Dr Zeshan Qureshi is a paediatrician based at King’s College in London, with a special interest in Medical Education. Dr Qureshi founded the successful Unofficial Guide to Medicine textbook series, which is regularly among Amazon’s best selling medical textbooks. Imogen Thompson was fortunate to be able to sit down with Dr Qureshi when he visited Sydney as part of a trip to learn more about how medicine is taught outside of the UK. They discussed med school, a life in paeds, the art of getting published and resuscitating zombies, here is the transcript of their chat:
I: What first sparked your interest in medical education?
Z: It’s one of those things, that just seem to just happen. I guess the most powerful stimulus was that when I teach, students are always very receptive and grateful. I remember starting a s a junior doctor, and I felt like – oh I’ve been given overwhelming amounts of work to do. A lot of it was quite mundane, a lot of it was following orders and I didn’t really have ownership or control over any of it. But when I taught, it was something that I could prepare, I could do what I thought is best for students, and it was a very worthwhile experience – literally every time that it happened. And then after that experience, I thought how can I expand teaching further, how can I have more of an impact and create something more positive. And so I went from teaching at the bedside to helping implement teaching programs to helping implement teacher training programs so we reached even more people. And then to writing medical books, which meant that although even more work had to go into preparation, all it took was one click on amazon for people to buy them.
I: So you’re visiting Australia to learn about how medical school is taught here. What have you found to be the biggest differences between the way that medicine is taught in the UK compared to Australia so far?
Z: The biggest difference that’s been most immediately noticeable is the relationship between the students and the faculty. I feel that although there’s hierarchy, it isn’t anywhere near as embedded. I see students asking way more questions in lectures, I see them refer to their professors by their first names, I see teachers in the same bars as students and it’s a very positive relationship, which ultimately can only be a good thing. Another thing that is very obvious compared to the UK, is that there is a much greater culture of advocacy amongst students, a much great culture of organisation and engagement. I’ve seen medical student societies which have 70 plus members with their own legal advisors that are intimately involved in developing curriculum. Not just on the basis of the opinions of a few individuals, but actually gathering organised data from the student body and looking at the long term improvement for the medical school.
The biggest difference that’s been most immediately noticeable is the relationship between the students and the faculty. I feel that although there’s hierarchy, it isn’t anywhere near as embedded.
I: That actually links really well with my next question, our medical school is currently in the process of developing a new curriculum. What aspects of medical education do you see as being the most important for the training of good doctors?
Z: I think it’s difficult to say. The most important thing actually is not what is in the curriculum, but the process by which the curriculum is arrived at. Two groups of people that I think are very important – one is the patients themselves and what they perceive is important, even in paediatrics where we increasingly consult children who are teenagers or even younger about what they want in hospitals and what they want from their doctors. And they say very simple things, like having unisex bays, having a play area, having Wi-Fi access in the hospitals. And you know even just informally speaking to my friends that have had medical experiences as patients, they speak of wanting communication to be better, wanting to be listened to when they have ideas of what needs to be changed. And so yeah, I think patients are a very important group to be listened to. And then the other group is the students. Academics, professors, consultants, they have the learned experience of treating and managing disease. But the student body know their own methods of learning, and their own knowledge gaps. And I think curricula should be as sensitive and responsive to that as possible. Particularly considering it’s the students that pay for their education. So what sort of things does that mean? I really value the use of comedy or drama in medical education. One thing that I saw in a conference in Edinburgh a few months ago, was an alternative way of teaching resuscitation, instead of using standardised scenarios, for example “Stephen gets hit by a car driving 90mph”, fantasy scenarios are used. The scenario was Stephan gets bitten by a zombie and has his blood drained – and it was all run in a SimLab. Everyone had lots of makeup on, and it was made fun and interesting but with all the same principles behind it. And then when the group studied outcomes comparing the zombie apocalypse stimulated scenarios with the standardised ones – students had greater retention of knowledge and more fun when it was associated with the comedy. It’s non-traditional but it’s something that works and is effective.
But the student body know their own methods of learning, and their own knowledge gaps. And I think curricula should be as sensitive and responsive to that as possible.
I: Given that you have a successful book series, undertake research and are a practising clinician, how do you go about maintaining a good life balance considering all of these different demands?
Z: In everything I do, I work in teams and I make sure that I recruit people and work with people that share the same values and the same vision as me. And I found that increasingly as my work grows, more people are aware of it and more people want to do similar things. I think one of the greatest things that I have achieved is creating pathways for people to be successful that wouldn’t have otherwise existed. So for example the last book that I published: “The Unofficial Guide to Medial Research, Audit and Teaching”. I worked with a really bright young student from Oxford University, who I rapidly promoted to chief editor for the book, despite her only being a final year medical student. After months of hard work, it was published before she graduated and she won a “BMA Medical Book of the Year” award. And that all happened because of pathways that wouldn’t have existed without the work of the “Unofficial Guide to Medicine” textbook series. So I find that very valuable – helping other people be the best they can be, giving them opportunities and helping to achieve outcomes that I really believe in at the same time.
I: I think it’s a sign of a good leader as well
Z: And then the second thing is, I put a lot more thought into my personal wellbeing than I used to. I really value and invest in my friends and I know that they’re people I can always talk to when things go wrong. I do simple things, like making sure that I eat three meals a day, I sleep, I exercise, I reflect on things even when they don’t go particularly badly, just so I know that I am being the best version of myself that I can be.
I: Onto your research – what role do you see research as playing in a medical career?
Z: One of the big problems with research to me is that lots of people feel obliged to get involved in research despite it not being important for them in their career.
And there are whole sways of research done that is technically not very good, that crowds the literature and makes it hard to discern what is good and what is bad. And this all stems from a desperate desire to get published.
Because you need to get published to get ahead. In terms of what the true value of what research is in a curriculum, I think the most important thing that people need to know is how to apply research into their clinical practice. How much of the curriculum this requires I don’t think is very much. Particularly as we move away from a very strongly basic science based curriculum, to one that is more integrated and clinical.
I: What has been the most rewarding aspect of your life as a paediatrician?
Z: I remember my first shift as a registrar, I was working in the new born baby unit. I was covering the labour ward and a 33-week mum developed pre-eclampsia and she was being monitored. She then developed eclampsia, she started fitting, and her blood pressure went up to over 200 mmHg. I remember going to theatre because they’d called a category one caesarean section. And then whilst in theatre, I was there with my team of nurses and junior doctor, and then all of the sudden, this lady’s heart stopped pumping – she arrested. Then everything changed, chest compressions were started, mum was given adrenalin (she eventually got 8 rounds of adrenalin) and the baby was carved out of her stomach in about 20 seconds with no anaesthetic. And I was handed a blue, floppy baby, with no signs of life, I thought that they were dead, that they were stillborn. But then with my team we stimulated the baby, we applied basic resuscitation measures to them, and by about 8 minutes the baby had started breathing for itself. We took them across to intensive care, within a week both the mum and the baby had gone home. Mum’s biggest complaint about the baby was that it had the sniffles! And this is the greatest personal thing I get in paediatrics – where you know that there are simple things you can do, that make a really big difference. That baby would have been stillborn in most parts of the world. But what we were able to do as a team, was save that baby’s life so that for all intents and purposes they are going to have a normal life.
I: On the flip-side of that, what do you think has been the greatest challenge of your career so far?
Z: The hardest thing for me has been when things aren’t going well, when I see that things might be able to get done in a better manner. And I raise concerns or ask questions and it doesn’t go anywhere. And that process has always been extremely frustrating. And sometimes me raising the concerns has made things worse, because it’s forced people to become more defensive and maybe even try and silence me because I’m questioning authority. What I’ve learnt as I’ve gotten older and more experienced with healthcare services is that everyone has the same shared vision of wanting to provide extra patient care but you just have to work out the appropriate pathways to voice concerns and to make a change.
So you don’t immediately shout out the first thing that comes into your head when it appears that things aren’t going as they should be.
But you take time to reflect on it, to collect information to objectively quantify the problem. And then go through the pathways that are there already to raise it appropriately so that a proper long term solution can be implemented.
I: You’ve spoken about the importance of mental health and self-care, something that is particularly important to medical students. Do you have any advice regarding this?
Z: I think that the first thing to note is that if you have a problem don’t blame yourself, don’t think it’s a weakness on your part.
In the UK the suicide rates of doctors are double that of the normal population. Depression is rife, anxiety is rife, post-traumatic stress disorder is rife. It’s a problem with the system, rather than you as an individual.
Be honest with yourself as soon as the problem arises, as early as possible. Work out what you can do to genuinely improve things, the day-to-day challenge is preventing mental health problems and the solution is very individual. Simple things like making sure that you eat well, spending time with your friends, and you sleep well are often easier said than done but important to be aware of – in the same way that you are aware of deadlines for essays. Put personal wellbeing in the same league as academic commitments. I’d say also be honest with yourself, really try and think about how things are, the challenges you have on a day to basis and reflect on them. Keeping a diary is a wonderful that you can do. Remember the experiences you have at medical school: they are nothing like what normal human beings do, you could easily have a shift where one or two babies die – and most people never see a baby die in their whole life. And the trauma that comes with that is important to recognise.
I: Just on that note, this is a particularly pertinent issue in the UK at the moment with the changes that have been made to NHS junior doctor contracts. In an ideal world what provisions what you like to see put in place to protect the mental health of junior doctors and create a safe working environment for both staff and patients?
Z: I think that the difficulty in the UK has been that the government are felt to be completely out of touch with junior doctors and the problems on the frontline
One of my colleagues, Professor Clare Gerada, she said that if the NHS was a coal mine, it would have been shut down years ago because of how awful the conditions are, and that’s just the implementation of the NHS.
I think that the job itself needs to give people time to spend with their family and with their loved ones, it needs to give them time to rest between shifts and within shifts so that doctors can be healthy themselves. And then if things do go wrong, the culture has to be one of I want you to speak out, I will support you if you speak out. And there will be something meaningful we can do about it if a problem has been identified. Rather than now, when people feel ashamed to talk about mental health problems, because its seen as a weakness, a weakness that you as a doctor who has learnt about depression should know how to overcome, and should be clever enough to overcome. Mental health doesn’t work that way, and back in London, we have anonymous specialist services for doctors with mental health problems to help deal with this unnecessary dilemma.
I: Do you have any last pieces of advice or words of wisdom for our medical students?
Z: One thing that medical students forget is how special they are. I remember when I started at Southampton, a guy called Professor Norman Carr stood up and said that you are the brightest of the bright, the majority of you are going to sail through medical school, you are going to enter into them top tiers of society and will have a long term fulfilling career, that you will be very proud of. I think that being drowned in assessments, being told what to learn and what to do, can often drain that spirit out of you. But just remember you’ve got another 60 years to contribute to medicine and you can start that contribution as a medical student, right now. With the medical books that I do, I have over 500 students across the world working on various titles, but it doesn’t have to be medical textbooks that is your passion. You can get involved in global health, local community action, you can get involved in education. You have the intelligence to do it. Keep the drive alive that got you to apply to medical school in the first place and do what you want, so that you can be the type of doctor that you want be. You don’t have to wait until you graduate to do this, you can start doing this now.
I: Excellent advice, thank you so much for your time.
More information about the Unofficial Guide to Medicine textbook series can be found at http://unofficialguidetomedicine.com.