I suppose there’s no need to explain what’s currently happening in the world and the fact that many of us are concerned and have had to make drastic changes in our lives as precautions. It’s an uncertain time for us all and as tensions run high I hope we remember to stay compassionate and respectful to each other.
Having said that, I need to discuss what my title is all about. I’ve harped on about this many times before, but if there’s anyone who is unaware I am a final year medical student in Melbourne. Life in Australia is currently constantly changing, with new precautions and bans coming into place every day and toilet paper becoming the main currency nationwide. Hospitals have urged non-essential personnel to avoid coming in, which means all students have been stranded with our clinical placements suspended and we are idly twiddling our thumbs at home, unsure of what the future might hold. We are no longer able to complete core elements of our learning and it certainly cannot be easily replaced by remote, online resources. So much of medicine is a service that requires interaction with others and physical practise of skills to improve. For us final years, our future is even more uncertain, as our internship matching process may be heavily disrupted and it could throw everything into chaos.
What does that mean? For generations of Victorian medical students, the final year of the degree consists of much anticipation as everyone applies for jobs, going through months of CV preparation, interviews and submission of hospital preferences. Historically, allocation has been based off merit, which includes your academic scores, interviews and CV. The entire process requires a lot of effort from administrative and clinical staff at all hospitals, as judging cannot be completed without the input of senior doctors and the matching process cannot occur without meticulous organisation. We put in our preferences of hospitals we would like to intern at, and depending on how the hospitals preference us (based upon their evaluation of each individual), hopefully everyone gets a match they are relatively happy with. In this system, you are more likely to get a job at a hospital you want if you can prove yourself to be better aligned with their requirements and values. That is why our exams and assessments matter a bit, because academic abilities are a desirable element of a potential employee.
However, in light of recent events, there is talk of potentially changing to a ballot system. This means eradicating the merit-based allocation process in favour of random selection. It could be completely random, where your name is drawn from a hat and given to another randomly chosen hospital, or based your residential location, or some other method. There is the possibility of still allowing us to put down some preferences, but essentially our grades, CV and interviews may be completely removed from consideration. This is so that clinicians do not need to spend time reviewing applications and can instead focus all of their time and efforts into the pandemic that is currently ravaging the world.
I understand. I know exactly why such a system seems favourable right now, and all the reason and logic that supports such a transition. The current state of affairs is completely unprecedented, and no one could have expected such a thing nor prevented it. There are bigger issues to be worried about and I certainly will be accepting of any changes that will impact me. But since we’re all here like sitting ducks, with nothing else to do, would you all indulge me for a moment and allow me to vent and complain for a little bit? Yes? Cool, thanks!
So, why does it upset me? Firstly, when the news of these possible changes were first made known, many students in my cohort were ecstatic at the prospect of not being judged based on merit. Suddenly, everyone has an equal opportunity to get into a competitive hospital and I suppose it makes everything fairer. This is great, especially for people who never cared where they ended up to begin with, and are happy to uproot and leave everything behind for at least a year. I want to be able to happily embrace this and leap with joy alongside some of my colleagues, but I can’t help but feel a tiny bit cheated. I’ve worked hard these past three years to achieve a score and make an impression that would hopefully allow me to have a greater say in where I worked. My top three preferences are all major hospitals within an hour’s drive from my home, that have always been somewhat competitive to get into. Sure, I don’t have any children or obligations grounding me to a particular place, but my parents are the only family I have in Australia (and I theirs), so I’d rather not be somewhere four hours away if possible. If I had known that all of my studying and efforts to achieve good marks were not going to have a huge impact on my future, maybe I would have been less stressed and treated these past three years a little differently. You may judge me for that, and say I should’ve worked hard to become a good doctor regardless, but understand the road ahead is only going to become more challenging and I would have appreciated a slightly more relaxing start to the journey. I’m not saying I would’ve given up entirely and not cared at all, because anyone who knows me or has read a single blog post of mine knows my perfectionist and high-achieving tendencies. But, I do think I would have treated my social life and mental-health with a little bit more love, and let go of some of the things that were giving me anxiety. So, it sucks a little that all of my efforts to ensure things go to plan may have been in vain.
On that note, I’d like to mention something related that irked me. Some of my colleagues have condemned the current merit system and called it a “privilege system.” And that is an exact quote. They believe evaluation based upon academic scores only rewards privileged individuals. They argued that anyone who has a child to care for fundamentally works harder than a student who doesn’t, anyone who has to live alone and take care of themselves works harder than a student who lives with their parents and etc. That examination scores only reflect people who have the luxury of no other obligations aside from studying. Essentially, if you are going to be recognised by the merit system as a desirable employee, it is wrong and you better check your privilege at the door. Look, I am empathetic of my colleagues whose complex lives are often unrecognised by standardised assessments, and I admit I sometimes feel guilty because I am that childless and “carefree” student who lives with her parents. I understand the need for special considerations and I feel for them, having to juggle a full-time postgraduate course alongside other important aspects of their lives. I will support changing the merit system in some form or another to achieve greater equality and I can see why they are pleased with the current implications for a ballot system.
But to have my merit reduced to privilege and be told that all of my hard work is unjustified, hurts. To be degraded to an unworthy recipient of my achievements and to have my efforts dismissed as frivolous is insulting. I can see where the frustration comes from and there’s certainly some justification in what they said, but somehow I can’t seem to agree with them. Perhaps it’s the way things were implied and the antagonistic tone of the statements, but it made me feel as if I had to defend myself and that’s just not right. We’ve all worked hard in our own ways and dragging others down is not how you should be validating yourself. All university courses, high school examinations, every method of assessment that exists in the world is designed to stratify individuals based on a scoring system. They are never going to be completely fair and there’s always going to be people who feel as if they have been neglected. Whilst constructive criticism on how such systems can be improved is welcome, I do not condone attacking your peers who function within the same system as you. We are all doing our best.
And if you are going to be talking about privilege, think about the privilege of being able to go where-ever you want, no strings attached. We don’t know how the ballot system works, but if they opt for a completely random allocation of students, many will have to make huge changes to their lives to accomodate it. The same people with families and children may find it difficult having to move houses within the span of a few months. I wouldn’t necessarily jump to conclusions and scream with enthusiasm for removing our current system, which has been in place for decades and isn’t necessarily undergoing review for being, “broken,” but rather due to exceptional circumstances.
At the end of the day, there is nothing I can do if such changes go ahead and I can take consolation in that we are all in it together. And I know in the grand scheme of things one year of internship at a hospital is not going to change my life drastically. But it doesn’t mean I can’t be a little disappointed. This may have all sounded incredibly entitled and trivial considering there are people facing much worse hardships during these times, but everyone’s concerns should always be validated and no one should ever feel uncomfortable sharing their worries due to fears it cannot compare to others. I don’t expect you to agree with what I’ve said, but I’d like to be respected and understood. I hope everyone is staying safe and looking after themselves during these difficult times, and I wish you all the best.