Strike? - and what about clinical education?

Abstract

As I write this editorial, at this precise moment in time in the UK junior doctors are on strike. This comes shortly after the multiple strike actions of other healthcare professionals within the British National Health System. Strikes were not simply invented for a rainy day sometime in the future. They were born out of a desperate need for change in the face of overwhelming power which sought to maintain the status quo. History is littered with numerous examples in many countries where that power was challenged in such a way, and we need to remind ourselves just how few options to effect change people have in modern societies. There are certainly not many, but strikes are definitely one of them. So where does that leave the education of healthcare professionals? Well, in the case of the current doctors’ strike, the British Medical Association guidance has included advice for students to still attend placement as directed by their medical school [1], whilst reminding those same students how important it is that they don’t work beyond their competence. One would hope that the ultimate goal of such action is to make the world a better place. Most health professionals would certainly want that for the care they provide, and see such strikes as putting patients first. The decision to strike in the face of a caring approach to your work is therefore not a small one and should not be thought of as having been taken lightly by the many thousands of healthcare professionals who have chosen to strike recently. Taking such difficult decisions inevitably causes individuals to question their own personal constructs of professionalism. After all, most of us combine our personal identity with our professional identity to the point where it is difficult sometimes to distinguish between them. I grew up personally and professionally in an era when striking was unconscionable for a doctor. However, that was the same era when it was not uncommon for doctors to work up to 80 hours consecutively without a proper rest, and when non-core hours (over time hours) were paid at a much lower rate of remuneration than core hours. Such things at least have been confined to the history books and the memories of older healthcare professionals such as myself, and that has to be good. And where is education and training in all of this unrest? Following the COVID-19 pandemic, it certainly does feel as if it is one assault after another on healthcare professionals’ education. It appears that education providers are currently maintaining clinical placements for undergraduate learners wherever they can, and whilst educational provision may be in need of modification in the face of the present industrial action it is still taking place, and in some circumstances is actually enriched by the tuition of more senior people temporarily filling the roles vacated by junior colleagues in order to maintain essential services. Education, by its very nature, is resilient and capable of generating exceptional teaching and learning in the most extraordinary circumstances. All it really needs is an enthusiastic, energised learner and a supportive, thoughtful educator. Whenever those two meet in an environment that is conducive to learning something safely then it is almost inevitable that learning of good quality takes place. In return the educator, who is likely to be under additional pressure in the face of industrial action, is reminded of the passion for healthcare that future healthcare professionals possess, and is energised by their positive attitude to learning about our patients and our professions. Therefore, even in the face of the turmoil created by the ongoing industrial disputes, rest assured that we are all still members of outstanding professions with important and inspirational parts to play in our global community. The industrial cycles will come and go but the core tenets of our professionalism and our commitment to service for the communities in which we live will persist.