Archive for August 31st, 2010

Stress, fighter pilots and medical students

August 31, 2010

In which Dr Aust offers, instead of bad science, a rather meandering anecdote.  Sorry.

En route back to Britain last week from our rather damp annual holiday, I couldn’t help noticing all the media coverage of the 70th anniversary of the Battle of Britain.

Like all children growing up in Britain in the 60s and 70s, I guess, I became familiar early on with the story of the Battle as it has passed into British folklore (or history).  I remember my mum taking my little brother and I to see the 1969 film version during a rainy holiday (another one!) on the Isle of Wight. At the time (the tail end of the 1960s) Winston Churchill was not long dead, and we children could all recite by heart his famous line about the Battle:

“Never, in the field of human conflict, was so much owed by so many to so few”

So the picture of young RAF fighter pilots pushing themselves to the limit to keep the Luftwaffe (the German air force) at bay in a knife-edge struggle against the odds was a very potent one in those days – and of course, there were many people still alive then who had been part of the battle. The struggle and the bravery of “The Few” seemed to embody what British people felt were “the British virtues”. Perhaps that is still true – though I was interested to find, reading the modern Wiki entry on the Battle, that the historians nowadays debate the version of it that I grew up with.

Anyway, the coverage this Summer reminded me of learning about the Battle of Britain some forty years ago – but also about another context in which I have come across the story being used.

Let me fill in this other context for you.

One of the things you get used to dealing with over the years, if you are a University teacher, is students who feel under pressure. Now, for people of my vintage there is a definite tendency, I think, to see University in hindsight as a right old lark. From the perspective of ten or twenty or thirty years spent earning a living, and dealing with all of life’s other vicissitudes, it is rather difficult to see the University years as a time of stress and pressure. Indeed, I think this view is common among most people looking back at their student years. When I learnt, rather late, to drive, I had a driving instructor who used to describe his one year at University before dropping out as “the best year’s state-sponsored drinking I ever had”. And I had a good laugh at this very funny David Mitchell piece from the Guardian last week.

Now, it is fair to say that things have changed in more recent years. The state in Britain is not sponsoring students nearly as much as it used to, and nothing like it was when I was young. Many of our students now have to have part-time jobs to help with their finances – though this seems to be far less common in “vocational” degrees, like medicine, that have more fixed time commitments during the week. We set a lot more formal assignments for students to do then when I was a student, and we set students exams far more often too. And many of our students are certainly worried about getting a degree results good enough to ensure they will be competitive in the employment market. So it is, I freely admit, not like it was when I was twenty years old.

Having said all of that, the first couple of years at University must still be, I think, one of the least stressful times work-wise in most people’s lives. In most UK Universities and courses, you merely need to pass the 1st year exams. You don’t have to get 80% – or even 60%.  In the 2nd year of UK science degree courses, the exams typically count in part towards the final degree grade (classification), but usually only a bit (often contributing something like 20-25% of the final mark). Meanwhile, in professional degrees, the 2nd year is another “you simply have to pass” deal. Depending on the particular degree, the pass mark for the year (or its component units) will typically vary between around 40 and 55%. There are sometimes “Distinction Points” for those who record the top marks, but mostly it is pass/fail.

Given all this, you would not think students in this part of their University course (the early years) would be that stressed.

Some of them, however, are.  Or they certainly feel, and tell us, that they are.

Medical students are a special example in some ways, partly for the following reason. People who reach medical school are typically those who have been used to being the top, or near the top, of the class throughout their years in the school system. Conversely, they are not used to failing things. But obviously, the step up from school to University is a significant one. And now you are in a group where everyone has been selected as being from the top echelon at school. Anyway, there is a top of the medical school class, and a bottom. And some people do fail medical school exams in the 1st year.

The good news for them is that they get another chance.

Further good news is that, if you are going to fail one set of exams in medical school, the best ones to fail are probably the first lot that you do. Everyone knows there may be an “adjustment”, both for academic or personal reasons, in the transition from school to University. Away from home for the first time, for instance. Busy socialising, for another. Getting used to working without teachers and parents prodding you along for a third. As a result of this, you typically get cut a little slack if you are a student having a few bumps. You have to pass the resit exam, but the initial failure does not get you written off as a no-hoper, or even a problem case.

But some students take any failure very personally. And each year, at least a couple of those that have failed the first Semester exams fetch up in the Faculty offices complaining that they are having problems with stress.

Now, views on how to approach discussing this with students differ. Back in the 1950s, in the era of the Dirk Bogarde Doctor movies, such a student would no doubt be told to “Pull your socks up, work harder and stop talking such utter nonsense.”

We don’t do that any more.

We are sympathetic. Really, we are.

Indeed, we in the University are rather more sympathetic than some in the medical profession itself might be. Hardliners in medicine (which might at times include Mrs Dr Aust, for instance if she has had a bad week in the medical trenches) have been known to offer the view that if a person can’t cope with failing their 1st year medical student exams and having to resit, then they are going to be about as much use as a junior doctor (a job that undoubtedly is stressful) as the proverbial udders on a bull.

So one take on the stressed 1st year student who failed their exams is that they perhaps benefit from being gently reminded that it is a minor setback that they can hopefully address and overcome, regroup and move forward, worse things happen at sea etc etc.

So, sympathy, but also a gentle steer that failing an exam isn’t the end of the world, or really that stressful in the greater scheme of things, and you need to get things in some perspective.

Which brings me back to where I started – with the Battle of Britain.

You will see why in a minute.

At a medical school where I worked, the person who for many years saw the students having “difficulties” (including those who were feeling stressed) was called the Senior Tutor for Students. The occupant of this role was a slightly crusty (but actually very wise) Yorkshireman, honed by many years of teaching gross anatomy whilst also working as a GP in a local health centre. By the time I met him, this chap, who was one of the best medical teachers I have ever come across, was in his 50s and already a legendary figure among generations of undergraduates.

One of his more celebrated routines for talking to 1st year students who were complaining of stress problems went something like the following.


(Fixing student with deep hooded gaze over his glasses)

” Yes… well, How to look at this.”

A pause.

“Consider, if you will, A Battle of Britain fighter pilot in the Summer of 1940, fresh from training school. Solo flying hours on a Spitfire… perhaps a handful. Sleep in the last week… perhaps 20 hours in all. Chance of returning from the next day’s sorties against the German fighters, perhaps two out of three…”

Longer pause.

That (word very slightly emphasised) would be stress, I’m sure we could agree”

Another pause.

“Now…. you are a first year medical student…..”


Which is, I hope you will agree, the stuff of legends. I have certainly met doctors who could still remember, a dozen or more years later, themselves or their friends being on the receiving end of  this spiel.

And finally, with another teaching year at the University about to start, with all its inevitable minor vicissitudes – not to mention the uncertain economic future for the University sector –  I shall be taking my own advice.

I shall be doing my very, very best to keep it all in perspective.