclimating to their roles, drawing from personal experiences and diverse research findings.

“Any doctor who has been through the opening months after qualifying will tell you that there is a gulf between the theory and the reality, between the title of doctor and feeling settled and safe working as one,” says Dr. Austen. “But the truly difficult aspects which contribute to this divide, such as learning from making mistakes, caring for dying patients, making decisions in the throes of total exhaustion or emotionally recovering from harrowing events are not things they write about in the medical textbooks.”

Tired nurse at work exhausted from night shift
(© LIGHTFIELD STUDIOS – stock.adobe.com)

The author further emphasizes the role of mutual respect among medical professionals in ensuring patient safety. He cites a study in which anesthesiology residents paired with a polite surgeon performed significantly better in a simulated crisis than those paired with a rude surgeon.

His book also offers practical advice on handling difficult conversations, managing patient deaths, and delivering bad news. These insights are contextualized within Dr. Austen’s own experiences as a COVID-ICU doctor. He advises doctors to steer away from self-blame after mistakes, proposing a pragmatic approach that places personal errors within the broader context of error chains and system failures.

“When things go wrong for hard-working doctors, who often link their self-worth to the quality of their clinical work, the mental downward spiral can be dramatic. We must get better at treating humans as humans,” says Dr. Austen.

Although he acknowledges the dire state of the U.K. healthcare system, he insists that his book is not merely a critique, but a call for understanding and tools to address immediate issues, particularly for doctors in the early years of practice.

Like other nations, the United Kingdom is grappling with a crisis in medical recruitment and retention. According to a recent survey by the British Medical Association, 40 percent of junior doctors plan to leave their positions as soon as they secure another job.

In the United States, a nationally-representative survey finds a large portion of nurses nowadays are fed up with their profession and plan to move on within the next two years. Study authors found that while nurses are usually passionate about the meaningful work they do, and earning a good income, only one-third plan to remain in the profession for the foreseeable future. Roughly one in four say they’ll probably leave within the next year or two.

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South West News Service writer Alice Clifford contributed to this report.

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