Always pay it forward: Dr Matthew Chu on championing equity
FACEM Dr Matthew Chu has a key life philosophy: you should always pass on what you have learned.
He formed this belief early in his career when he was a junior doctor at a busy hospital in Sydney. A common practice at the time was that, when doctors were allocated their compulsory week of night shifts, they were allowed to take annual leave to avoid it. As Matthew was the relief resident, he was assigned those night shifts.
““We all realised that this kind of workplace behaviour contributes to burnout and is no longer acceptable.””
During this challenging time, Matthew felt that he was stuck in a limbo of nights, unable to know when these ceaseless shifts would end. He said, “I did sixty-three nights straight!”
Dr Matthew Chu as a junior resident medical officer.
Now, it is understood that sleep deprivation and long hours without breaks can impair cognitive ability and decision-making. But in that era, junior doctors often felt that they were judged as being weak or not resilient if they said no to shifts, especially in the early years of their training. Because of this culture, Matthew didn’t question the workload that was expected of him. “If you said no, there was the implication that you weren’t dedicated, and there was a risk that you wouldn’t get a job the following year.”
Fortunately, times have changed. Since then, “We all realised that this kind of workplace behaviour contributes to burnout and is no longer acceptable.”
But this challenging experience instilled in Matthew a determination to ease the path of the junior doctors coming after him, and to help them succeed. He said, “I didn’t want to see other people being subjected to such situations.”
Making it better for the next generation
A later career experience cemented this determination to support others.
When Matthew started working as a senior doctor, there were few practising emergency physicians. This was due, in part, to the recent recognition of emergency medicine as a specialty. However, there was also a pervasive lack of understanding about what emergency specialists could do, what they did, and the need for well-staffed and supervised emergency departments.
Dr Matthew Chu receiving his emergency medicine fellowship certificate.
Matthew said, “Other specialties thought we would only administratively run the department.” It wasn’t unusual for an entire metropolitan emergency department to be run by just one emergency consultant. This same consultant would be on call 24 hours a day, seven days a week. Matthew was one of these solo consultants.
Because he was on his own, he learnt to deal with non-clinical issues through trial and error, learning from his mistakes and seeking advice from his mentors. There was no ‘Community of Practice’. He had to learn how to manage, but then would pass on his expertise to others. “If I was trying to learn a new skill and found out how difficult it was, I thought it would be amazing for people to learn that skill without having to jump through the same hoops I did.”
Because of this principle, junior emergency doctors and other health professionals sought his advice, and he would give it – with one condition. “I would only teach you if you passed on what you have learned to others.”
““If I was trying to learn a new skill and found out how difficult it was, I thought it would be amazing for people to learn that skill without having to jump through the same hoops I did.””
While Matthew was significantly involved in teaching at Canterbury Hospital for a substantial period, he didn’t actively seek out the world of medical education outside of the hospital setting – it came to him instead.
In 1991, while he was working as a senior clinician, one of Matthew’s fellow emergency physicians, who was an ACEM examiner, tapped him on the shoulder. He asked Matthew, “What do you think about being an examiner?”
He threw himself into it and by the early 2000s, he had progressed to be a senior examiner, and was involved in various examination committees responsible for formulating and reviewing written questions for the College examinations.
Changing the process
This involvement in education fine-tuned his philosophy, as he realised that easing the path for others was intimately linked with creating equal opportunity of candidate success through the standardisation of examinations.
When Matthew started working in education and examinations, written questions had to be supported by a minimum of two reference texts – but many key texts had conflicting information.
There was also a lack of educational evidence to support the best approach in structuring written questions. As Matthew came from a non-English speaking background, he was aware of how challenging the written questions could be for people whose first language wasn’t English.
Back then, there was no equivalent examination to the OSCEs, which were implemented in 2015 to be equitable for all candidates. Before the OSCEs, as part of an ‘Exit’ examination, candidates would do a combination of ‘long’ and ‘short’ clinical cases and Structured Case Examinations (SCEs).
Unlike today’s OSCEs – which often use ‘simulated patient’ actors and FACEM role players who use standardised scripts and responses – candidates had to perform histories and examinations on patients who would be sourced from the hospital, or outside hospitals, just days or hours before the exam.
The availability of patients at the time then determined what was included in the individual exams, so there was no guarantee of equity. There was no assurance that all parts of the syllabus would be tested, or that each segment of the exam would have equal complexity of cases for all examinees.
Fortunately, this no longer happens, thanks to the OSCEs. Matthew said, “I have been informed that it now takes 100 hours to produce just one OSCE exam scenario. The resource usage is so different from trying to put everything together at the last minute!”
Dr Matthew Chu in discussion with a co-examiner.
Recognising unconscious bias
Unconscious bias was not well recognised when Matthew began examining either, and could potentially lead examiners to unconsciously influence a candidate’s performance based upon their own social upbringing.
When Matthew began examining in 1991, examiners would sit around a large table at the end of the day and discuss each candidate individually. While this may seem like a pragmatic way to reach a consensus, an examiner’s initial opinions of candidates could potentially influence the opinions of others.
The College has undertaken a series of wide-sweeping changes to the examination process since Matthew started, to ensure impartiality and objectivity at all levels, and that stations reflect real-life experiences — including rural and regional considerations.
Becoming a peer mentor was also something Matthew described himself as having ‘stumbled’ into, when once again he was tapped on the shoulder in 2011 by someone in the ACEM examination team and asked, ‘What do you think of being a Peer Support Examiner?’
““What we’re trying to do is make sure everyone is treated equally and under similar conditions, to allow them to perform to their optimal standard.” ”
One of the things Matthew finds the most rewarding in the mentorship role is being able to encourage new examiners, who are often overly critical of their own perceived weaknesses. “I notice that when I come over to new examiners, they will say, ‘Oh, what have I done wrong?’, or they would be surprised when I told them they were doing well, or that what they’re doing could easily be fixed.”
He believes that this self-critical mindset of assuming something’s gone wrong when receiving feedback may stem from often having to be on the defensive as emergency doctors – in justifying a decision one’s made or advocating for inpatient admission under a particular sub-specialty.
This trait can follow candidates when they take the Fellowship examinations. Matthew finds it gratifying to show trainees that, in fact, examiners each feel a great sense of responsibility when determining a level of attainment, and strive to be objective, non-judgemental and on the side of the candidate.
For Matthew, the process of examination is simply about trying to give the same conditions to all candidates and, by being aware of the unconscious bias everyone inherently has, to create a level playing field.
“What we’re trying to do is make sure everyone is treated equally and under similar conditions, to allow them to perform to their optimal standard.”
