Warwick Medical School, part of the Warwick University campus
You could be forgiven for thinking that we live in a world where people succeed or fail on their own merit. You could be forgiven for thinking that anybody engaged in high level study in their chosen field or vocation would be treated equally. You could even be forgiven for thinking that in a collegiate and caring profession such as medicine – where the needs and welfare of those in your care must always be of utmost importance – that our future doctors would be treated with the utmost respect and consideration in such matters as equality, diversity, and even more importantly, their welfare as students. Afterall, the relationship between the teacher and the student, or the padre and his flock, is not entirely unlike that of the patient and the doctor in the most basic of respects. There’s a duty of care, a need for responsibility and trust on each party, a confidence to be shared, and a purpose to be discharged. The difference, however, is that never have these things been more crucial where the teacher is the doctor, and the student is the doctor to be.
I’m going to tell you now a story about somebody I am close to. We’ll call her B. I can no longer keep quiet about this, and I have to make it known.
B is a Medical Student, and she also happens to be trans. She’s had a hard time, but managed to get through her first degree and went on to gain acceptance onto a graduate medical course at her university. A few months into her first year, she discovered that during both the GEP medicine course she had embarked upon, as well as the 2 years immediately after it, there would be no opportunity for her to have and recover sufficiently from surgery apart from that summer. Ever determined, she wrote to her NHS Gender Identity Clinic in an attempt to facilitate this, but they had no care for this issue, nor for it’s consequences, instead preferring to hide behind policy in excess of the WPATH guidelines for treatment.
As a result, she realised that the only chance she had to have surgery during this summer break would be to have it privately, during the summer break, and so she went to the Senior Tutor of the Medical School for advice. The advice given was that if she had the surgery after her exams, then she’d miss the resit date scheduled just a couple of weeks after the exam, but if she had the surgery after the resit there would be insufficient recovery time prior to the start of the next year of the course, Even if she were to take a 3 week absense due to sickness at the beginning of term (the maximum that the Medical School would allow due to teaching time requirements imposed by the GMC). Moreover, this would mean that if she had to take just a single day off in the rest of her second year – whether due to flu or bubonic plague – she would fail to meet the minimum attendance requirement and be forced to retake the year.
She was desperate to not have to re-take the year, and she was desperate to avoid taking a year’s temporary withdrawal. It’s hard to blame her for that, as gender dysphoria had claimed enough years of her life, without claiming yet more, like many other transgendered individuals. In the irony of ironies, she’d actually managed to set the bar higher for her Medical School in terms of LGBT issues by putting them on the agenda at all as part of her course at all.
Her work was good all through the year – it even surprised her tutor to find that her name wasn’t on the pass list for the year’s final exam. Her notes were so good that they were celebrated by her fellow students and helped many people –including some of the weaker students– pass the exam. She’d made such a successful transition prior to starting medical school that nobody knew of her gender history save for a few members of staff (she’d applied under her previous name)… although that had been enough for them to force her into an additional Occupational Health interview about her transgender status at the local hospital upon being required by the Medical School to tick the “mental health issues” box. Naturally she protested –pointing out it was illegal to put any additional barriers to employment on the grounds of someone being transgender under the Equality Act 2010 but the Medical School refused to support her or correct this glaring error, illegally and callously forcing her outing to hospital staff in the process. Still, her cohort remained none the wiser to this irrelevant and confidential information, and she not only added to the med school’s reputation through her writing, but proceeded to give one of the most useful, popular and well attended extra-curricular lectures that a cohort at the school had ever seen.
It was in this context that the Senior tutor extended the advice she gave with a statement to the effect that (paraprasing) “If I were you, I’d go to Thailand and have surgery there. You’re a strong student”… advice which came back to haunt her…
She went to Thailand and had the surgery. I was there, beside her hospital bed, and with her at the hotel for the whole time, and just a day after surgery, she received news that her name was not on the pass list for the final exam of that year. It was a devastating piece of news, for which the only source of mitigation was the morphine drip constantly numbing her mind and her feelings. Still, this sort of news does no good for one’s recovery from major surgery, especially having had it half way across the world – and privately – as opposed to on the NHS with the support of friends and family to avoid just this sort of situation – to avoid having to lose yet another year of her life as a result of being transgender.
I have never seen anybody fight as she did – as the morphine continued to numb her pain in both senses of the word pain, she researched what had happened and what she might be able to do about it. As it turned out, an exceptionally and unexpectedly high number of students failed the exam that time around, the atmosphere on results day having been described by the Medical School themselves as “positively funerial”. The medical school, however, investigated it’s own exam and found that there were no issues with it owing to there having been a wide spread of scores from 100% down to marks of abject failure. B had a higher overall mark than many who had passed, but never the less had not passed herself; her score, mathematically speaking, could only possibly have been a mark or two short of the required standard.
Resits were scheduled for just 2 weeks later. Had they been scheduled just another couple of weeks later – or had the Medical School followed the standard used by every other department in the University, and most other Universities for that matter, of having the exams immediately prior to the new term – leaving time between exams for students to revise more, whilst giving time for B to be back in the UK, she would undoubtedly have sat them – post surgery or not. Had the NHS GIC given a damn that their superfluous procedures were liable to have a severe detrimental and needless impact upon a patient in it’s ‘care’, she would have been in the UK. Unfortunately, she was in recovering half way across the world and on bed rest.
She explained the situation to the Pro Dean of Education of the Medical School. She requested that she be able to sit the exam as a viva voce examination. The answer was no. She requested that she be able to sit the exam upon her return. The answer was no. She requested that she be set an alternative paper using either one of their rather secret, and heavily guarded past papers, or one set using questions from their question bank, or some sort of hybrid. The answer was again no. Whatever solution she proposed in order to obtain the same chance as everybody else at the resit – a paper which had a far more acceptable pass rate, incidentally – the answer was no.
She complained, exploring every avenue and opening every door with the medical school – and all from her bed in Thailand following major surgery. I have never seen somebody with such intelligence, commitment and tenacity in fighting so hard even under these conditions… save, maybe, for a fox as it tries to fight it’s way out of the hole and past the hounds.
When that route was fully expended, which included a journey of an hour and a half each way to meet with the Pro Dean shortly following her return to the UK, she filed a formal academic complaint. During the panel meeting for that complaint, she was outed to a further member of the medical school staff without her consent (unless of course she’d previously been outed without her consent – a violation of the Gender Recognition act either way), but was forced not to complain on grounds of expediency since her term was due to start within a week of the panel meeting. She’s waited a great deal of time to get to the result of that complaint, and she now has it – the complaint has not been upheld. Couched in the usual polite and compassionate language you’d expect of a process intended to be a rear guard against legal action swinging the Universities way – as is the purpose of most complaints procedures – not only has it spectacularly failed a student, but has done so with so many levels of wrong in it’s decision it’s really hard to highlight them.
Amongst it’s reasons are:
- The ‘fact’ that nobody forced B to have surgery privately and thus spend all her savings on trying to avoid taking a year out and the consequent disadvantages of doing so – not to mention personal cost.
- That the she had a choice over when to have this “elective surgery” (yes, that is a direct quote); either before the resit or afterward. This ignores the fact that taking it after the resit would have effectively forced her to take a year out and would not have given her sufficient recovery time, and doing it before would have meant missing the resit. That, or be expected to wait 5-7 years. (WPATH guidelines explicitly state that it is not considered to be elective and is non-postponable)
- That the Med School offered a “reasonable” adjustment in the form of temporary withdrawl (a year out), which would have been available to anybody (as available to anybody, surely not an adjustment as such? And since this requires no change or deviation on behalf of the University or Medical School, how is this an adjustment? )
- That the advice of the Senior tutor was correct and in no way misleading despite the fact it played down the likelihood of failure, and the fact that – somewhat uniquely to Medicine – the fact that the resit forms a part of the full examination process. This is not to mention the fact that it’s known to staff that medical exams are, in the words of one of B’s tutors following the exam, ‘a lottery’… a lottery which on this occasion resulted in a high fail rate, including that of an excellent student.
- That a resit paper would have required 60 man-hours to create, and if they did one for B, they would have to do it for everybody (ignoring the fact that situations like this don’t come up very often, and if they did, everybody could sit the same appropriately timed paper)
- That while other faculties write individual resit papers in exceptional circumstances reasonably routinely, the medical school shouldn’t have to for reasons that aren’t quite fully clear. The Medical School seem to be strangely exempt from this policy for reasons not stated.
- That B knew that she’d need surgery before starting the four year course and so, presumably, the situation is one of her own making. (This is in spite of the fact that she’d have been castigated by the NHS GIC for “not getting on with her life” had she delayed in starting it – being seen to be actively getting on with your life is a requirement of the RLE)
- … the list continues. Further details on the more technical aspects can be found over on the Trans Activist blog.
In one saving grace, however, the Academic Complaints and Standards Committee (standards? Hah ha ha) does concede that B “believed [she] required surgery as a matter of medical need”. How good of them to understand that she believed it was a need. If only they could have gone so far as to realise that unnecessarily denying her the chance to have it or else to take a year out is a cruel and tortuous thing to be doing to somebody with more courage, commitment and determination than most other people at the Medical School. The veritable Sophie’s Choice she was faced with should not be forced upon anyone by even the most medically ignorant of higher education institutions, never mind somewhere that can set such an atrocious example to future doctors.
And all this, from a medical school that is seen by the majority of its own students to be consistently failing (*cough* – sorry… “needing to do better”) in terms of equality issues and of LGBT issues in particular. This, against a student who managed to both raise the bar and the reputation for the medical school, who has now been rewarded with horrendous discrimination and apathy. This, from a medical school which has supposedly upped it’s game following a recent GMC review – a GMC that’s supposedly all over equality issues at the moment having recently discovered that discrimination and poor treatment is rife, especially where transgender issues are concerned. This, from a medical school that has a large LGBT society which cannot recall a single openly LGBT student who has not been required to retake a year at some point or other.
This is the state of medicine in this country. This is the state of equality within medicine. This is the state of power, privilege, and inequality within medical training. This is how hard it is for even passing trans people, let alone openly LGBT people, to get on in a medical career. This is the pain and the sacrifice. It MUST change.
I am obviously concerned about B at this point, but this stretches further than that. As mentioned over on the TransActivist blog, the issue concerns future students at the Medical school, be they transgender, disabled, in need of sudden medical treatment, or in any way liable to suffer discrimination. If you wish to contact the Medical School then please do, but please, no harassment, hate mail, threats, or needless and problematic abuse.
That said, it’s important that medical schools and universities have near perfect examples of everything, and this case is no different. Discrimination: Thy name is Warwick.
* The student concerned wishes to remain anonymous.
** Warwick Medical School were asked for comment, but have as yet declined to answer.
Update: For a more medically oriented perspective, complimentary to both this and TransActivist‘s article, see the rather excellent TransMedic blog.