Improving medical workexperience for studentsNeil Hunter, Alexander Shah and Prasad Bollina, NHS Lothian, Edinburgh, UKHarsha Bollina, University of Edinburgh, Edinburgh, UK

SUMMARYBackground: This exploratorypiece details the development ofthe programme Medic Insight,which was established in 2007 inLothian. This is an aptly-namedunique organisation that providesan insight into life as a doctor forschool students.Context: We believe that theprovision of work experienceneeds to be improved for bothstudents and doctors. Securingwork experience in medicine hashistorically been biased: individ-uals that have family or friendswho work as doctors are able toorganise shadowing placements

with greater ease. Shadowingexperiences are of questionablevalue, and frequently offer expo-sure to only one field, andadministrators struggle to matchdoctors’ working schedules withthose of students.Innovation: Medic Insight hasbeen developed to address thesekey problems. It provides a free,application-based shadowingexperience for 15–16-year olds,in addition to interactiveseminars for younger students.Over the course of the 5-dayshadowing experience (MedicInsight Week), students rotatethrough a variety of specialties,

meeting doctors of all grades.Doctors agree to act as mentorsprior to the shadowing weeksand post their availabilityonline.Implications: Data from our pilotin 2008 has been encouraging.All students who answered ourquestionnaire found the experi-ence to be either useful or veryuseful, and ongoing datacollection is proving this to be anenjoyable and effectiveprogramme. We are confident thatMedic Insight will help all suitablyenthusiastic and able schoolstudents make informed decisionsto apply to study medicine.

The provision ofwork experience

needs to beimproved for

both studentsand doctors

Makingchoices

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INTRODUCTION

Students aiming to studymedicine are looked uponfavourably if they are able to

display commitment and motiva-tion for the profession, and havegained experience of working inhealth care settings.1,2 In theiraim to secure places they seekwork experience, but this is opento criticism: after all, what doyou remember of your workexperience before applying tomedical school? Usually disor-ganised and lacking in varia-tion, this is a lottery dependingupon which family friend you hadwho was a doctor. Some mightsay that this type of work expe-rience will provide little insightinto what a career in medicineinvolves.

The role of work experience isfar more important than ensuringthat school students have anadequate curriculum vitae (CV) toachieve places at medical school.It is about ensuring that theright students are offered places.Once accepted, a significantnumber of students drop-out ofmedical school, not for academicreasons but rather because theyrealise that medicine is not anappropriate career for them.3 Inthe 1960s there was concern thatfamily connections countedheavily during application tomedical school.4 This may not bethe case today, but there exists astrong body of discontentregarding the allocation of workexperience. This year the BritishMedical Association (BMA) medi-cal students’ conference decidedpupils from lower socio-economicgroups should have easier accessto work experience, and recom-mended establishing a bankof placements that prospectivestudents would be able to applyfor.5 The Schwartz report recom-mends a fairer, more accessiblesystem of admission to medicalschool.6 Why should this notalso be the case with workexperience?

We believe that we havedeveloped a programme thatprovides a realistic solution.

THE DEVELOPMENT OFMEDIC INSIGHT

Medic Insight is an organisationthat runs a unique free pro-gramme that allows prospectivestudents to gain an appreciationof a career in medicine (http://www.medicinsight.com). A keyfocus of the organisation is MedicInsight Week, a free application-based scheme that places 15–16-year-old students in a variety ofspecialties in hospitals and gen-eral practices over the course of aweek. Initially conceived by thedichotomy of a consultant and amedical student, it is now backedby a dedicated team of volun-

teers, ranging from doctors at alllevels to medical students, as wellas university and UK NationalHealth Service (NHS) staff. Theprogramme was constructed toaddress the needs of key individ-uals in the process of providingwork experience, including doc-tors, schools and human resourcespersonnel, in addition to those ofthe students we cater for.

Since an initial pilot consist-ing of 20 students in 2007,interest in the programme hassoared to enrol over 106 studentsin 2009, and receive applicationsfrom over 300 students in 2010.As demand and interest has grownfor the concept, this year sees theinception of Medic Insight Day, inaddition to Medic Insight Week,which targets 14–15-year-old

The role of workexperience is...aboutensuring thatthe rightstudents areoffered places

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students, who are too young toundertake meaningful work expe-rience in NHS hospitals. MedicInsight Day involves a course oflectures, workshops and basicpractical skills.

REASON FOR CHANGE INNHS LOTHIAN

In 2007, NHS Lothian receivedin excess of 450 applications formedical-related work experi-ence.7 We identified that therewas scope for improvement inthe catering of work placementsas it was noted from our ownexperience that the set-upwithin the NHS had inherentproblems.

• Clinical staff face spontaneousapplications for work place-ments that are not the productof a structured or formalapplication.

• Doctors frequently struggle tomatch their highly variable

schedule over the course ofthe week to that of the schoolstudent.

AIMS OF MEDIC INSIGHT

Medic Insight was developed toaddress these areas. The founda-tions of the programme are builtaround four aims (Figure 1):

• To provide a fair and accessi-ble route of access to medicalwork placements for all schoolstudents.

• To illustrate the numerousworking practices andspecialities open to medicalgraduates.

• To provide an objective viewof medicine in an unbiasedenvironment.

• To create a seamless andflexible scheduling process forclinical staff to support schoolstudents in their exposure tomedicine.

CLINICIANS

For clinicians there is no mini-mum commitment required: thedoctor can mentor one studentfor a couple of hours on a singleday or take many more sessionson various days across the MedicInsight Week. Doctors are pro-vided with simple availabilityforms that are accessible online,via e-mail or on paper. Theclinicians are reminded closer tothe programme week of theirscheduling times, and if there isany difficulty in meeting thesecommitments there is a relevantpoint of contact that quicklyreschedules or cancels theappropriate sessions. Cliniciansare provided with guidancehandbooks that outline the aimsof the week and the students’expectations.

SCHOOL STUDENTS

Each morning and afternoon thestudents rotate around variousspecialities and shadow differentgrades of doctors. They aresupported with comprehensiveguidance on locations and intro-ductory materials on eachspeciality, which enables themto recognise what to look outfor and how to optimise theirexperience. The Medic InsightWeek also includes two plenarysessions that allow pupils tobe involved in team-buildingactivities, supervised clini-cal skills sessions, short lec-tures and group discussions(Table 1).

For cliniciansthere is no

minimumcommitment

required

Figure 1. Medic Insight model.

Table 1. A sample timetable for Medic Insight Week at the Western GeneralHospital, Edinburgh

Morning Afternoon

Monday Introduction House officer: respiratory

Tuesday Mammography Pathology

Wednesday Practical session: BLS Free

Thursday Urology theatre Medical student discussion: ethics

Friday Diabetes clinic Closing afternoon

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APPLICATION ANDLOGISTICS

Application entry criteria forMedic Insight are academicallysimilar to those of medicalschools. The school studentsubmits a short application formincluding their predicted grades,which is used with carefulconsideration to select onlyappropriate students.

The applications from thesuccessful students are linked tothe availability of the cliniciansthrough a semi-automatic soft-ware-driven process. The processof Medic Insight is linked to thepre-existing programme Pathwaysto Professions (http://www.pathways2professions.org), whichtargets under-represented stateschools, aiming to secure NHSWork Placements for students.

RECRUITMENT

All grades of doctors and seniormedical students have beencontacted throughout NHSLothian. Medical students intheir final and penultimate yearsare recruited through the Uni-versity of Edinburgh, and juniorand middle-grade doctors arecontacted via the NHS Dotsnetwork. Consultants receive apersonal e-mail from the MedicInsight consultant staff. We haveinformed local schools of ourprogramme and supply them withinformation packs, which containposters to be displayed in

schools. This has ensured asteady increase in the numbersof both our tutor staff andprospective students seekingwork experience.

FUTURE OF MEDIC INSIGHT

At the end of the week-longprogramme in 2008, we askedstudents to complete a feedbackquestionnaire. We consider theweek to have been a success:the overwhelming majorityfound the week useful and thatit met their expectations. Only10 per cent of students felt thatthe experience had no impact ontheir desire to study medicine,with over 70 per cent of studentsreporting a greater inclination toapply to medical school. The drop-out rate at medical school isapproximately 12 per cent.8 Wehope that Medic Insight willfilter uncertain candidates andthose not suited to the job atthe pre-application stage,helping to bring down this ratein the long term.

Medic Insight is an evolvingand expanding venture, and wehope at some stage to provide allschool students with an interestin medicine, and who are suit-able candidates, the opportunityto participate in the programme.Our model has also receivedinterest from staff involved inphysiotherapy and nursing train-ing. Our results from 2008 areencouraging, but the numbersare small. In June 2010 we

estimate that we will be able toaccommodate 157 students inNHS Lothian for Medic InsightWeek, and will undertake moredetailed evaluation. With thisinformation we will be able tofurther improve our programme,with the possibility of introduc-ing it to other health boards.

REFERENCES

1. Parry J, Mathers JM, Stevens A,

Parsons A, Lilford R, Spurgeon P,

Thomas H. Admissions processes for

five year medical courses at

English schools: a review BMJ

2006;332:1005–1009.

2. Council of Heads of Medical Schools

(2006). Guiding principles for the

admission of medical students.

London: Council of Heads of

Medical School.

3. McManus IC. Drop-out rate in medical

schools seems reasonable. BMJ

1996;313:173.

4. Royal Commission on Medical

Education 1965–68 (1968) Report.

London: Her Majesty’s Stationery

Office.

5. BMA Medical Student’s Conference

(2010) York: http://web2.bma.org.

uk/stubma.nsf/wd/BSKN-84RJH9?

OpenDocument&Login&C = 24+

April+2010

6. Admissions to Higher Education

Steering Group (2004). Fair admissions

to higher education: recommendations

for good practice. Nottingham:

Department for Education and Skills

Publications.

7. NHS Lothian human resources. Royal

Infirmary of Edinburgh, 2007.

8. Parkhouse J. Intake, output and

drop-out in United Kingdom

medical schools. BMJ 1996;312:885.

Corresponding author’s contact details: Alexander Shah, Western General Hospital, South Crew Road, Edinburgh, EH4 2XU, UK. E-mail: alex.shah@nhs.net

Funding: None.

Conflict of interest: All four authors are involved as clinical mentors in Medic Insight, and are also involved in its development.

Ethical approval: Our article is predominantly a descriptive piece detailing the work experience programme that we have developed, and

we do not feel that it is ethically contentious in any way. We have therefore not sought ethical approval.

[Theprogramme] hasensured asteady increasein the numbersof both ourtutor staff andprospectivestudentsseeking workexperience

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