Dr Bethany Norman: Junior Doctor

To celebrate the 20th anniversary of Hull York Medical School (HYMS), Alumni Voices caught up with recent graduate Dr Bethany Norman about her experience and thoughts on studying Medicine and starting her career as a Junior Doctor.

Hull York Medical School (HYMS), which took its first intake of students in 2003, is the joint medical school of the Universities of Hull and York, and home to world-leading research and one of the UK’s most exciting and innovative undergraduate medicine programmes.

“The way that the foundation program works is a two year course;  I’m at York Hospital this year, and then Scarborough Hospital next year, but because I love surfing and like the sea so much I thought I’m just going to do the commute and live in Scarborough for two years.

I grew up in Brough and stayed in the area mainly because of the support network. My friends and family are here. I also really wanted to be somewhere by the sea so what better place than Scarborough? I already know I like the area and I can go surfing around my work hours. 

We had such a nice year group at HYMS.  I took a year out in an intercalated degree and when I came back I remember being really worried that I wouldn’t get on with my new year group but I came back and actually had my rotation in Scarborough. We used to go down to the beach all the time and go surfing. That’s where I realised that this was the area that I wanted to work in. 

I think one of the really good things about HYMS specifically is you really do get hands-on experience on placement from the first year, which a lot of universities don’t do. It’s really useful throughout the course to see patients and relate your learning back to actual cases.

I remember actually diagnosing my first patient as a GP – that was quite a big moment. It was a patient who had come in about a completely unrelated issue. It was only because I had 30 minutes for the appointment, not the standard 10 minutes that GPs usually have.

I was chatting with the patient waiting for the GP to come in and it dawned on me that there was something else that the patient actually wanted to talk about and it ended up being a serious issue that this patient had, which we were then able to diagnose and treat. That was a bit of a milestone when I realised that I had picked up on something and it had a real benefit to the patient. 

I think there’s a lot of patients who have so many problems aside from the actual main issue that they have, that they want to come in with. It takes them a while to say it. That’s just the issue of the NHS in general, you need more time with people.

I’ve always said my top five areas of medicine are Pediatrics, Obstetrics, Gynecology, and Emergency Medicine, Anesthetics and GP. I tried to choose my specialties for the foundation programme to cover as many of those specialties as I could. I think it comes back to the opportunities I’ve had on placement. I really enjoyed my Pediatric, Obstetrics and Emergency Medicine placements at med school.

I think the most challenging thing about being a doctor is when you see unwell patients and there are limited resources available. There’s a lot of delays with how overstretched the NHS is. It’s really challenging to not be able to provide the textbook care for patients and not have everything available to you. If you watch things like Grey’s Anatomy, they always have the top technology and the best medicines available to them and that’s just not what you have on a day to day basis on the wards. It’s difficult sometimes when you feel like you could do more, and you can’t. 

On the flip side, the rewarding part of it is when you actually do treat patients and you can go above and beyond. If you think that actually a treatment might be beneficial when you manage to jump through all the hoops and get that sorted, it actually does make a difference. 

Especially with pediatric patients, there are a lot of sick children generally as children get gastroenteritis and tummy bugs. They come into the hospital and they’re out very quickly. That’s day to day rewarding, seeing patients get better. Whereas obviously you do have the cases that are really challenging to go through but they’re few and far between so the rewards outweigh the bad.

It’s challenging to balance academics, clinical work and personal life but I’m quite an organized person. I always have a diary and write a little post-it note of how my day is going to pan out to make sure that I manage to get the time in for work, for seeing friends and family and surfing. I think being really organized with your time is key. It’s a difficult degree to do but you definitely can balance everything. Doing things that you enjoy, like going surfing or seeing family and friends, makes the time you spend working actually more productive in the end.

I think having a really good support network around you is vital for handling the stress and pressure that come with the job. I could not have done this without my family and friends. My mum and dad have always been so supportive and especially my medic friends who really understand what it’s like to go through. That’s the reason that I decided to stay because for me there was no point moving somewhere new when my whole support network was round here.

“It goes back to the fact that the NHS was never really created to withstand this type of population or these types of treatments that are now available.”

From a personal point of view, I’m already thinking as soon as I finish my foundation program to go abroad for a few years as that’s always been what I wanted to do anyway. I love traveling. I think the issue with high attrition rates of doctors at the minute is the offers abroad are just so much better than in the UK. It seems pointless to stay in a system where you feel like you can’t do everything for your patients because you physically don’t have the resources available. I think for a short amount of time that’s okay but I know consultants that have left the UK for those reasons. You feel like you could do more and if you’re going to get paid better elsewhere, you might as well go elsewhere. 

There’s strikes at the minute to increase pay but I think that we really need to be keeping hold of the doctors that we have rather than making new medical school places. There’s a lot of focus at the minute to have expanded medical schools and training more doctors but that’s no good if we’ve got the high rate of people leaving. Expanding medical schools is great but the process of core training and specialty training programs aren’t available yet so you end up with a large cohort of graduates who actually then can’t get on to the specialty training because there’s not enough places available. There’s bottlenecks with medical school graduates increasing but they haven’t got the options available for training.

I don’t think there’s a simple answer. Even if political parties were to change, it goes back to the fact that the NHS was never really created to withstand this type of population or these types of treatments that are now available.  If you think about all the new novel cancer treatments, operations and joint replacements that we now have. This is why sometimes you feel like you’re not doing the best you can because there are treatments out there but they just cannot be funded by the NHS. There are so many people on waiting lists for these treatments which just wouldn’t have been a thing back in the 60s or 70s. Now they are available, we want to offer them to everyone, but there’s just not the funding available.

“I think a lot of med schools, particularly HYMS, are now trying to widen participation. I think they’re trying to get more people from different backgrounds with different strengths into Medicine”

Another reason for high attrition rates could be that when you decide to do medicine, you’re usually 16 years old. At 16 I knew Medicine was something I was interested in; I never knew if it was something I wanted to do forever. I think it’s difficult to find the answer to what we need to do to retain doctors. If you look at America’s process, they do an undergraduate degree and then a postgraduate degree in Medicine, whereas we go straight into Medicine. Then you end up with high achieving people at school, who maybe have parents who want them to do Medicine or who come from high achieving schools that want them to do Medicine but actually at 16 years old, do you even know if this is what you want to do for the rest of your life? I think maybe that’s contributing towards the attrition. 

People sometimes get to the age of 26 and question, ‘Do I actually even want to do this?’ I think a lot of med schools, particularly HYMS, are now trying to widen participation. I think they’re trying to get more people from different backgrounds with different strengths into Medicine. If you don’t get straight As then you can’t apply and I think that mentality is still there. Now there are the gateway years where you get reduced entry requirements but there’s still that mentality that you need to be incredibly smart to be a doctor and I don’t think that’s true at all. 

I think getting into med school is still very grade based to test your intelligence rather than resilience. The selection process is all focused on intellectual capability, whereas I think it’s resilience that you need as a doctor and the ability to cope with stress, changes in environment and continuous learning. The only measure that people have come up with so far to test those attributes is in a standardised way that’s not subjective and can be objectified in terms of ranking people for interviews by intelligence, which is one factor you need to be a doctor, but it’s not the only thing you need. 

“I think it’s resilience that you need as a doctor and the ability to cope with stress, changes in environment and continuous learning. “

At HYMS we did rotations in Grimsby, Scunthorpe, Hull, Scarborough and York. I think there’s a completely different patient demographic. Particularly if you look at the demographic of patients that come through from the GP surgeries in York as quite an affluent area, compared to the GP practice that I was in in Grimsby, which was a more deprived area. I think it really helps your learning as well because you get to see a wide range of patients. 

One thing I’ve learnt from interacting with many patients is you can never judge a book by its cover, in the sense that you see so many patients day in, day out and you never really know what’s going on in people’s lives. I met a hospital patient back in second year who was a trans woman. She was quite old and she’d transitioned while she was quite young, when it was still very stigmatised; it was not talked about at all and we discussed the struggles that she’d gone through throughout her life. We only saw a snapshot of her in a hospital bed but she had this whole life of stories to tell us; you realise how privileged you are, as a doctor, that you see these people and the way they open up to you. I think it’s important to not only think of patients as patients, but also as fully rounded humans as well. That was a very valuable interaction.

“You realise how privileged you are, as a doctor, that you see these people and the way they open up to you.”

Studying Medicine is difficult and you will question sometimes, like I have, why you’re doing it. I think it’s important to remember why you wanted to do medicine in the first place. There were always patient interactions that reminded me this is actually what I want to do, thinking back to those patient interactions or the people you’ve helped – that is what keeps you going. I always think of how proud 16 year old me would be of me, she would never have thought I’d have got here so remember the growth that you’ve made.”

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