Scott Fraser: Work experience

After a hard morning interviewing enthusiastic young people who wanted to get into medical school I went for a coffee. These days this is a highly complicated business. Did I want a latte or a cappuccino, mocha or skinny, to go or with a shot, without chocolate, or with a small umbrella? I chose an appropriate coffee for someone of my age and obvious dignity (i.e. I didn’t use the word “skinny” or “to go”) and shortly afterwards was served what turned out to be a pretty perfect cappuccino. I was mildly surprised that it was so good as the coffee shop was noisy and crowded and it was difficult to make myself heard. Further, the barista appeared to be aged about 12 and not listening to me. In fact he had listened and had heard (or read my lips) above the din and presented me with a warm, extremely well formed cappuccino some 3 or 4 minutes after I had ordered.

As I drank I watched these young people working efficiently and politely in a cauldron of noise amid a steam of impatient customers. Their ability to take instructions, assimilate information, and retain a high level of customer communication at the same time as performing a complex physical task was impressive to witness. You will of course see the obvious parallel that struck me. I had interviewed a group of highly intelligent, highly motivated, and highly articulate young people in an attempt to decide who would make good doctors (and to try to weed out those who might be too fragile for the rigors of a medical career). You will also of course know that it has long been a subject of debate whether A levels, a personal statement from the candidate, and a few appropriate words from a headmaster are the best way to decide if someone is suitable for medical training.

Even with the addition of the UKCAT can we really make a judgement in 20 to 30 minutes on someone’s suitability for one of the most demanding jobs there is? Of course not. All we can really do is to try to use as many methods of deciding as is possible within the constraints of time and money.

Since my coffee I now have a different method to suggest. Potential medical students “offer” themselves to coffee houses or chains for a week of unpaid work (sorry students, you had better get used to working for free—that is essentially what you will be doing for large parts of your training). In return they would be fully trained in taking orders, making the coffee, and serving it to the customer (they can opt out of taking the money directly if they wish—depending on their future specialty ambitions). They should not be protected from difficult or demanding customers, nor from any customer complaints. Ideally they will work long days, arriving as the shop opens and leaving as it closes, and will work through the busiest time of the day (preferably with at least one other member of staff being off sick). If at all possible at least one of their trainers should mutter that coffee making was much harder in their early days.

At the end of the week they will have an assessment from a large selection of customers, all their fellow members of staff, and their line manager. These assessments (graded—excellent, good, satisfactory, and unsatisfactory) will cover overall performance, courtesy, practical skills, customer care, and progression through the week. Numbers of customer complaints will be recorded, as well as plaudits (e.g. amount of tips), and a 360 degree feedback from colleagues. I am thinking that the total score could be added in a new box on the UCAS form. Perhaps call it the UKCAF score?

Although the preceding may seem flippant there is a serious point. Medical care is increasingly defined by customer satisfaction and choice. Whereas in past decades the doctor would be judged by his or her outcomes—do his patients survive their operations? Does he send you to hospital when you need it? Nowadays being good at the technical aspects of medicine is not enough and patients increasingly care how you speak to them or how much information you give them. It is therefore important for doctors not only to perform practical skills competently, but also to be able to do them rapidly enough not to keep patients waiting, and to communicate appropriately as they go along. What patients want and how they judge the results of their wants are obviously more important than a cup of coffee but perhaps the skills needed for each have some overlap in judging technical and personal performance under pressure.

Perhaps best of all it might tell the sensitive souls who are determined to be doctors that they might want to think again before they are caught up in the rapids of medical school and postgraduate training.

Finally it might be worth pointing out to politicians that, as I found out, a good cup of coffee is surprisingly expensive but that many people are willing to pay the price for a well made drink served in agreeable surroundings by well trained and polite people.

Scott Fraser is a Consultant ophthalmologist at Sunderland Eye Infirmary. He is visiting professor at the University of Sunderland and adjunct professor at the University of New England.