Medical

Q&A with Rajiv Sethi, Medical Student, Clinical Entrepreneur Fellow

Rajiv Sethi is currently a student doctor in London, Clinical Entrepreneur Fellow at NHS England, and the founder of Sethi Health, an organization that collaborates with students, patients, professionals, and the public to improve healthcare and health education globally.

He has taken time out during medical school to undertake postgraduate studies in Public Health at the University of Manchester. He completed his MBA at Anglia Ruskin University, where he worked with the Global Health department at Health Education England. Following this, Rajiv has continued this work as Honorary Research Fellow.

He is also a faculty member of Barts X Medicine at Queen Mary University of London, the world’s first digital health module for medical students, and co-founder of the Faculty of Digital Health. He helped pioneer open access learning in health through International Collaborative Grand Rounds in March 2016.

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Mr. Sethi has co-authored a book, been published in leading journals, and presented his work nationally and internationally. He is a keen drummer, having performed world music with Explosive Group since the age of 14. They have performed for thousands of people across the UK, Europe, Dubai, and India.

When did you first decide to become a doctor? Why?

I’ve always wanted to do everything, as is true of people who have varied interests and don’t want to let go of any! I loved learning, but at 15, as per the educational system demands, I had to begin thinking about what I might like to do in the future. So I was confused. But I knew for certain that I was interested in how society worked, and how its members could cooperate to help one another. I went about organizing as much work experience and volunteering as possible. Much of this was in hospitals and care homes. While I was inexperienced and had little knowledge of treatments and procedures, I could see myself working as a doctor and saw how impactful and rewarding a career this could be. Volunteering regularly at places like the Trafford General Hospital (the first NHS hospital in the country) and helping in ways such as operating the tea trolley service allowed me not only to interact with patients, but also observe how the wider multidisciplinary team worked together in the care of a patient.

Prior to university, I was chosen to represent the North West of England as well as be the National Youth Hindu representative at the 1st National Interfaith Week in Westminster, which was all about bringing people together from different backgrounds to build mutual understanding. Being born and bred in Manchester, I was heavily invested with community and charity projects; these experiences also helped inform my desire to pursue a career in medicine.

How/why did you choose the medical school you attended?

I was lucky to receive three offers, which made it tougher to make the final decision. I wanted to go to a medical school/university which would allow me to interact with people from all walks of life. It’s part of the reason why I enjoy a university like King’s: it’s such a large university with so many different disciplines, and it allowed me to get involved with a wide variety of activities and opportunities.

I guess the more teenage reason for why I chose Kings was that it sounded good and I knew of friends in medical school who were at Kings. One of my role models was a family friend who, like myself, was also from a non-medical background and a clinical medical student at King’s. He was hugely inspirational to me: he mentored me and helped me to understand more about a career in medicine.

While at university, I have made every attempt to understand the wider world. The more you put in at uni, the more you get out. I somehow ended up as President of King’s College London Interfaith Network in my first year, which was carrying out important work in bringing together students from various walks of life through speaker events, interfaith week and a cross-campus festival. Being part of a non-medical activity or society provides a refreshing perspective on society and allows you to meet a wide variety of individuals from different disciplines.

What surprised you the most about your medical studies?

Leaving home was strange, as I’m quite family-oriented. I returned home frequently to catch up with family and friends. I think support networks are incredibly important. Stretching your comfort zone is crucial. If you don’t make the effort to establish new networks, you don’t know anyone, and no one knows you. Large medical schools often have over 400 students in each year. If you don’t try to connect, you are going to be left as an ID card number. Opportunities rarely find you, so if you want something, you really do have to go and get it.

Apart from this, there is the unfortunate fact that medical training is often delivered in isolation. While you might have been a people-person at 15, by the time you’ve left medical school, you risk reducing your view of the world. It is very easy just to socialize with other medical students or doctors. Taking advantage of the variety of clubs and societies at your university and keeping in touch with old friends and family can help avoid this.

What information/advice do you wish you had known when you were beginning your medical studies?

I wish I’d known that I didn’t only have to be defined as just a medical student. In those first few years, when asked to introduce myself, I would say “I’m a medical student.” That’s where the conversation would start and stay. The advice I would give my younger self would be that if I’m going somewhere, I should go unbranded. I don’t have a label saying medical student, so I don’t have to act like that’s all there is to me. We are human first.

How have you prepared yourself for a diversified career?

The things which medical CV building call for—getting involved, trying to get publications—can encourage you to try new things, but can also lead to competition, and to doing things because you “have to” rather than because you want to.

I eventually took time out to complete postgraduate studies in public health and business. Public health is such a broad area. As Andy Burnham, Mayor of Greater Manchester, says, ‘There’s no health without housing, no health without the environment’. Everything is inter-related. If we don’t know what role every stakeholder plays in the system, how are we going to be able to make an impact? The same is true for inter-professional learning: if we don’t know what a nurse does, how will we know our roles as an F1 doctor/intern? It’s a small, but crucial learning point….

I self-arranged a SSC with the Dean of the medical school which involved working on the new medical curriculum 2020. This was a new experience which was challenging but exciting, too, as it was the first review of the curriculum since the 1990s. My work centred on the theme of preparation for practice (i.e. the transition from medical student to an F1 doctor/intern). I was awarded the Sir John Ellis Prize, a highly regarded national prize for medical education by the Association for the Study of Medical Education for our work. I would strongly encourage students to follow their own interests by creating their own projects and garner support from a faculty member to make this possible. Don’t be afraid to submit your projects to conferences or for prizes! What’s the worst that can happen? It doesn’t get accepted. Feedback from peers and reviewers is valuable for improving on future work…

My networking skills have grown a lot through pushing myself outside of my comfort zone over the years, and social media has allowed me to connect with like-minded people from across the globe. This has been invaluable in some of my research in medical education and public health campaigns such as #NamasteHealth… Each experience really does shape your future trajectory and I have learnt a huge deal till date.

What’s your typical work-week like?

I’m based in the hospital or GP surgery during the week. Where possible, I endeavour to follow the patient journey from admission to discharge. As students, we have the unique opportunity to ask many questions and shadow other professionals in the multidisciplinary team. Having an insight into these unique journeys and how each expert and process contributes to the care of patients is invaluable learning and will set me in good stead for the future.

What specialties are you considering?

As you have probably guessed by now, I thoroughly enjoy being in the hospital and primary care environment. I have tried to experience as many specialities as possible inside the hospital and beyond by attending study and insight days or taking part in research projects. ..

Since completing a longer primary care placement I believe primary care (family medicine) is an appealing specialty, especially in the UK, where a general practitioner is arguably the most important clinician in the community. They not only have to have good holistic knowledge, they also have to make the right call at the right time. As essential gatekeepers of the NHS, it’s a challenging but rewarding job. A GP can have a portfolio career as well; this suits me, as I’m keen to be able to continue my portfolio of diverse interests. Let’s see what happens!

Tell me more about how you started Sethi Health.

Sethi Health was founded in my second year of medical school when I had just started to go beyond the traditional medical curriculum through reading articles and blogs, as well as attending events on themes such as quality improvement, innovation, technology and education. It has grown over the years with the support of a diverse team to pioneer and deliver some great work to improve both healthcare and health education on the UK and globally.

What made you do an MBA?

I took business studies at GCSE (General Certificate of Secondary Education), and was also awarded the Midland Bank Prize for Business Studies. My brother founded an entertainment company in Manchester nine years ago, and this was my first foray into business. I was 15; he was 17. That’s grown from us offering DJ and entertainment services to private and corporate UK clients, to going worldwide. It taught me lots: how to put the customer first, to provide a professional and transparent service, to have the right people involved, and to put on high quality performances and events, skills I’ve been able to apply across my ventures… This experience, coupled with my desire to make an impact in health on a wide scale, led me to pursue a MBA degree….

What have you learned from starting up collaborative projects?

Connecting with the right person is important, as is sharing the same values and goals. Meeting the wrong person can sometimes stop your work from progressing especially within larger organisations. The beauty of collaborative projects is the larger impact these can have, bringing together similar synergies and striving towards goals together. During the first international collaborative grand round, we brought together students and faculty from many countries and it really did show that collaboration will always achieve more than competition.

How do you balance work and life outside of work?

I enjoy playing hockey, spending time with my dog. Aside from my projects, I’m a performing dhol drummer. This is great outlet for creativity and allows me to be part of a different world. We have been featured and interviewed on Radio and TV stations across the UK and globally. As performers we have also been able to use our art to support and raise money for charitable causes. Beyond that, our debut single reached the top 40 on iTunes World Music charts in 2012.

What types of outreach/volunteer work do you do, if any?

I set up the Becoming a Doctor volunteer-led initiative and website which offers free support for prospective and current medical and allied health students. Our conference last year had over 1000 delegates and was supported by over 30 organizations including several universities, Royal Colleges, Medical Schools Council, GMC, BMA, and Student BMJ. We have a growing team of volunteers who deliver an extensive outreach programme by visiting schools, colleges, charities and hospitals to deliver interactive sessions. It has been very rewarding to help inspire the next generation of doctors and allied health professionals…

From your perspective, what is the biggest problem in healthcare today?

The NHS has a lot of patient data which could be used to improve patient outcomes through influencing research and treatments. There is the danger of health not keeping up to date with the advances in technology. There are rising demands and limited, sometimes diminishing, resources for health provision. How do we maximize value? What should be prioritized? How do we go about this? Our populations are living longer with multiple long-term conditions: how can we enable a high quality of life for these people? There is the towering threat of antibiotic resistance. These are all important issues which must be at the top of the agenda.

I am also keen to ensure there is parity between mental health and physical health. We need to break taboos and have much more support for mental health and wellbeing across all sections of society. This requires a multidimensional approach. There might be plenty of challenges, but through collaboration, innovation and technology we can face these.

What are the biggest issues in medical education?

The models of training for medical education are driven by competition, ranking, points, publications etc. But how many teams are there in medical school? 500, because everyone is in their own team. But let’s say something like a hackathon is organized on the first day of medical school. Everyone comes in, and must pitch a problem in healthcare, by working in multidisciplinary teams for a week, even including engineers and computer scientists. This would truly create interdisciplinary collaboration and bring innovative change change to the culture in medical schools. We need to foster collaboration, not competition!

Where do you see medicine at large in five years?

I see patients leading the conversations. We know that patients are the experts in their condition, and it is only right that they curate the health conversations and interactions that they have. There are growing communities of patients on social media which are sharing a wealth of information on treatment and health experiences.

The intersection between technology and health has never been so exciting and tangible; however, we must ensure that technology does not widen inequalities in access to health. Not all tech will bring benefits so it’s important to evaluate each intervention as with any other treatment.

I also see a growing recognition and tangible steps being made to make #HealthForAll a reality. It is imperative that all members of the world have access to health provision and we must all help make this a reality.

Where do you see medical education in five years?

Students will be seen as partners in education with much a greater involvement in the design and delivery of education. We have already seen the power of Massive Open Online Courses (MOOCs) in helping make knowledge open access.

People may not pay for education to the same degree they do now. There is a rise in millennials looking for a sense of purpose and meaningful impact on the world. We are also seeing a return of apprenticeships, and I think it is important to recognize that we do not always have to reinvent the wheel. Apprenticeships offer hands-on experiences with responsibility—it is easy for medical students in the UK to feel as glorified work experience observers and this translates during the transition to being a junior doctor. How can you expect a medical student to be a doctor if the student has never been given any responsibilities? Of course, there is a fine line, as it would not be beneficial to students or patients to have students in service provision roles.

How do you hope to change education?

I helped establish the Faculty of Digital Health. One of the aims of the Faculty of Digital Health is to influence universities to incorporate digital health into their curricula for all health students. This is building upon existing new programs such as Barts XMedicine, the first digital health curriculum which Professor Shafi Ahmed launched in January 2017.

We will be identifying competencies and developing professional standards for digital health education. This will help lead the conversation on how digitally competent doctors and health professionals can be developed, beyond writing emails and completing emails. How can health professionals play a role in the development and implementation of digital health tools?

What is your final piece of advice for medical students looking to diversify their careers?

My top tip would be to go to an interdisciplinary hackathon before graduating from medical school! Beyond this:

Take every opportunity to network. Get emails, go to events that interest or don’t interest you, go to events that are totally unrelated to what you’re studying. Teams exist because everyone comes with different skills. You need to have a non-medical network.

Maximize your student status. Students get into places for free or minimal costs; doctors don’t. Once you qualify and get a job, that malleability and openness to new insights can significantly reduce. At the point of choosing a specialty, you become part of a club and this might make you less like to entertain different views.

Be active on LinkedIn and Twitter! For social media practices: tweet only what you would say in public. Social media plays a big part in developing your profile. I initially doubted its value but started using Twitter when I went to medical conferences and started contributing to academic discussions. I’ve been able to initiate a lot of collaborative work using social media. It can be easy to be impulsive, so always think carefully before posting in excitement. Lastly, always be kind, honest and collaborative.

I would love to connect with anyone interested and it would be great to hear from you too – drop me a line at [email protected]