In the crisp sunshine of a Saturday morning, I walked to Whiteladies BTP to have a coffee with John Gilbert, fifth year medical student and former Faculty Rep for Health Sciences. John pioneered the establishment of the University-wide Student Mental Health and Wellbeing Survey. We talked about John’s journey into medical school, his university experience and his time working as a faculty rep. Imagine coffee clinks and a persistent hum of steam in the background, which underscored our conversation.
Content Warnings: discussions of issues pertaining to mental health, suicide and self-harm.
So John, what inspired you to apply for medical school?
I suppose it’s probably because my brother and sister are both doctors – that had a lot of influence. I looked at other things to do, but medicine just seemed right at the time. It’s quite young to decide what you want to do, but I think I’ve been quite lucky because I’m still enjoying it.
I used to live with a medic and I was really interested in the Bristol medical course because, despite being a degree that is quite scientific at heart, you do creative and practical, as well as more traditional forms of assessment, and I was wondering if you could tell me about the kind of things that you get up to in journey to becoming a doctor?
So there’s an element we do call ‘whole-person care’, so instead of just focusing on the disease and the treatment, the medical school are really keen for us to focus on personal treating, as that’s what makes a good doctor – you don’t just come in and treat the cancer or the lung condition, you treat the human that’s sat there and it makes the process a lot nicer for everyone. So a lot of it is focused around the dualism between the doctor as a scientist and the doctor as an artist – we explore how creative you need to be for innovation and to make change in medicine, and there was a lot of opportunity to be creative.
The other quite fun ones are called ‘OSCE’s’, Objective Structured Clinical Examination. It’s made up of ten-minute stations where you’re asked to break the bad news of Cancer or do a cardiovascular examination, all checking that you have the real-life skills to be a doctor. Depending on the unit, we might have to do a presentation or an essay as well, it’s really varied which is quite nice.
Absolutely. What did you do for your whole person assessment?
I think I did a print about Alzheimer’s, and it was just the Alzheimer’s word repeated. At first it started multicoloured and then it faded to grey scale, and then the word just faded out completely – just that sense of losing everything.
See that’s what I think is so good and interesting about this course – I find your diversity of assessment, while I guess it is tailored to becoming a doctor, should nevertheless be applied to lots of different subjects. How do you find that range?
I think it reflects the whole spectrum of specialities that doctors end up in, and I think that’s the key thing. You’ve got surgeons at one end, or psychiatrists on the other and the range is just trying to satisfy and get people interested from an early stage in what they want to do.
I guess it goes back to the fact that if you only have one form of assessment, then that’s only favouring one kind of brain and one kind of speciality. Medicine’s variety of assessments is much more democratic.
The nice thing about medicine is that in the past couple of decades, there’s been a massive focus on evidence-based medicine and that has transferred into medical education and medical assessment. In terms of all the ways we are assessed, medical schools across the UK try to evidence that these are valid tools of assessment, shown to make a safe doctor. So as a student, you can feel confident that you’ll be good enough if you pass, which is quite nice.
Yeah absolutely. Just to feel like you have a safety net, and you feel secure. What’s been the highlight of your university time so far?
I’ve been really lucky to be involved in a lot of societies. I’ll be going into my sixth year of university next year, so I’ve had a lot of time to do fun things. I think one of my favourite trips has been diving in Gozo in the Mediterranean with the university’s underwater club, and that was incredible. It was a really fun trip and a great society. Other things that have been really fun…just sports at Bristol. I know they get a bad rep, but if you’re just looking for something fun to do, I’ve enjoyed it.
I don’t think it’s the sports themselves that get a bad rep, it’s the wider culture.
Yeah, sometimes the culture of intense initiations can exclude so many students. One of my friends was really involved and became the chairman of the medic’s rugby and completely changed the culture of it. He got so many more people involved and opened it up to vets and dentists, and essentially anyone who wanted to play. He got the highest turnout to training ever. They have fun drinks but there’s never any pressure to drink and it completely turned the club around.
So tell us a little bit about your time working as a faculty rep for health sciences. When did you do that? What initially compelled you to apply? How did you establish the Mental Health Survey?
At the time was as I was applying, a lot of my friends were suffering from mental health issues but they weren’t really willing to go to the university about it, and that really shocked me. I was asking them why and people were scared of things like Fitness To Practice, so potentially being struck off, not being allowed to complete the year, or being forced to take the year out. There was a big myth around what the General Medical Council did, and how willing it was to stop you studying medicine, as you have to show that you’re fit to practice. And I think that was partly one of the issues around students not approaching the university for mental health help.
I guess it means you have to grow up very quickly, as well.
You do, yeah. And when you’ve got mental health issues and you know you’re being overseen by a professional body, it’s a massive barrier to seeking help. So the survey started when I spoke with Zoe Backhouse and Helen at the SU, and we just wanted to do a small in-house survey at the SU, so we designed a survey and started asking a few personal questions about drug use, self-harm and suicide. It got quite serious and the university said that we couldn’t ask these questions unless you get ethical approval. Eventually after three attempts, with the help of some really kind academics from the School of Social and Community Medicine, we got ethical approval and ran the survey in May of 2017. We got a really staggering response rate of over 50%, and some really useful data for the health sciences, so that’s the short story.
We wanted to run the survey again, and the university suggested that we disseminated it across the whole university. I haven’t been involved since, but I think there hasn’t been as much student involvement since we first did it. Since a student hasn’t been directing it, it hasn’t really got as good a response rate, which is a bit annoying. Students are always hounded with requests to do things, and I think I was particularly persistent in trying to get students to fill it out because it was so important at the time.
It’s difficult isn’t it. Most people will always respond to a Student Union dissemination, and obviously the Student Union does need to be separate to the university to hold them to account, but at the same time that divide also creates a rift of engagement.
Yeah, so I think the challenge for the future will be, as with all surveys, trying to get a better response rate. I’m obviously very biased but I think it is the most important survey that Bristol has to do.
Off the back of that, what steps can be taken to improve response rates?
You need big billboards in libraries with a QR code, you need to get the SU on board, lecturers involved, you need heads of student societies and presidents on board and it just needs so much more student involvement and engagement, and getting an email from someone you’ve never met before from the senior management team at the university probably never gets read. They should be monitoring if these emails are being opened and if the link’s been clicked on, and they definitely have the capability to do that.
What steps do you think this university, and universities across the country, can take to improve their stance on mental health?
I think Bristol is under a lot of pressure because of the suicides that have happened here, and that puts a big spotlight on Bristol. One thing that I’ve noticed recently, especially in the press and with peers, is that everyone’s been very critical of Bristol. And they’re allowed to be, and I fully understand why they’re being critical, but not many people are offering solutions or ideas for change. All I’m seeing is an anti-university rhetoric instead of a ‘this isn’t good enough – change it’ attitude. That’s what I feel, but I’m not sure if that’s right and I’d be happy to debate that with people.
The NHS used to provide a lot of these services, and it’s faced massive cuts over the last few years. Coming from an NHS background, you do see these cuts in person when you visit psychiatric hospitals or see that a GP only has ten minutes to deal with any patient. The NHS also has a massive role to play in student health.
In terms of the university, mental health services need more funding, we need to cut down key student concerns like waits for student counselling, or encourage more positive help, such as group therapy and better access to mental health services. It’s a really difficult question and I think if there was an easier answer it would have already been done. Nothing that’s worth doing is easy. We need to start thinking about, not just universities, but how we as a society and a national health service, are to look after these students and provide for them.
Aside from academic knowledge, or medical knowledge, what has your time at university taught you?
I want to say, more than I’ll ever know. I don’t think I’ll know what it’s taught me until after I’ve left university and I’m a few years away. I’ve gained so much from being at university. Just being a more confident person, engaging more in things, dealing with when things go wrong, growing up as an adult – learning big adult things. Learning how to relax is a really important one. The most important thing in life is just to have fun, and enjoy yourself.
I think that’s an interesting point about feeling the impact but not being able to articulate it yet – that’s a sign of personal transformation. Following on from what you were saying about the importance of relaxation, what kind of things do you personally do to chill out?
Whilst I was studying in Bristol, and I wasn’t away working at hospital, I joined a lot of clubs, I did diving, Judo, I did a triathlon for a year just to get a bit fitter. Nowadays, I just do a bit of cycling. I really enjoy making pizza. Otherwise, just a bit of Netflix – often I’m just a bit tired so I like to lounge around and do nothing!
This takes us back to the importance of sports and exercise. I find for me that exercise, and the release of endorphins, is often the best way to make me feel better when I’m feeling a bit lower than usual.
I have the perception at Bristol that sport is a competitive thing and you need to be good at it. This goes back to the previous question of what I would do to try and improve mental well-being at the university. I’d try to create far more opportunities for inclusive sport where people don’t need to feel judged or good at something.
Performance sports is all great, but if you’re applying for performance sports as a club, and you have to show that your top teams are completing at a high level, how are those clubs expected to provide for people who used to play social netball or hockey or rugby or swimming at school? Those people aren’t going to turn up anymore, as it’s not the right environment, and you’ll be forcing people who used to do it for a bit of fun into a highly competitive atmosphere. This puts so many people off from doing sport and I disagree with that entirely. I think there needs to be a major rethink of sport and exercise at university.
I completely agree – there’s not enough opportunity to take up a new sport as well!
I think a lot of students at the university would do more sport if it wasn’t so exclusive and competitive and there’s definitely not enough opportunity to go and have a bit of fun, and do something once a week, or just to try things. The Sports Officer a few years ago did a good job of trying to change that around and make it a bit more inclusive, so there was freshers’ week and a second week in January when you can go and try another sport, as a taster.
So speaking of tasters, if you could take on another subject aside from medicine, what would it be and why?
I’ve always really loved planes and helicopters and part of me really wants to be a pilot, so probably aeronautical engineering, I find it so fascinating and cool. I love those really boring plane documentaries about airports and how do they do it and how do they build it – it’s really dull, but I love it.
What are your top three places to hang out in Bristol?
Cabot Tower’s a really nice, free place to go and get an amazing view from Bristol. I like places with really good views, so the suspension bridge. Then either the top floor of the Bristol Royal Infirmary or the top floor of Biomedical Sciences, where you can look out across the whole city.
Shout out to biomedical sciences, that’s such a beautiful building! Do you have anything else you would like to throw in before we wrap up?
Just make the most of university, get involved, make mistakes, and don’t be afraid to make mistakes – it’s the only way we learn. We’re all very afraid of getting things wrong, failing and whatever.
I think we could do a whole other interview about fear of failure among students.
I really think we need more life lessons from a younger age: learn to fail, relationship advice, money advice, all the things we never get taught – there’s more to life at that age than learning how to do trigonometry and calculus.
I think we’re facing so many problems in this world that we have no idea how to solve, so we need to instil a better sense of discussion and critical thinking in the next generation. I just think there’s a much larger place for philosophy and critical thinking in our education system. I just think there needs to be a massive reform in the nature of our education, as it stands.
Phoebe Graham BILT Student Fellow 18/19 – working on the project ‘Empowering Students to Impact their Teaching and Learning’.