We need to reform the UK’s archaic clinical work experience system

The unstructured nature of work experience for pre-med students is inefficient for students, medical personnel, and administrators alike, writes Finn Lavington

Clinical work experience is one of the more impractical idiosyncrasies of the British medical school system. Defined by the Medical Schools Council as a “direct observation of healthcare,” work experience is seen as a key, if not essential, part of a successful application to study medicine. More importantly, getting even the slightest glimpse of what the day-to-day life of a medic looks like is vital to any A level student (like me) who is hoping to embark on the long journey to qualifying as a doctor. 

Shadowing a doctor or nurse primarily allows us to answer practical questions, such as whether we can stomach the sight of blood or whether we would like to work in a healthcare environment. Most of all, this process allows us to explore the areas of medicine that interest us in a clinical setting and helps inspire us through the inevitable long nights spent revising for exams and preparing for interviews. After all, we understand very little about the realities of working in medicine apart from what we have read in idealised books and watched in dramatised TV shows. Unfortunately, as a result of the pandemic, there will likely be a generation of medical students starting university who have only visited hospitals a handful of times and have very little idea of what being a doctor actually entails. 

For me, like many medicine hopefuls, September last year—the start of the academic year—was a shock to the system. Having spent the summer in a relatively lazy, exam-less daze, I arrived at school and found that similarly inclined friends were already talking about clinical work experience. In my ever competitive spirit, I deemed it essential to get a headstart on them. Through reading several websites promising to reveal the most effective ways to find work experience, I learnt of the dog-eat-dog nature of these placements. Simple maths will tell you that some 29 000 students applying for medicine at UK universities (28 690 students applied in 2020 according to UCAS, with more expected to apply this year) cannot all cram into hospitals and GP practices to shadow doctors and nurses.      

So I began my search, scouring NHS hospital websites for placements that weren’t tagged with the ominous line “not able to offer work experience at this time,” naively hoping that I might be able to just squeeze in. Eventually, I found the application page for the work experience programme at a large London hospital. I wrote and redrafted my application, knowing that if the programme was running this might be my only hope of getting any clinical work experience. After a few months of waiting, I checked back on the trust’s website and saw it now said they couldn’t offer work experience. 

Of course, I understand their reasoning. The pandemic has put hospitals and GP surgeries throughout the country under severe strain, and work experience for pre-med students is not a priority. But I think my experience of the NHS clinical work experience programmes during covid-19 is representative of wider endemic problems within the system. Even under normal circumstances, its unstructured and casual nature is inefficient for students, medical personnel, and administrators alike and largely relies on the goodwill of already overstretched doctors and nurses. 

When the few organised shadowing programmes in hospitals and GP practices are full, students are advised to reach out to family and friends who are healthcare professionals for work experience. This represents a considerable inconvenience for doctors and nurses who feel obliged to take time out of their busy day, both to fill out the numerous forms needed to organise these placements and to continuously supervise their students while they carry out their work experience. 

What is more troubling, however, is that this “family and friends” arrangement, caused by a lack of structure in the work experience system, is very likely a contributing factor to the low rates of social mobility seen in the medical profession. After all, if you come from a wealthy socioeconomic background, you have a much greater chance of knowing healthcare professionals than those who come from a less privileged background. 

As with all major crises, the covid-19 pandemic will undoubtedly be a catalyst for change in the UK healthcare system. And although the vagaries of the work experience system for pre-medical school students may seem unimportant in comparison to larger NHS reforms, I’d argue that it too should be added to the list of areas needing change. A more structured, efficient system would allow hospitals and GP surgeries to accommodate a greater number of students while reducing the burden on healthcare professionals of organising individual placements. Crucially, this extra capacity could also help to attract a greater number of students from different socioeconomic groups and increase social mobility—all to the benefit of the NHS and its patients. 

Pre-med students can often be overlooked, but given that they represent the future of our healthcare service, we should keep the door firmly open for them.

Finn Lavington is a year 13 student at St Paul’s School London applying for medicine at university.

Competing interests: none declared.