New UCSF Alcohol Policy is Indicative of Deeper Problems
There has been a fair amount of attention paid to UCSF’s new policy that a staff or faculty member must be present at campus events that will be serving alcohol. On one hand, administrators have put the policy forth to help ensure student safety, but on the other hand, many students who are able to make their own legal decisions about alcohol in any other setting feel infantilized or insulted by the need for a chaperone.
In a recent Synapse article, Nicolas Strauli expresses his dismay over the policy, stating that if UCSF allows its students to perform medical procedures on patients, surely it should trust them to consume alcohol responsibly. Having had some training in both medicine and dentistry at two different institutions prior to starting my time at UCSF, I would actually argue that this new policy is quite in line with the meager limits typically placed on students’ clinical experiences during pre-doctoral training here.
As an example, as a medical student on my OB-GYN rotation, I participated in a total of one vaginal delivery from start to finish and performed a total of zero digital vaginal exams on laboring women. There was always a reason why a particular case might not be a good one for a student – this patient has had some emotional distress or this resident (who was higher on the totem pole) needs some more experience. When my own wife was pregnant and unsure if the sensations she was having at 34 weeks were early labor, she asked if I would check her cervix. I did, and frankly, I had no idea what to tell her.
In my own field of oral surgery, when dental students rotate through our clinic at San Francisco General Hospital, there is a sign over the drawer holding Cowhorn forceps (an instrument designed beautifully for removing lower molars) that reads “No Students.” Granted, there are precautions that need to be taken to use the instrument safely, but shouldn’t that be exactly what we teach during professional school? This is not isolated to the oral surgery department, as dental students are almost never given the chance to perform root canals on molars (which can have challenging root systems) and are not allowed to do simple gum surgeries, even under direct supervision. These procedures are well within the scope of pre-doctoral education at many other institutions.
I believe these patterns hold relatively constant across lower level training at UCSF. After all, there are so many specialists in any given field that there is inherent tension in letting someone still training as a generalist to do much of anything. I believe it is that culture that has contributed to the acceptance of the new alcohol policy, and it is my hope that UCSF grows to appreciate that students need to be given a certain amount of freedom to grow. While legal counsel will usually advise taking an approach that avoids risk of liability or mistakes, it is up to clinical instructors and policymakers to take appropriate precautions to minimize risks and maximize learning while giving students the opportunities they need to become the best they can be.