Aliens ate my mojo: First-year horrors

Is it better if you’re a graduate before you start? Is the first-year health sciences course harder than the old “medical intermediate”? Zahra Shahtahmasebi looks at how our two universities prep wannabe doctors for the years of study ahead

The competitive nature gets to everyone at some point…it takes its toll

Auckland GP Garsing Wong was shocked to dis­cover what his eldest son was getting up to at university.

But probably not for the reasons that you’re thinking.

Borson Wong had swapped the comfort of his Auckland family home for Dunedin hostel life, to take the University of Otago’s health sciences first-year course.

With seven compulsory papers covering a range of basic sciences, the year acts as the prerequisite for many health professional courses, including medicine and dentistry.

Gruelling is just one way you might describe it. Intense is another.

Dr Wong knew this, but was still surprised to see the level of work Borson faced, compared with the medical studies of 30-plus years ago.

“My general impression is that you need to know so much to just get in now,” says Dr Wong.

“You’re in your classes from 8am to 5pm, there’s lots of homework, three to four hours of study a night, and so much reading.”

Dr Wong might think it has got harder, but the universi­ty’s director of that first-year course, John Reynolds, says exactly the opposite.

“In the last 15 to 30 years, we’ve seen advances in bio­medicine, we have the students sitting in front of active researchers who are keeping the content up to date,” Pro­fessor Reynolds says. He admits, however, there might be a bit too much content.

In recent times, efforts have been made to scale down the scientific content and include more about the humanities and Māori and Pasifika culture, he says. The overall contact time for students has also been reduced.

I took the course in 2015, with the aim of becoming a doctor. At least eight people in my residential hall left for mental health reasons, seemingly triggered by the course.

I tell GP Kim Escott what the course was like for me – four papers a semester with back-to-back lectures, labs, weekly tests and assignments, hours and hours of readings and tu­torials, all the while being intensely aware of the problems of my fellow students.

Dr Escott had followed the same path 10 years earlier via the alternative category (see panel, opposite page) and felt her year was much easier. She says the course now sounds as if it’s at medical school level.

Students say the course is demanding and the compe­tition, fierce. Up to 1500 students pit themselves against one another, knowing there are just 282 med school places and, of these, 197 will go to the health sciences first-year students.

The university hall life seems to amp up stress and anxiety.

Says Borson: “The competitive nature gets to everyone at some point…it takes its toll.

“It’ll always be there, no matter how much you try and reduce the content or make it easier. There’s such a range of people, the bar is a little higher. You might have been top of your school, but here that’s very normal, everyone is like that.”

At Borson’s hall, it seems everyone is studying 24/7. Staff have had to enforce 11pm closures of the hall library as stu­dents were working there into the early hours.

It’s a great work ethic, but it’s not healthy, Borson says.

“I still like having a life, it’s all about balance. I experience a great time, but you also have to know when to knuckle down. You have to make some compromises.”

There’s also the constant discussions about course con­tent, tests and grades, which Borson tries his best to avoid. He has heard people boasting about how easy they found a test, or asking others about their grades.

This prompts feelings of guilt and inadequacy in some students; many stress over little errors.

And, while the need to achieve high marks hovers over them, students never know what grade will cut the mustard.

University of Otago associate dean of medical admissions Brian Hyland says people believe you need to be a rocket scientist to get into medicine, but the minimum academic requirement is a B in each of the seven papers.

However, because the course is so oversubscribed, the uni­versity must rank medical school applicants based on their grades. To get in requires a very high grade point average.

“All we can tell them is to do the very best you can,” Pro­fessor Hyland says.

All the compulsory papers are laden with content, and students don’t have the time, nor are they given the chance, to process the infor­mation they learn in a logical way

Sometimes that is not enough.

Shuvayon Mukherjee, who took the course in 2013, failed at his first attempt. Shuvayon had no idea what the course or university would be like.

“I rated myself, I thought I would get in,” he says. “But there were just so many smart people. I started to think, perhaps I’m not as smart as I thought I was.”

He was achieving about an A-grade average in the first semester, but friends got 99 per cent in their exams, so he could see his chances reducing.

He remembers being stressed “all the time”. “It’s not the lowest I’ve been, but I think I was so busy there was just no time to stop and think, Oh, I’m hurting, and depressed.”

Shuvayon says he remained nonchalant – he has always been that way.

“I never really felt the competitive edge. I had a good sup­port base of friends and was quite self-contained…there was definitely an undercurrent of competition but there was no sabotage or anything like that,” he says.

However, for others, the panic was real. “It was undenia­ble, so many people crack under the pressure.”

When a philosophical Shuvayon returned to his hall of residence as a second-year Bachelor of Science student, with several friends who were medical students, he planned to apply again for med school as a graduate in two years’ time.

Meeting new people, he sensed disdain when he disclosed what he was now studying.

He had many awkward and plainly insulting moments, basically being told that anything less than medicine was worthless.

This is damaging, he says. The battle for a place in medical school becomes more about prestige and respect.

He says one of the reasons he wanted to persist and try again as a graduate was “to prove to myself that I could do it”.

Shuvayon applied again at the end of his degree, got into medicine at the University of Auckland and is now in his fifth year.

The competitive edge isn’t as sharp now, but it never goes away, he says. The competition becomes evident again when discussing which specialty to choose.

Fifth-year medical student Dougal Hilson says it was under­stood that medical students are the “cool kids”.

“If you even mentioned you were thinking of studying something else, it was like sacrilege…but it’s healthy to ques­tion ourselves. If you’re suppressing feelings like that, it can only lead to trouble down the track.”

Dougal got into medicine in 2015. He says it takes self-be­lief, “otherwise you’d probably struggle to stay motivated”.

“You have to cram all year,” he says. “It’s not sustaina­ble. You’re rote learning, and coming up with silly ways to remember facts, like the reference ranges for chloride ions.” Facts that end up with minimal or no clinical rele­vance in medical school.

The stress of that first year crept up on him. “I started to lose sleep and spend more and more time studying, sacri­ficing more and more things, without ever seeming to go back to normal.

“You’re having trouble with anxiety, but you play it off as not being a problem because so many people around you have anxiety issues – it seems normal.”

Looking back on his journey, though, Dougal says he would do it all again. “Having got in, it seems worth it, but I guess I’m biased in that respect,” he says.

Priyam Varma is also a fifth-year medical student. Pri­yam did a biomedical science degree at the University of Auckland.

She says her experience was “insane”.

“I guess it’s what you make of it…Some people got in [to med school] while still socialising but, for me, I was stud­ying every day.”

Priyam would attend all of her lectures and labs, then go home to study for the rest of the day.

She lived with her parents. “I would’ve been quite distract­ed in a hall…At home, there was only me to focus on, no one else around was going for medicine. Living with people all doing the same thing would have been hard.”

Her social life was non-existent and essentially, she did nothing except study.

“While there were people from school doing the same course, I would go to lectures by myself then go straight home,” she says. “I was not there to make friends.”

Mind games played a significant role: “You kept feeling guilty that you weren’t doing enough, and then someone would know something you didn’t. But the truth is, you prob­ably knew things they didn’t, but you just couldn’t see that.”

And that’s when the panic would set in, as students strug­gled to learn every fact, even if it meant an inefficient use of study time.

Dr Wong says the course is simply too much. No one tells you that you don’t have to know absolutely everything, he points out.

And the time pressure is “the biggest killjoy and stressor”.

All the compulsory papers are laden with content, and students don’t have the time, nor are they given the chance, to process the information they learn in a logical way, he says.

It is 1975 at the University of Otago, health sciences first year doesn’t yet exist, and there is a “medical intermedi­ate” year.

When Professor Hyland embarked on that year, stu­dents took biology, chemistry, maths and physics. “Literal­ly everything hinged off one exam, at the end of the year.”

The course was oversubscribed even then, with anywhere from 400 to 600 students chasing 170 places.

From 1979 to 1993, preferential entry to medical school was given to some students who applied in their final year of high school. They were required to achieve a certain stand­ard of grades in their first tertiary year in order to continue.

By 1993, the health sciences first year was offered in its current form.

Dr Wong got into medical school at the University of Auckland in 1983, straight from school on a “direct entry” scholarship, which required excellent marks. There was no sense of a “dog-eat-dog environment”, he says.

“Staying in a hostel...we collaborated more, there was no internal competition, it gave a real collegial sense.” People sought to understand the content rather than gun for top marks.

Camaraderie extended to the students who had gained preferential entry, Dr Wong says. He recalls helping them

out, thereby reinforcing his own knowledge. “Essentially, that’s what medicine is all about,” he says.

Direct entry was dropped at Auck­land in 2000, when the biomedical sci­ence or health sciences approach was adopted.

Faculty of Medical and Health Sciences dean John Fraser says direct entry might sound appealing, as it re­moves the stress and fierce competi­tion, but it isn’t ideal.

“How prepared or unprepared you are for university depends on your school,” Professor Fraser says. “If you come from a low-decile school, the chances are you’ll be disadvantaged.”

Admissions these days are a level playing field, as much as possible, he says. Students have the opportunity to compete to the exact same standards across the year.

Both professors Fraser and Reyn­olds say their programmes produce graduates across a range of disciplines from medicine to zoology. But Profes­sor Fraser admits he is not proud of the stressful nature of the pre-medi­cine courses.

Professor Reynolds points out any course with such a gross mismatch of applicants to spaces will inevitably produce a self-imposed intensity.

When it comes to mental health, it’s the universities’ job to make sure they’re staying ahead of the crest of the wave, he says.

“We’re definitely more aware of it, and there are lots of services in place to address this. It’s our job to instil aware­ness and make sure students don’t isolate themselves…and know there’s more to life than studying.”

University of Otago Student Health acting director Mar­garet Perley says the service acknowledges tertiary study can be stressful and challenging, across a variety of disciplines. Students are specifically encouraged to develop healthy hab­its, especially with sleeping, eating and exercising.

“We work in partnership with other university depart­ments to support students in understanding and developing skills to maintain their wellbeing,” Ms Perley says.

Professor Fraser says programmes in some countries se­lect students by random ballot, but this could reduce the in­tellectual calibre. Intellectual capability is required, he says.

An argument could be made to make all admissions grad­uate entry, as in the US. Professor Hyland says many Aus­tralian universities are going this way.

Students and academics agree graduate students seem to be more balanced and well rounded. They have had time to be certain they want to study medicine.

Shuvayon, who had to move to a new city and leave his friends behind when he was accepted as a postgraduate stu­dent, thinks he would do it that way again.

Not only is he more mature now, but he much preferred having to work consistently over three years, rather than cramming it all into one high-intensity, pressure-cooker year.

“It was like running a marathon rather than a sprint,” he says. “You had more room to breathe.”

Auckland-based pain medicine specialist Giresh Kanji suggests a move towards postgraduate entry-only to med­ical schools in New Zealand.

Dr Kanji says these students are serious about medicine and more likely to follow through.

Courses such as health sciences first year are breaking young people, and contributing to high rates of mental health issues, he says.

“According to latest studies, the depression rate for med­ical students is 30 per cent in New Zealand and the US…a higher rate than the general population.”

Along with the prestige associated with medicine, job and financial security are other major drivers of the intense pop­ularity of courses such as health sciences.

Dr Kanji questions whether the current system produc­es the best doctors. He says the most important qualities are compassion, a strong work ethic and professionalism.

Once specialised in a field, a medical professional does the same thing day in, day out, says Dr Kanji.

“So how intelligent do you have to be for that? It’s more about pattern recognition…so you could argue selection from intelligence is irrelevant.”

Further, he wants exams abolished.

“They hold no place in society: you’re never going to be asked to sit for three hours and complete a test.”

While deadlines are imposed in the workplace, Dr Kanji says people often get adequate time to complete their tasks.

“There should be more focus on assessments during the year, where students are able to reflect and understand the content.”

Stiff competition for medical school entry

The University of Otago approach:

Students must achieve excellence in a seven-paper health sciences first-year course, and are ranked on their marks.

The course starts with physics, chemistry, cellular biology and an anatomy paper or a paper on human body systems (musculoskeletal, nervous, endocrine and immune).

In semester two, students focus on cardiovascular, respiratory, gastrointestinal and reproductive systems. They also take a biochemistry and a population health paper.

When applying for medical school, only the seven papers with the highest grade are included. Students can take an optional eighth paper, which could also be included if they excel in it. These can be in statistics, nutrition, Māori culture, music or psychology.

About 70 per cent of those selected for medical school will have taken the course, while about 30 per cent will have a degree, obtained within the past three years.

An “alternative” category is offered for mature students, where it has been longer than three years since they completed a degree, or they have some life experience in an allied health professional role.

At the University of Auckland:

Students choose between a Bachelor of Science in biomedicine, which includes biochemistry, chemistry and physics papers, and a Bachelor of Health Sciences based on population health.

• Students apply for medical school during their first year and, if successful, move to the med school programme the following year.
• About 70 per cent of medical school entrants will gain entry this way.
• About 30 per cent will have another degree, obtained within the past three years.

You what? You-cat?

The University Clinical Aptitude Test (UCAT) is required for medical school applicants at both Auckland and Otago universities.

This is a two-hour, computer-based exam offering situational questions specific to clinical professions.

At Auckland, students also face an interview. For Auckland students, their grade point average is worth 60 per cent, the interview is worth 25 per cent and the UCAT, 15 per cent.

For Otago students, the grade point average makes up 70 per cent of their admission application, and UCAT, 30 per cent.

The University of Otago approach:

Students must achieve excellence in a seven-paper health sciences first-year course, and are ranked on their marks.

The course starts with physics, chemistry, cellular biology and an anatomy paper or a paper on human body systems (musculoskeletal, nervous, endocrine and immune).

In semester two, students focus on cardiovascular, respiratory, gastrointestinal and reproductive systems. They also take a biochemistry and a population health paper.

When applying for medical school, only the seven papers with the highest grade are included. Students can take an optional eighth paper, which could also be included if they excel in it. These can be in statistics, nutrition, Māori culture, music or psychology.

About 70 per cent of those selected for medical school will have taken the course, while about 30 per cent will have a degree, obtained within the past three years.

An “alternative” category is offered for mature students, where it has been longer than three years since they completed a degree, or they have some life experience in an allied health professional role.