Improving student engagement based on a sample of n = 1 = me

Early experiences of primary care at medical school solely acted to solidify Dr Jodie Blackadder-Weinstein’s ambition to become a plastic surgeon. However, now a Portfolio RAF general practitioner enjoying her career more than ever, Jodie explains the inspirational chance encounter that changed her path, and encourages others to open their eyes to all possible career options; namely one in general practice.

Having just finished swiping through last night’s magical photos of the aurora borealis, I sit in a medical centre in the Norwegian Arctic Circle, with mile upon mile of perfectly white snow outside of my clinic window, preparing all of the cardiac drugs for the next round of “ice breaking drills”. Before replying to emails about upcoming student engagement events, I get a moment to acknowledge just how lucky I am to do a job I love, in a place I’ve always dreamed of visiting.

I was the type of medical student that today I focus on most. Before even starting medical school, I was planning where I wanted to be in life. There was no questioning that I was going to be a plastic surgeon. Before applying to medical school, I volunteered at a local orthopaedic veterinary practice to develop my surgical skills, and while at university I fought to ensure every self-selected component was surgical-based. In my pitch for a Royal Air Force medical cadetship, I made clear my plans to be a plastic surgeon in the field, highlighting my youthful fervour and determination that nothing would get in my way.

I was ecstatic when I found out I would be doing plastics in my foundation training programme, but frustrated that I would have to waste four months doing general practice as a foundation year two doctor (FY2), as is expected of all military trainees. “Who would go to medical school for six years just to be a GP?” I thought in medical school, and the four weeks I spent in my fourth year sitting in the corner of a room belonging to a retirement- planning, self-proclaimed “failed surgeon” did little to alter my pre-conceptions.

What I had not accounted for in my blinkered, headstrong and naïve approach was that the 16-year-old (I’m Scottish, not a child prodigy) applying to medical school would be a rather different person from the one selecting a training pathway eight years later. My FY2 general practice placement changed my outlook, plans, way of thinking: it changed my life. I was working with a team of people who enjoyed their job. My supervisor was a young, enthusiastic trainer who split her time working between general practice in the UK and short projects with Médecins Sans Frontières (MSF) abroad. She wasn’t a failed anything; she knew her stuff, the polar opposite of the stereotypical GPs I had previously encountered. The blinkers were starting to be peeled back.

From my very first clinics it became clear that this was not an easy job. breadth of medical knowledge required was vast. Patient presentations were often complicated. The level of risk and the chasm of the unknown was something I had neither encountered nor anticipated. I was a 23-year-old with my own clinic room (name on the door and everything!) when Ann entered for her appointment. Ann’s presenting complaint was a cold, but it soon became clear that was not why she was here. Ann had three children, a dog called Poppy, a husband who had been made redundant… and a breast lump. A breast lump she had known about for at least nine months but ignored. A breast lump that following my urgent referral to the breast clinic resulted in bilateral mastectomy, radiotherapy and chemotherapy. During my four- month placement, I was with Ann each step of the way. It gave me a completely different perspective on medicine and humanity.

In that one training rotation I had seen a plethora of patients with a spectrum of conditions, from the life-threatening to the sublimely ridiculous. Yes, the days were busy and there was a lot of administration, but I was making a difference. I had purpose, and for the first time in my life as a doctor, I had an element of autonomy in the care of my patients. I was hooked and didn’t know how to break it to my growing group of surgically blinkered friends that I was stepping towards the cardigan-wearing dark side — I was going to be a GP.

That was seven years ago. I am now a qualified GP, with a portfolio career in the military, simultaneously enjoying clinical sessions in the NHS and Armed Forces, as well as teaching GP trainees, doing contraception clinics and studying for a diploma in Sports and Exercise Medicine and MSc in Primary and Community Care. There is plenty on my plate, but my principal project — a personal priority — is to ensure that individuals at varying positions along the training spectrum do not miss out on their opportunity to become a GP. That is why I am writing this article: using my story, research which is admittedly based on a sample of n = 1 = me, to identify three gaps which need closing:

  1. I did not see GPs much as a student. We were not lectured by them; small group work was led by hospital doctors; and the limited exposure to primary care was one of the least inspiring experiences of medical school.
  2. As medical students interested in becoming surgeons, we had a society, which gave us a tribe. Nothing similar exists for general practice.
  3. When I realised I wanted to be a GP, it felt like a guilty, embarrassing little secret. We are encouraged to reflect a lot as GPs and, on reflection, this was ridiculous. So, now it is time to bang the drum for a career in Primary Care!

Four years ago, at a Royal College of General Practitioners Associate in Training Committee meeting, it became clear that my experience was not unique — so we started an initiative to increase the visibility of general practice as a career in medical schools. Making links with medical schools via visits and many Sunday evening Facebook chats, I found there were lots of students who were interested in being a GP but were not sure where to get information and were not that keen to “out” themselves as potential GPs. A few medical schools had already developed thriving GP Societies, which provided teaching, socials and access to career advice, as well as working to integrate general practice into their curriculum from day one. Using these trailblazers as evidence, I helped those who were interested in setting up something similar in their own medical schools. The network is growing, and the Royal College of General Practitioners is becoming more supportive: the appointment of a full-time Student Engagements Officer, Chris Bull, is testament to the growing commitment to engage medical students and provide an optimistic, yet realistic, introduction to the profession.

We encourage relatable GPs with achievable career plans to speak at medical schools and act as approachable role models. People you can send an email or tweet to and expect a reply. Because if it had not been for Little Miss MSF, I might not have the job that I do today; I would not have been paid to spend three weeks in Norway chasing the Northern Lights on a juiced-up Hummer every night; and I would not be planning medical cover for a climb up Kilimanjaro this summer. I got lucky and I want you to get the career you deserve.

If you are interested in GP as a career, get in touch with your local GPSoc, and if there isn’t one, get in touch with us (students@rcgp.org.uk) to help get one started. If you just want to ping me an email for a bit of a career chat, feel free on jodie.blackadder@gmail.com.

By Dr Jodie Blackadder-Weinstein,

 Portfolio RAF GP