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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.
This interview was carried out and transcribed by Phoebe Graham, BILT student fellow.
The following post was written by Amy Palmer, BILT Digital Resources Officer.
This year’s Digifest explored the theme ‘Shaping education for a hyper-connected world’, in which ideas around the digital challenges we are facing were shared and discussed. I attended three panel events while I was there and found that similar conclusions were drawn from them all: the use of technology may be increasing, it is imperative that we do not lose human interaction. This may seem obvious, but throughout the day there were moments where I felt a tension between discussions around how technology in education was becoming central to the learning experience and technology’s role in the creation of current mental health challenges facing universities.
The first session I attended looked at a
report recently released by Jisc in which a qualitative study was
undertaken with lecturers across the sector.
Five key themes emerged from 2-hour interviews with staff, with a number
of recommendations being made. The one I’d like to highlight is:
‘Teaching staff are concerned to support students’ wellbeing and they take a holistic approach to student welfare. Currently, much of this work is done face-to-face. With time and space at a premium, universities and colleges could consider how digital technologies can help to support student wellbeing as well as other, less strictly academic aspects of the student experience’
One part of this statement really jumped out at me, ‘digital
technologies can help to support student wellbeing’ – my mind immediately conjured
a scene in which a student having a mental health crisis was faced with a computer
instead of a human and the potentially damaging impact this would have. I
opened the conference magazine to a double-page spread looking at this exact
question, ‘Can technology ease the mental health challenge facing universities
today?’, with six solutions set out, the most striking of which was chatbots –
a solution recently employed by Bolton College in which students struggling with
stress or self-harm are provided links by a chatbot to online information and
contact details for the mental health team. I couldn’t help but feel this was
more a cost-saving approach that one that had direct benefits for these students
in need (but perhaps I’m being cynical).
I was encouraged by comments made from panellists in which
they emphasized the importance of human interactions, agreeing that
face-to-face engagement should be maximised, but that appropriate space on
campus was needed for this. Risks around disengagement from students where they
can not attended were raised, but were balanced by risks of students feeling isolated
and lonely when too much emphasis was placed on technologies.
The second session was a horizon-scanning panel discussion
in which the 2019 Jisc
Horizons report was launched. The report’s title is ‘Emerging technologies
and the mental health challenge’ with panel members discussing the different
ways this could be addressed. One panel member suggested technology could be
used to ‘streamline human interaction’ – another concept I felt uneasy with.
It was agreed that a balance needs to be struck between the
increased use of learner analytics and the potential reduction of human
interactions though increasing number of online services (such as lecture
capture and VLEs) and the mental health challenges facing universities. The panel
members all agreed that a key take-home message from the report was that there
was a need for a person-centred approach and that the technology must not
replace the human, though I wondered how this would practically play out in a
climate of reduced budgets, streamlining of staff, automation of administrative
tasks and increased reliance on online services.
The final panel discussion I attended was on the ‘fourth
education revolution’ – with the host asking the participants what they believed
was ‘Education 4.0’. Responses were mixed, but all centred around the idea that
education needed to be personalised, on-demand and customisable. The relationship
is changing between the student and professor from one which is a transactional
to a more balanced, less hierarchical one. All panel members had a background in
educational technologies, but all noted that these services created more time
and space for richer, face-to-face interactions.
At the end of this session a question was raised about
whether we would even need a physical campus in the future, which leads me beautifully
onto the final part of my day.
Jisc have created a virtual reality experience, ‘Natalie 4.0’,
in which the user can experience a day in the life of a student that does not
attend a physical campus. You wake up in a ‘bedroom’ at the beginning of your
day and interact with tutors and students though making choices in the virtual
world. The experience was eye-opening and something I believe many others in
the University would enjoy – we hope to put on an event with Jisc in the near
future to allow staff to try out this new way of learning!
A Teaching Innovation Grant was awarded to Dr Louisa Slingsby, Dr Rose Grogono-Thomas, Dr Julie Townsend, Ms Lucy SW Bates for the academic year 2017/18 – you can find a summary of the project they undertook with their grant below. If you would like to read the full report, please contact firstname.lastname@example.org.
Mental wellbeing encompasses the ability to feel good and function well within one’s life. This is a priority area to address within the university and beyond; wellbeing is a high importance topic within the veterinary profession.
Building on previous work we have devised a novel, evidence based “Mental Wellbeing Toolbox” (MWT) which we have introduced as a wellbeing vertical theme within the undergraduate veterinary programme (BVSc). The aim is to assist students in building their mental wellbeing, personal resources, skills and confidence, and in doing so prepare them for graduation and the workplace. It also aims to highlight how anyone can benefit from improving their mental wellbeing, resulting in better job (and life) satisfaction.
Each year group of the BVSc now has a three-hour seminar introducing one aspect of the Toolbox. A MWT Handbook has been developed for students to access at any time; if desired, it is possible to look ahead to aspects of the Toolbox taught in later years.
Following ethical approval, quantitative and qualitative data has been collected from students to evaluate the introduction of the MWT into the curriculum. Generally, feedback has been positive, with some key areas highlighted for improvement.
The MWT offers a more forward-thinking approach to teaching mental wellbeing, by encouraging all students to engage in their mental wellbeing, rather than focusing on those that are unwell.
The integration of the MWT has been well-received.
An aim of the project was to build a curriculum that will assist students in building their mental wellbeing, personal resources, skills and confidence, and in so doing prepare them for graduation and the workplace. On average, 80% of students learnt something new as a result of the seminars and 60% will look up something new and/or do something differently as a result of a seminar, hopefully indicating the curriculum has helped students build resources and skills.
Teaching methods which are deemed positive when delivering a mental wellbeing curriculum include providing interaction with the material (while allowing anonymity), and content which is relatable, personal, interesting and/or scientific. Anecdotes are also well-received.