MedEd: Grown-Ups and the Subtle Art of Not Ruining People

“You’re an Academic, Harry”

I got called an academic recently. Not in a brag-worthy way — I just needed to be a “second academic” for a student support meeting.

Still made me laugh. I mean, sure, I’m an Honorary Senior Lecturer, but “academic” felt like a stretch. In my head, academics publish. Academics sit on grant panels. Academics have wine and quote Derrida. I mostly teach chronic pain and fatigue. The sexy stuff.

And I teach it because it’s where I live professionally — chronic disease, general practice, complexity over drama. Not because I ever thought of myself as “part of the academy.”

Why I Teach Undergrads (But Not First-Years)

Despite the imposter syndrome, I do care about undergraduate teaching. It forces me to keep up to date. It keeps me rooted in the fundamentals. And honestly? It’s good CPD disguised as curriculum delivery.

But I don’t teach freshers. Not because I think they’re hopeless — because I’m not strong enough for that job.

There’s a dissonance in early medical education:

• You’re teaching adults an adult subject…

• …but some need to be handled like school kids.

It’s pedagogy versus andragogy. Transactional analysis in real time. And I don’t have the bandwidth for Year 1 mollycoddling - QED this blog endeavour I'm way to blunt on a bad day for that level of nuance.

The Myth of the Self-Motivated Learner

The dream is that adults learn because they want to — autonomy, mastery, self-actualisation and all that.

The reality?

Many medical students come from comfortable, middle-class backgrounds where expectations were external and comfort was a given.They arrive intelligent, but not necessarily reflective.Great at passing exams. Not great at learning.

Many students arrive with exam success but limited reflective capacity. They’re intelligent, but often externally validated.When stress hits, the reflex isn’t problem-solving — it’s retreat. Regression.

Sometimes into a helpless child-state.

Sometimes into defensiveness.

But rarely into reflection.

I see it play out in failures. In entitlement. In that reflexive phrase:

“I’m just not getting the support.”

Ask what support would help, and the room goes quiet. Because it’s not about scaffolding. It’s about lack of self-regulated learning.

Why I Stick With Later-Year Undergrads

Year 4 and 5 students are my people. Not because they’re perfect, but because the filter has finally tightened; by that stage, most have either evolved or self-selected out.

By that point, “coachability” outruns cleverness. You can give honest feedback and not watch someone implode.

And this is when masking starts to fail. The neurodivergent, the complex-background students — the cracks show. And it exposes the gooey center of potential someone saw. When it does, they’re often more open to meaningful guidance.

They’re more open now they’ve lived something worth reflecting on.

Why I Don’t Teach Postgrads

If I’ve got so much love for coaching and clinical teaching… why don’t I touch postgraduate education?

Because it terrifies me.

Undergrad failure is individual. Postgrad failure is systemic. You’re not patching a student. You’re stabilising a doctor — on shift, in motion, with patients.

And worse? There’s the illusion of competence. You’ve passed finals. Got the badge. You’re a doctor now. Cue the Dunning-Kruger curve.

FY1 hits like a wall. FY2 is a slow climb out but now the scaffold’s gone. Reflection feels like failure. Feedback feels like threat. And all that coaching? Way harder to land.

You’re supposed to know what you’re doing. So feedback feels like failure, not growth.

Failure to Fail: The Danger of Over-Retaining

I don’t take pride in being “harsh.” I’m not hawkish. But I do believe in failing well.

Medical school should filter, not inflate.

Because if they can’t hear feedback in a room with tutors who care, what happens when they’re standing in resus and the only person giving them feedback is the coroner?

This isn’t elitism. It’s accountability. It’s care.

And if universities are pressured to pass more students - due to funding pressures, optics, quotas - we will graduate more doctors who aren’t ready.

Postgraduate education then becomes a salvage operation.

The Systemic Challenge

The terrain’s shifting:

• More widening access students (great).

• More diagnoses, trauma, complexity (real).

• Less capacity for early filtering (concerning).

• More social complexity, more fragility, more trauma (understandable).

This means the path to insight is steeper. More uphill. More patience needed. The more time needed - a resource short second only to ECG stickers on a nightshift.

And the more we ignore that, the more we pretend undergraduate medicine is about kindness over competence, the more we fail these students — and their patients.

Final Word: The Net Must Be Tight

Postgraduate education isn’t where I belong — not because I couldn’t do it, but because I don’t want to risk missing something critical.

Attention to minute detail is not my strong suit. Not even my weak suit. It's the one I got from Primark one day I use for Wedding receptions that are definetaly going to get messy.

I stay in Year 4. In the zone where coaching still lands and course correct still has time. Where you can say:

“You’re not failing. You’re learning. But you do have to get better.”

If we can’t redesign the pipeline, and we can’t redesign society, then medical school has to stay the filter. Catch the cracks early.

Even if it stings.

Even if it means telling someone they’re not ready — yet.

Because medicine demands the ability to hear hard things and grow from them - the Eutopia is not ready for this change.

That’s not cruelty. That’s care.

Stay coachable

—DW