“Where the love of man is, there also is the love of healing” reads the plaque on the front of the University of Otago School of Medicine Hercus Building. The stately School of Medicine buildings resonate authority, over a hundred years old, and flank the hospital where medical students and graduates will learn the finer points of their craft. This, to many a freshly arrived Health Science student, seems a distant, yet all-consuming, dream. Treating one of the patients being rolled outside the hospital on vinyl wheelchairs is a foreign concept, but it could be in their future. However, a single intensive year of study must first be excelled in, if that goal is to become reality. They have little time to ruminate on the suitcases unpacked just yesterday and the strange new city they now call home. The rigours of the Health Science course mean that, for some, a pensive walk through the medical campus might be considered a waste of a precious hour of study, the one that might tip them over the finish line into medicine.
“I still remember it pretty vividly,” Fiona Sutherland says of the intense days demanded by the Health Science course, "Chemistry lecture at eight AM. From eight to nine I would write up the lecture, then I would go straight from St David, [and] power walk back to my hall. I’d go to my room, write up the notes, and make sure I understood them. I remember I had Cells at 11, and then I would come home, write up my Cells lecture as quickly as I could, then have lunch, then go to my lab. I had labs most afternoons at two. The lab would go till five, then a HUBS lecture, and then I’d have dinner. Basically I wouldn’t let a day go past until I’d written up all my lectures.” This routine secured Fiona the grades to be offered a place in Medicine after Health Science. However, in spite of the buzz surrounding Medicine, she decided that the career path wasn’t for her. “A lot of people would ask me, why would you turn that down? They kind of stuck to their idea that Medicine was the ultimate goal and the best career that you could go into.”
Fiona is now a Chemistry PHD student, and she has several years of demonstrating labs for the compulsory first semester Health Science paper CHEM191, as well as tutoring students privately, under her belt. In 2016, 2057 students, including 1503 studying Health Science, took this paper and of the Health Science First Year (HSFY) students approximately 20% failed. “They drop out pretty quick,” Fiona says of the students in CHEM191, “They each pay a thousand bucks for the paper. Then they put money into the university via the textbook, lab coats … and then there’s tutoring.” The Health Science course consists of a year with seven compulsory papers. At the end of the year, providing they have sat the generally applicable health professional skills test, UMAT, students can apply for a place in the professional courses. There are approximately 210 undergraduate places in Medicine and around 750 HSFY students apply for them yearly.
The 2017 prospectus states no entry requirements for the Health Science course. Commenting on prior knowledge students may need from high school, it reads “CHEM191 and PHSI191 are challenging papers for those who have not studied Chemistry or Physics at NCEA Level 3. Otago provides a distance-taught introductory Chemistry and Summer School paper CHEM150 and Jump Start Physics courses”. The Health Science department puts the high failure rate in these papers down to students not having done Chemistry or Physics at NCEA Level 3 or the applicable bridging course. However, they feel that limiting the entry would restrict the diversity, both academic and social, of students able to participate. After her tutoring positions, Fiona has a unique perspective on exactly how the course affects its students. "It moves so fast, I’m trying to teach people who have never done it before, and they are still trying to grasp the concept of what an atom is. I’m trying to explain to them the basics that aren’t even in the course because it’s assumed that you know them. At the same time they are going to lectures of stuff they don’t understand. When I’m tutoring them, the more I teach them about the basic stuff, the further they realise they have to go to catch up. I can feel in their mind, they're like ‘shit, I have so much stuff to do’. This could be all avoided if they did the bridging course. I could feel the stress in my first year, but I didn’t realise how hard it was for people that weren’t prepared. It’s not just about getting money from people. It’s actually harmful letting people into this programme if they aren’t ready."
Panic is not isolated to students who come into the course without prior knowledge of chemistry or physics. Health Science students are as renowned for their stress as freshers are for their flu. A 2011 study conducted at the University of Otago by Jameson and Smith interviewed a number of past and present Otago Health Science students and reported that many found the course workload, and its unrelenting examinations, stressful and demanding. The study said of the students, "they claimed that the number of exams in close succession left little time to socialise. HSFY took all of their time. Students also felt intimidated by the large number of students enrolled in the programme which lowers the probability of them getting into the programme of their choice.”
“In Health Science me and my friends always joked ‘we’re killing ourselves to save other people’,” laughs former Health Science student Rachel, “I think everyone starts off wanting to do med.” Rachel had always had her heart set on Medicine, and felt that she was prepared for the formidable first year. "I was from a high school that was very academic and I did all the pre-sciences. I had the basis." Rachel, like many first years, went to a residential hall where the majority of students were taking Health Science. “There was a kind of vibe where everyone was stressed out, but we were laughing at how stressed we were ... The stress really broke me. I went in demanding perfection. If people are going to aim for 100%, I’m going to aim for 110%. And after first semester, I got a grade point that was - I just knew I wasn’t good enough for med. So I crashed.” Near the end of the year, Rachel was diagnosed with major depression and anxiety. "The entire second semester - I didn’t even leave my hall most of the time. I just stayed in bed. It was tough.” Rachel says she was “too far gone” to even gather a sense of what was happening to her. “I was just crashing. You lose a sense of self. You are the study machine. There is no you. There is study and that’s it. So it’s like I wasn’t even able to be aware that I was depressed, because I was that depressed.”
Eventually one of Rachel’s friends realised something was wrong and encouraged her to seek help. She received counselling and talked to the Health Science department, who she says are used to dealing with students who are “crashing and dying”. This helped her see that Medicine was not the be-all end-all. Rachel feels that the mindset that led her to her troubles was not an unusual one amongst students, although mental health problems were rarely a topic of discussion. "I feel like at my hall, the reason why it wasn’t talked about is because a lot of people were depressed.” Having so many people studying Health Science packed together in halls appears to be a boiler of intensive competition and stress, rather than a positive environment for students to tackle this already daunting programme. Rachel reports "People were crying in the corridor. It wasn’t an unusual thing. It would be like ‘oh, someone is crying in the corridor again, should we help them?’ Looking back at it, you’re like, that is fucked up that that’s a normalised thing”.
Bayden Harris is a 2017 Residential Assistant (RA) at Hayward, who agrees that the students in the course are dealing with a challenging environment. “It’s kind of like an incubation of stress, anxiety, and awful mental health problems.” Harris commented on the week this year between two Health Science tests, saying "I was just walking around and I could sense the anxiety, and that stress.” Despite the semester only having been underway for a couple of months, Harris was concerned about the attitude students had toward talking about the stress of the course. “For a fair amount of our students, there is quite a stigma [around talking about mental health] … You are meant to put on a show, ‘I got ten out of ten in my GLM, I’m going to get into med school’. I think the programme innately plays students off against each other. I get that, with a competitive course, but it’s just cruel.”
To balance new-found independence with the full-throttle Health Science course requires all the support that the university and the residential colleges can give to students. I asked Harris how much training RAs receive in dealing with identifying and combating mental health problems. “None,” was the reply. RAs for university owned colleges were given general group training, but Harris says that, if there was any information about mental health, it was in one of a number of ten-minute speeches, alongside others about international exchanges and class rep promotion. Bayden believes that the majority of help that RAs are able to give to students comes from those who had personal experience with mental health problems. “I’m doing it off the bat … It’s shit that not every RA can do.”
An RA from a private college, who wished to remain anonymous, said that his college had improved over the three years he had been working there, through student led initiatives. "Every college doesn’t like to talk about their problems with mental health … you want people to believe that there are no problems,” he said. However, his college’s RAs knew from personal experience that more help and support were needed for students undertaking the Health Science course. Often former Health Science students themselves, they had seen that the well being of students was often compromised by the course, and that the hall did little to mitigate this. The authority of RAs in his hall was great enough that senior RAs worked to change their training to consider students’ mental health. This included health professionals voluntarily talking to RAs about dealing with mental health problems in students and RAs checking in with their residents regularly.
Despite this progress in the right direction, he said “there was a clear notion that if the RAs weren’t able to deal with the situation themselves, and if the situation had to be brought up to the master, the approach taken would often mean that the student would have to leave the college, possibly leave the course and wouldn’t be allowed to come back. This would often be in extreme situations.” The ramifications of this were twofold: students weren’t always getting the professional help they needed, and there “was a large pressure on RAs to do their jobs correctly, because we felt like we were the last resort for some of these students. Which obviously should never be the case, because we are not professionals, we are just friendly young people who try our best.” The sensitivity toward the issue at a management level seemed lacking, he said. He had heard of incidences of "masters saying “go take a hot bath, go read a bible””. The RA says that mental health doesn't even register as an issue for many members of management, adding "they are not aware of it. They don’t consider [issues with] mental health to be a serious condition."
As they find support networks to replace family and friends from home, and adjust to both a new way of life and this weighty course, students receive close to no education from their colleges about the struggles they may face. Aside from pamphlets posted under room doors vaguely suggesting “home-sickness” might assail them, many students may not even be aware that mental health problems might affect them. Intelligent HSFY students directly from high school, who have often had a fairly cruisy ride through NCEA, don’t always have the skills yet to deal with this high pressure environment. “Failure is not something they have experienced in their education,” the private college RA said, "They tend to have quite low resilience. So when those first results, from that first HUBS test of 7% comes back, with 89%, they crash. For the first time they feel like they are being told that they’ve been lied to about their capabilities, and they don’t know know how to pick themselves up." The RA says their college offers "one or two sessions in the year of people coming in to talk about stress levels, or even suicide”, but "they tend to be optional for students, and therefore a lot of students don’t turn up”. The reason for their absence, it would seem, is a catch-22: “they have the Health Science mentality that anything extra is a waste of time, and they should be studying”. Bayden said this was also true of his university-owned college. Increased preventative measures from the university and the colleges could foster a more supportive culture, including educating students about dealing with the stress they might experience.
Director of Health Sciences, Professor John Reynolds, is no stranger to the stress of a professional course, having completed Medical Intermediary here at the University of Otago in 1989. The course had a similar atmosphere to HSFY, he said: “double over-subscribed, terrible stress, terrible behaviours by some students, stealing others’ notes from the library. It was stressful because you knew you had to be on your top game”. He acknowledges that this climate of stress is still present in the course, and believes that it comes about because of the competition for places in the professional courses. “I don’t know how to get that out of people’s being, that they’re competing.” Reynolds hopes that one day, study groups could be organised in the model of the Maori and Pasifika centres, whose mentoring programmes have been effective in supporting students in those demographics. Collaboration, he says, is essential for building resilience and reducing competition. Reynolds says that the department tries to ensure that all students have access to all the information they need to succeed but that they can’t “drag them” to the resources. Initiatives include help desks for the papers and course advice from the health science department, although both tend to be underutilised. According to Reynolds, there has been plenty of discussion around determining reform needed within the course.
Reynolds says the Health Science department keeps conversation open with the halls, and acknowledges their important role in supporting students through the course. The department is “relying on the pastoral care of the RAs, welfare staff, the wardens” to deal with problems individuals might have. Reynolds seems surprised that most RAs do not receive formal training to deal with mental health issues. He says he also has received no education about mental health issues. In the Health Science department, the decision makers are “lecturers who have come through a certain academic pathway. I’m a medic but I’m not trained specifically to have that skill set.” The key for those at all organisational levels is to “pick up on flags that we might identify and refer people in the right direction.” When it comes to dealing with issues out of their depth he says “I would hope that RAs go straight to their wardens and say look, I’m very worried about these students”. Unfortunately, it can be hard to identify those struggling, he believes, as often “they don’t want to admit that they’re not coping”. As far as the responsibility of the department in destigmatising and addressing mental health problems, he says that it’s “a national social problem to try and demystify it”. Reynolds believes people are becoming more aware of the issue due to media coverage such as Prince Harry’s recent discussion of his experience with therapy.
Youthline Otago manager Brian Lowe agrees that colleges are failing to support their students properly when it comes to mental health issues. There is a “generational gap” in understanding, he said, with older generations not comprehending the pressure students are under to achieve. “We get students who are supposed to be doctors, but they’re not getting the grades,” he said of those who ring for support at Youthline. Telling family back home that they are not doing as well as expected can sometime feel like admitting, “I’m a write off”. Students need to be able to turn to the institutions that are familiar with their circumstances, but often the generational gap in understanding gets in the way of this. Brian said he thought that “colleges needed to look after their RAs and their students. They’re fee-paying students. I think the system hasn’t really caught up with this generation. I think there’s a reality we don’t understand.” Progress, though slow, was apparent in some halls, as Youthline Otago was invited in for an afternoon this year to train RAs at Aquinas and Cumberland. It was the first mental health-focused training Lowe was aware of for RAs in Dunedin.
Several years into medical school himself, the anonymous private college RA was doubtful that the Health Science course even selects the people appropriate to practice medicine. "It [HSFY] definitely does have a selective pressure for people that are good at passing exams. Other than that, a high level of being able to cope under stress.” This might seem ideal for a doctor, who as a resident at a hospital might be asked to work up to 10 days in a row, sometimes in 14-hour shifts. To select for people who can handle stress seems wise. However, the Health Science course, according to our RA, could lead to medical professionals who are "able to ignore their own stress limitations,” that develop unhealthy lifestyle habits and potentially burn out. In his experience, taking study skills from Health Science to Medicine is difficult. He said students had a tendency to cram the course and fail to understand or engage with the material deeply, because to get into a professional course one had to jump through a series of multi-choice test hoops. Studying Medicine was a completely different ball game: "if you complete it in the same way you complete Health Science, you would struggle to become a really good doctor … or even maintain a healthy mental state.”
Undergraduate entry into Medicine calls for freshly minted adults to commit to a medical career path for many years. Many young people bring to the Health Science course a burning desire to undertake training which will help others, to have careers which will save lives. Health Science is just the beginning of a long, hard road for medical students. “Maybe the whole of the course should provide better support, provide better cushioning for people. But in a sense, is it their responsibility?” said Rachel, “Because we are adults, that’s the reality of it.” Adults, she thought, could make and deal with the decision to put themselves through the rigours of the course. “This is just studying, you’re going to go into a profession where people are literally dying in your hands. It’s not going to be less stressful than this.” The stress was an early sample of something they would potentially deal with for the rest of their careers, “the large-scale problem of why healthcare professionals are expected to sacrifice themselves and their health to help people.” Perhaps, she reflected, even if a few students get burnt along the way, “it’s not the health sci department trying to kill us. They’re just brutally realistic.”
To contact Youthline Otago:
Freephone on 0800 37 66 33
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Emergency Psychiatric Service - Mental Health
Freephone: 0800 46 78 46
OUSA Student Support Centre
Address: 5 Ethel Benjamin Pl, North Dunedin, Dunedin 9016
Phone: 03-479 5449
University of Otago Student Health
Medical clinic in Dunedin, New Zealand
Address: Walsh Street and Albany Street, North Dunedin, Dunedin 9016
Phone: 03-479 8212