For the new medical student, admission into medical college marks the culmination of years of study and effort, and the beginning of a new era in his life. He is on course to becoming a doctor. There is enthusiasm as well as expectation. There are dreams which await fulfilment.

But this excitement does not last long, as he starts experiencing challenges and stresses that he had not foreseen. These problems can be listed under two broad categories – scholastic and personal. Scholastic problems include the sudden transition from the study pattern of 10+2 and CET, to the vast and complex one of the MBBS; the fear of failing for the first time; and the pressure to secure a post-graduate seat. Personal and interpersonal issues include adapting to hostel life, the trauma of studying in a language in which one is not fluent; and peer pressure and groupism based on class, regional, or scholastic differences.

My observations as a student

As an undergraduate, I have observed that the nature of these challenges and tensions varies as the student goes through the different years of his education.

The first year is generally spent in becoming acclimatised to the new environment. Most of the students get to know each other in the course of the year and segregate themselves into groups, mainly based on regions. Interpersonal conflicts are minimal, but personal, linguistic and scholastic difficulties are dominant.

In the second year there is a lighter syllabus and relatively more time, opening up opportunities for various extracurricular activities. However, group dynamics are at their peak, with each group trying to dominate the others, and this adds to existing stressors. Lack of confidence, inadequate communication skills and insufficient orientation towards procedures and practices all deter students from going to the wards.

In the third year, the additional stress is that of scholastic performance, even as economic stress may become prominent for some.

Senior students can provide appropriate guidance to junior students. However, seniors invariably end up transferring their prejudices and tensions to the juniors, and these only get more acute over the years.

As students learn to cope with these tensions, and manage academics, they are left with hardly any time or inclination to spare a thought for the hardships of others. When passing an exam and scoring is the chief aim, the patient is bound to get relegated to being “just a case”. The habits formed during these undergraduate years continue into residency and become the guiding principles of practice thereafter. One can expect students to be sensitive to their patient only when they are at ease with themselves.

Suggestions for reform

The roots of most of these stresses can be traced back to the lack of dialogue between students during the first year. Dialogue alone can help sensitise students towards each other, clear many prejudices and prevent the snowballing of stress. Some of the following programmes could help achieve these changes:

• Basic training programmes in English and regional languages.
• Workshops on coping skills
• Random allocation of students to small groups for various activities.
• Introduction of compulsory reading hours in the first year, ensuring that every student reads a specified amount of regional and English texts, followed by group discussions.
• Promoting regular performances of small skits and plays depicting local customs and traditions to improve general knowledge.
• Proper orientation in the principles of epidemiology and ward practices before the commencement of clinical postings.
• Workshops and simulations on communication skills and patient management.

Once we have a class of students who have experienced such programmes, they can be a positive influence on their juniors.

Conclusion

These programmes and activities must be introduced in the first year, building up to advanced training in the later years. Whether we name these programmes “medical humanities” or something else, they need to be relevant and useful to the student, helping him address the problems which he faces every day, during his undergraduate years. Only then will he develop an interest in the medical humanities. And only then will he be in a frame of mind to learn to be a good doctor.