A vocation to heal

Otago Daily Times

4 days ago

Training at the Otago Medical School has changed dramatically over the years, but the dedication to care remains a constant, Paul Gorman discovers.
Dunedin may still be waiting for its new hospital but look on the bright side - this weekend there will be a couple of hundred extra doctors at the other end of town. King's Birthday marks the Otago Medical School's 150th anniversary, with more than 300 alumni, current students, staff and other guests expected from around the country, Australia and the United States.
The oldest attendee is believed to have graduated in 1954, with other graduates from 1960 onwards.
The celebration of a century and a-half of medical teaching, clinical training and medical research at the University of Otago will include lectures, tours and displays, a gala dinner and even the Humerus Medical Revue .
However, despite the excitement and happy reunions, the sharing of stories and advice, the anniversary comes amid warnings that graduates face an increasingly challenging work environment.
The 150th will also provide vivid reminders of the antagonism and bigotry early female students experienced from males at the school.
Biographies of 150 of the more than 400 women who graduated MBChB between 1896 and 1967, (when the country's second medical school opened in Auckland) feature in Against the Odds (Massey University Press), by Prof Cynthia Ferguson and Michaela Selway, which is being launched in Dunedin this weekend.
The stories of chauvinism from academics and fellow students alike, the practical jokes and the stern words from lecturers they were wasting everyone's time, the exclusion from functions and the ongoing teasing, are shocking, but reveal that it made the women more determined to succeed.
As Ferguson says, one of the worst aspects is how long the sexism persisted.
''While it isn't nice, you expect to hear about these moments of hostility from the early years because these were the women bucking the system.
''But though it lessened, it continued all the way through to the end of our time period. Actually, it went beyond. When I was an undergraduate at Auckland Medical School I was told by a fellow student that I was taking a man's space.''
Prof Stephen Robertson would love to be at the anniversary.
He says he has always enjoyed medical school reunions, but this time he is deep in the throes of a sabbatical in the United Kingdom, Canada and Australia.
Robertson is the Curekids Professor of paediatric genetics at Otago University and graduated from the medical school in 1990.
After that he pursued a Doctor of Philosophy at Oxford University.
He also specialises in clinical genetics.
For him, class reunions have been a chance to talk with peers about the ups and downs of their professional lives.
''These are the people you're mixing with who recognise you from your formative years when you were unmoulded clay and they're just fascinated and interested about what you've ended up doing, and what sort of shape you are [in] now.
''We all recognise that we lead this tenuous and rather difficult professional life where, you know, things could sometimes be very, very good and sometimes be really really difficult and challenging.
''I hesitate to use the word 'bad' but, as one of my old classmates said to me at a reunion, we all know everybody's had a hard time in some way or another.
''Some of us know the details and some of us don't, and it's a great leveller.''
There's no doubt the pressure on medical professionals is increasing, Robertson says.
''We have rising public expectations, rising professional expectation in terms of how much we need to look after our patients, and then a sinking lid on resources.
''GPs are possibly at the sharp end, most of all, because the public have unfiltered access to them.
''The big challenge is finding the head space and the heart space to be a humanistic deliverer of care, and because we've been crowded on those three sides, that erodes you.
''There's no doubt about it - you find less and less space, and less and less resilience, to be an attentive and caring person.
''And I think in the end people end up in debit and it erodes them.
''It's terrible because - and it might be an unpopular thing to say - some of our brightest and best people choose to study medicine.
''They're not just talented in terms of their ability to pass exams, but they're talented in all these other directions in life. They're absolutely phenomenal people.
''But they're the people that end up ending their career not full of a surfeit of achievement, but having been really worn down.
''People somehow need to be able to find a space where they do enough medicine to be competent and remain on top of their game, but not too much that's so pressured that they end up being eroded.
''I don't think our current health system allows someone to inhabit that space. I think in the end, if you try to be a really top-notch doctor, you end up personally paying more than you receive.''
Doctors and the medical profession face unique challenges in Aotearoa, he says, and not just the ethnic differences in wellbeing, health delivery and uptake.
''That gets a lot of air time. But there's the uniqueness New Zealand's got in terms of being a nation that's relatively young, with the sort of class society that we have, which is relatively even but with gaps arising and an increasingly large class of people on the poverty line who are really struggling and those who are extremely wealthy.
''And, also, the challenges that we have economically as a nation that aspires to be innovative and developed, but still very commodity driven.
''All of these have impacts on health. And the fact we're a geologically unstable country that sits in the Roaring Forties and we're having these weather systems bubble up from there and bubble down from the subtropics.
''So adapting to a changing climate ... might be all the way from pathogens to how we build our homes and build our cities.
''Also, think about our rural-urban split, and how rural New Zealand is handling their health challenges and how they should be serviced, and what their culture and sociology is like versus the culture and sociology in urban centres.''
A further challenge is to ensure enough graduates move into science as well as working as clinicians.
''As a physician scientist, I'm still practising medicine, and I still do my clinical genetics as well as run my research lab.
''The people who are inclined could be given the chance to do some science and perhaps consider whether their clinical practice could be mixed with science.
''I know they are only a minority, and the vast majority of people go to med school because they want to be a healthcare practitioner. But we need our scientific workforce because we've got unique challenges.''
Robertson returned to Otago in 2002 and ''closed the loop''.
''I've come back home to my alma mater to walk the same corridors which I walked as a student. It's quite nostalgic at times, and it brings back lots of memories, good memories.
''I had a wonderful time as a med student in Dunedin. Not only was it a fun place to grow up amongst good friends, life-long friends, but also intellectually it was where things took off for me. Being back here, and having my lab here in the Hercus Building, closed that circle.
''Otago has been a fantastic place for me. So, I'm a bit sad that I am not going to be in town.''
''Fantastic'' may not have been the adjective first-year female students applied to their experience of the medical school, as Against the Odds suggests:
''As they took their places in the front row of the lecture theatre - as they had been advised to do by women students in the years ahead of them - they were greeted with boos, whistles and stomping from the young men in the back rows. Some noticed the words 'Women's place is in the home' engraved into their desks. Some professors stood at the lectern and declared, 'I see we have females. You have taken a male's place and will waste it ... You are all going to get married and have children and it will have been a waste of time training you'.''
Then there were the demands from male students for the women to strip when a professor said the class would be ''listening to hearts today''.
''It might be professors ignoring them or calling them 'chaps' and addressing the whole class as 'gentlemen'. It might be midway through the academic year, when it was time for lectures on reproductive organs and contraception, and a professor would declare, 'I now come to the part of my lectures I refuse to give before women. Therefore, the women must leave the room, or I will leave'.''
During dissections, ''pieces of flesh would be slid into their lab pockets'', or in lessons on the female anatomy male students and academics might make inappropriate comments.
''Experiences such as these, or variations of them, have been recounted by many of the women who studied at the Otago Medical School across the seven decades covered by this book. Not every woman experienced such hostility and, indeed, many were adamant that they did not ever encounter sexism or discrimination, either during their studies or throughout their careers. Others said that at that point in their lives they 'hadn't heard of the word ''harassment''. We didn't know about that. We just felt we weren't fitting in well enough'.''
The female graduates between 1896 and 1967 ''certainly had the odds stacked against them'', the authors say, with an average gender ratio of 90% men and 10% women.
''Their stories highlight not only the barriers they encountered but also their remarkable achievements. These pioneering women did more than just break into a male-dominated profession: they redefined it. Their legacy is one of perseverance, hard work and the pursuit of equality, and it continues to inspire and guide women in medicine today.
''The history of medicine in Aotearoa New Zealand is richer and more inclusive because of the invaluable contributions these women have made, reminding us that progress is built on the foundations laid by those who dared to challenge the established order, against all odds.'' AI cannot replace compassion: Professor
Advances in medical education using artificial intelligence cannot be allowed to replace the enduring core values and compassion of practitioners, Prof Tim Wilkinson says.
In the New Zealand Medical Journal last week, Wilkinson, a professor of medicine and medical education at Otago University's Christchurch campus, said there were plenty of challenges ahead for teaching and learning.
These included ''competency-based education, personalised learning, and the integration of AI''.
''These developments must be grounded in enduring values: professionalism, teamwork, and community engagement.
''The central task remains unchanged: to train doctors who are not only knowledgeable and skilled, but also compassionate and committed to those they serve.''
In its early decades, the Otago Medical School mostly followed international teaching trends, he says.
However, confidence grew and so did the appetite for innovation, including in rural medical training.
''By 2007, Otago had launched its Rural Medical Immersion Programme.
''This highly successful fifth-year placement immerses students in rural settings using a longitudinal integrated clerkship model.
''All students benefit from some rural exposure - even if they never practise in those settings - because understanding the needs of rural colleagues is essential to team-based care.
''This led to the philosophy of 'a lot for a few, and some for everyone', which means that, today, Otago medical students are placed in 57 towns and localities across New Zealand, 48 of them rural or regional, working with 135 medical practices.''
Otago has achieved international recognition for its medical education assessment, its work in Hauora Māori and Indigenous curriculum development, and admissions policies, have contributed to a ''student body more reflective of New Zealand society''.
''Otago is now recognised as a leader in rural health, assessment, interprofessional learning, and Indigenous health - not simply catching up, but helping set the pace.''
The role of doctors has evolved into a team-based one, Wilkinson says.
''Likewise, teachers have moved from knowledge-holders to learning-facilitators.
''Medical schools no longer own learning resources exclusively; instead, students and staff evaluate and co-curate such materials from many sources.
''Amid these advances, a new future tension is emerging: how far training should be personalised when healthcare is rarely practised alone.
''We assess students as individuals, but the work is always in teams. Learning may be increasingly individualised - but care must always be collective.''
Technology will keep changing how medicine is taught, ''but it must never change why we teach''.
''Our task is to shape doctors who are not only skilled and adaptable, but deeply connected to the people and communities they serve.
''That commitment - to care, to professionalism, to collective purpose - is what must endure, even as we continue to balance past wisdom with future innovation,'' Wilkinson's article says.