Bootcamp – how to train doctors?

Opinion by Robin Youngson.

The government in New Zealand recently announced that military style “Boot-Camps” would be created for young criminal offenders, with that idea that strict discipline, tough conditions and rigorous training would get these young offenders back in line. That had me wondering, do we train our young doctors and nurses any differently?

I think we brutalise our students and young professionals, who start with high ideals of caring and compassion but have their humanity knocked out of them by the rigors of professional training. At medical school, many of my teachers were bullies. Humiliation in front of patients and peers was a frequent punishment. On our first day of professional practice we are thrown in the deep end with little in the way of support or encouragement.

I will never forget my first weekend on-call as an intern. I worked from 8am on Saturday until 5pm on Monday with only three hours sleep. Six of my newly admitted patients died. Six times I had to meet with families to tell them the dreadful news, while I tried to cover up my feelings of profound fear and inadequacy. I ran from crisis to crisis, tried to remain calm, and did my best. I cycled home five miles on Monday evening weeping uncontrollably.

More recently, as a anesthesia resident, I recall one terrible afternoon when I witnessed in quick succession the deaths of a young mother, a baby, and a young motorcyclist. After completing all the paperwork and reporting the deaths to the authorities, I was expected to complete my fourteen hour shift. I had a cup of tea and then anesthetised five more patients that day. As I approached the first patient, the bizarre but unspoken thought in my head was, “I wonder if this should be part of informed consent? Should I tell this patient that my last three patients all died?

This tough hero model of doctoring continues through our careers. Two weeks ago one of my obstetric colleagues witnessed the death of a baby through a tragic series of complications. Nobody offered to relieve him of his duties that day. He worked through the night, even though he was emotionally and professionally traumatised by the events of that day.

I hope that nursing training is not quite so brutal but research shows that nurses, too, lose humanity during their training.

How then, can we expect our vulnerable young health professionals to treat their patients with compassion and caring. Isn’t it time that we closed down the boot-camps?

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