The Tick Box Culture Amongst Medical Students

Are the Recent UKFPO Changes a Step in the Right Direction?

Recently, the UK Foundation Programme (UKFPO) announced that from 2023, educational achievements will no longer count towards foundation programme application scores. Educational achievements include both additional degrees and publications. Expectedly, this has been met with mixed responses. Personally, I do have my criticisms about the timing and the lack of student involvement in the decision but I feel that it might be a step in the right direction. Especially, when it comes to dismantling the ‘tick box culture’ that is rife amongst medical students.

There’s a chance that you may think that this topic is a bit of a reach and it may not apply to you specifically. Hopefully, after reading this post, it will open your eyes to how medical schools breed an environment where we are encouraged to do things not out of genuine interest, but because it serves as an avenue to having more desirable medical CVs.

What Is This So-Called Tick Box Culture?

Tick box culture is a term that has come to describe the behaviour of completing specific actions that is perceived to be necessary to reach a certain goal. Amongst medical students specifically, I like to loosely define it as ‘pursuing an opportunity for the sake of increased credibility within the field of medicine rather than out of genuine passion’. Thus, figuratively, ticking a box. Whilst this list is not exhaustive, in medicine, this may manifest as taking up a research project just to get a publication, intercalating just to acquire a number of points for your foundation year application, or doing outreach work just to reference it on your CV. In case you haven’t noticed, the key word here is just. It’s likely that, if there are no signs of doing something for personal development or passion, it’s probably just ticking a box.

The earliest forms of the tick box culture in medical school stems from the very moment you decide that you want to be a doctor. We are expected to fulfil a certain skill set by participating in activities that we wouldn’t actively go out of our way to do (*cough cough* Duke of Edinburgh, *coughing once more* NCS). Often, we are told that we need to fulfil ‘X’ criteria in order to get to the desired destination. Given the competitive nature of medicine, it is understandable that universities have a set of criteria to distinguish between candidates. Unfortunately, this has created an environment where students are chasing opportunities without personal interest being at the core of it.

What Are Some of the Problems of this Tick Box Culture?

  1. Feeling Unfulfilled: Tick box culture may lead to this sinister feeling of unfulfillment. After chasing opportunities upon opportunities, you may come to a standstill and begin to question what it is that you are trying to achieve in life. Another consequence is the need to always look for what’s next rather than taking the time to reflect on what has happened. Are you genuinely happy with what you are doing? Do you see this working out in the long term?

  2. Not knowing what you stand for: This point is heavily linked to feeling unfulfilled. Losing yourself is incredibly easy. Some of us may commit to particular activities because it helps build our CVs, but we may witness certain things that we may not agree with that compromise our values. We often let it slide because society has said that we should take up as many opportunities as we can.

  3. Medical students being unreliable: This is a big problem. I’ve had my fair share of conversations with my peers about how medical students may get involved in opportunities, whether that be outreach, charity, research etc. and after a short while they just vanish. Especially when they realise that there is a significant amount of responsibility involved. Yes, it’s okay to fall out of love with something, but leaving after a very short period of time can really be unfair on the people who have spent so much time putting things together.

  4. Passing opportunities because there is no reward involved: It’s not unusual for medical students to avoid doing something if there is no reward involved. This has been seen with intercalation and the recent UKFPO changes. A lot of people are reconsidering whether it is worth their time now that there aren’t extra points at play. However, I can’t pass too much judgement on this as there are prestigious jobs and competitive regions in the UK that a lot of us want for various reasons, so I get it. It’s just unfortunate that this is the case.

Is the Tick Box Culture Completely Bad?

It’s important to note that tick-box culture isn’t completely bad and can have its benefits. Increased exposure to a range of opportunities can help those that don’t know what they want to do find their passion. Even through my own tick-boxing chronicles, I’ve found a lot of things that I have come to enjoy, and things that I have come to hate. However, I would advise that whatever you do, please ensure that you don’t compromise your values.

Also, there are the benefits of enhancing your CV, which is commonplace in medicine anyway and arguably necessary considering the amount of competition. Some may refer to this as ‘playing the game’ in order to get to the desired destination. Sometimes doing things that you don’t enjoy may serve as something an employer is looking for. I mean if you can’t change the system, you may as well play the game.

So How Do We Break Free from the Bondage of the Tick Box Culture In Medical School?

Ideally, it would be great for medical schools and other organisations responsible for medical education to stop expecting medical students to check off certain criteria to acquire FY1 jobs. The focus should remain on increasing the competency of doctors. However, personal development should be encouraged without having additional points at stake for additional degrees and publications for Foundation Year applications. Personal development could be incentivised in other ways such as funding certain opportunities to encourage and reduce the financial strain on medical students. This way students are supported for opportunities that they are genuinely interested in.

Be careful with people who say you must do ‘X’ things to get somewhere especially if it does not align with the things you value. Take what they say with a pinch of salt especially once you have thought things through! Usually their intentions are good but it may end with you making a decision you regret. For example, I’ve had people tell me that it isn’t wise to do an intercalated degree in Global Health because students are less likely to get a first, making it less useful for foundation programme applications. In all honesty, I’m so glad that wasn’t at the forefront of my mind because there is nothing worse than doing an iBSc you hate because it is easier to get a first. A year is a long time, so choose your iBSc wisely.

Aim to pursue things that you care about. I think, after having exposure to a number of opportunities, you will begin to know yourself better. Once you are at this stage, think about your drive to go down a particular path. Ask yourself whether you can commit to it for the required length of time, or even long-term. If not, maybe it’s not the path for you.

To conclude this post, I do feel as though the UKFPO’s decision to remove educational achievements is a step in the right direction, though very poorly executed. The timing is frustrating but I believe it will have more medical students thinking about the choices they make. Don’t get me wrong, I’d be a hypocrite if I said I haven’t done my fair share of box-ticking because believe me I have. A lot of the points that I write about, often apply to me. Nowadays, what I’m trying to do is spread my time amongst things I care about and also encourage other people to do the same. Put your personal interests first, and the happiness and success will follow.

Written by: Bimpe Adeyemi (Co-Founder of The Black & Forth Platform)


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