The pressure on Junior Doctors

In comparison with the lives of other postgraduate students, the life of a student doctor is far from easy. Despite the heavy workload, it seems that the more you learn, the more you realise what you still need to study, meaning that it becomes increasingly complex and difficult as the course progresses. As a result, it is not unusual for students to drop out. Misguided teachers attempt to simplify matters, but this can then result in incomplete understanding in an environment that demands the very best of its practitioners, and this can cause the situation.

The situation is little better in the year or two years after qualifying. Poorly paid for such long hours, many junior doctors find themselves becoming disillusioned with medicine. The more depressed they become, the more likely they are to look elsewhere for a career, wasting up to seven years of training and education. An unfortunate statistic is that of those that qualify as doctors, 18% do not remain in the profession for more than three years.

The problem can be more clearly defined by considering specific examples. In New Zealand and Britain, for example, the exodus of medical graduates is leaving the remaining newly qualified doctors with responsibilities that are beyond their capacity. In statistics from 1998 over half the graduates from one medical school in New Zealand left the country immediately after qualifying, and hospitals are really beginning to feel the shortage. Certain hospitals in Auckland, for example, do not have enough staff to cover the timetable, and some of the newly qualified doctors are finding themselves on call for 48 hours straight. In Britain, the situation is equally bleak.

The structure of the health service itself is the most important factor to be taken into account when considering the number of migrating British medical graduates. Junior doctors are required to take mentors, more senior doctors (often consultants), to act as supervisors. They are entrusted with the educational supervision of doctors in their first year of practice and are responsible for ensuring the application of the principles of good medical practice. However, when interviewed, slightly less than 60% of junior doctors had any positive feedback on the relationship. The remaining respondents described situations in which a consultant was accused of making unreasonable demands, bullying, being unfair, or being sexist. In more extreme cases, the consultant was portrayed as incompetent, insensitive or negligent towards patients.

A healthy mentoring relationship is likely to provide the mental and moral challenges essential to continuing self-improvement. But such statistics may encourage junior doctors to conclude that role models may not be a dependable way to impart professional values, attitudes and behaviour. Indeed, a survey of just under 200 nearly qualified doctors highlights significant gaps in their knowledge and understanding of basic care. It was found that many junior doctors do not know the signs indicating a patient is critically ill, a third of respondents failed to answer a question on how to deal with someone who was unconscious and none of the trainees identified all of the steps involved in using an oxygen mask.

In New Zealand, the situation, although having essentially the same effect of fewer junior doctors, has different causes. There are two main factors which explain this mass migration of medical graduates from New Zealand. The first factor is the student loans system where a medical graduate can leave university having accumulated a loan of anything up to NZ$60 000 in the course of training. By leaving the country, such graduates have the option of at least delaying the repayment of those loans. The other reason is the long hours. The stories of working hours a week being almost in the three-figure mark are often not exaggerated, and this is a situation which is worsening the fewer junior doctors there are.

In New Zealand, at least, a solution is being sought at a student level. The New Zealand Medical Students Association (NZMSA) is a national body that aims to advance the long-term interests of medical students and act as their advocate on a political level. Composed of students elected from the Otago and Auckland Medical Schools, the NZMSA aims to find a balance between the demands of the profession and the expectations of junior doctors. At a recent conference, the Association concluded that increasing student numbers or attracting overseas doctors is too short term to be successful and the roots of the problem need to be addressed, specifically in the area of student debt. Either way, there is no doubt that a solution is needed and needed quickly, not just in Britain and New Zealand, but in most countries.

Questions 1 – 17

Questions 1 – 11

Do the following statements agree with the views of the writer?

Write

YES if the statement agrees with the writer
NO if the statement does not agree with the writer
NOT GIVEN if the information is not given in the passage.

1. Medical courses are as difficult as any other postgraduate course.
2. For student doctors, the course becomes easier the more you learn.
3. A number of students do not complete the course.
4. Better teachers know how to simplify the course.
5. Once qualified, the situation for junior doctors slightly improves.
6. Junior doctors are poor.
7. Disillusioned doctors often move to another hospital to work.
8. The majority of students had nothing positive to say about their mentors.
9. The root of the problem in New Zealand and Britain is essentially the same.
10. Many junior doctors are unable to repay their student loans.
11. The NZMSA has found a balance between expectation and reality.

Questions 12 – 14

Complete the following text using NO MORE THAN TWO WORDS from the text.

A significant number of graduates from New Zealand and Britain are not remaining in the medical field. Poor relationships with (12) , student loan repayments and increasingly long (13) are all contributory factors. The NZMSA is attempting to find an answer to the problem, but is wary of supporting ideas it perceives to be only (14) solutions

Questions 15 – 17

Answer the following questions using NO MORE THAN TWO WORDS OR A NUMBER.

15. In which year did over 50% of newly qualified doctors from a medical school in New Zealand leave the country?
16. How are members of the NZMSA chosen?
17. Where are two-day shifts not uncommon?

Migration – the incredible journey

Twice a year, certain species of birds make immense journeys, often in excess of ten thousand miles, spending the summer months in a temperate climate and the rest of the year in more tropical climates. This migration is a long journey which many birds do not complete, yet it is an essential part of their natural pattern.

Many reasons can be given for this migration. Some argue that it is a result of some birds being unable to withstand extremes of temperature, especially the cold weather, explaining why many birds migrate to Africa during the European winter. It has also been suggested that this migration is a result of travelling instincts of millennia ago, before the continents drifted apart. As the land mass spread, birds continued to travel the required distance back to the area they knew was a good source of food or protection. The primary cause, however, is considered to be the search for food, particularly for their chicks. Staying in one place, the food sources would become increasingly scarce.

In preparation for their long journey, migratory birds undergo a number of physical and chemical changes. These changes are triggered by the rising or falling daylight and result in a considerable increase in the birds’ appetite (up to 40% more than during other times of the year). This food is stored in fat deposits and in some long-distance migrants, this fat becomes 30-50% of their weight, ready to be released gradually to fuel their journey. In addition, they are also considerably more active at night, influenced by chemical changes preparing them for their long-distance haul. Most birds travel long distances overnight, partly as migratory flight generates considerable heat that needs night-time temperatures to dissipate.

The speed at which migratory birds travel varies depending on species. Some birds can reach speeds of nearly 90 kilometres an hour, while others travel at a more sedate pace. Ducks and geese can fly between 60 and 80 kilometres an hour where herons and hawks travel at less than 40 kilometres an hour. Many smaller birds are capable of travelling at considerably faster speeds for short periods in order to escape predators, but cannot maintain these speeds for the distances required for migration. Another difference between species is that for some, the males migrate first, arriving at the breeding grounds early in order to establish territories before the female arrives to choose a suitable site for a nest.

One of the most impressive aspects of this migration is how birds can maintain a direction. Most migrating birds return to the same nesting areas year after year. Theories to explain precision of travelling such distances without getting lost have considered landmarks on the Earth’s surface, the sun and the stars, even wind direction and an acute sense of smell. Yet these theories do not explain how some birds can travel thousands of miles on windy and wet nights and still arrive in the same area year after year.

Naturally, given the dangers involved, migration is a dangerous journey. Untold thousands of smaller migrants die each year from storms and attacks by predators. Mortality during migratory flight, of course, is one of the several costs that are covered by the increased production of offspring that migrants obtain by nesting in locations where food is more abundant and competition for most resources is lower. Flying at night, lighthouses, tall buildings, monuments, television towers, and other aerial obstructions have been responsible for destruction of migratory birds who simply do not detect the problem before it is too late. There is also the simple matter of exhaustion, particularly for smaller birds with less energy reserves. Birds flying for up to 48 hours straight can run into adverse winds and find the last of their energy depleted before they reach land. Flying lower and lower as fatigue sets in, these birds fall into the sea.

The most recent challenge to migration is, however, man. Slow climatic and environmental changes have always occurred, but not on the grand scale people have been responsible for. Extensive forests have been burned or cut away, and open fields have been claimed for agricultural purposes. Urban expansion has further encroached on the birds’ natural habitats, and pollution, particularly in the form of acid rain, has damaged many of the remaining fields, mountains, lakes and forests. Wetlands that were once home to many species of birds are increasingly drained or filled as land is needed for new housing developments. After overcoming all the trials and risks involved in migration, many birds find that their homes of the year before are now unrecognisable and they are forced to find new grounds on which to breed, often straying into areas defended by larger and aggressively territorial birds.