Life ‘Up’ Close and Personal for Medical Students

A professor reflects on why he shows the beloved British series to his medical students

Published on June 26, 2013by David Blane

The Up series is a long-running series of documentary films that has followed the lives of a group of British children of various socio-economic backgrounds since 1964. Every seven years, director Michael Apted checks in with each of them—if they are willing to be filmed. Earlier this year, the eighth in the series, 56 Up, was released to notable reviews. Dr. Blane has taught using the Up series to the myriad medical students who have passed through his class. Here he reflects on the value of teaching with Up. 

I’ve been showing the Up series to my undergraduate medical students at Imperial College London for some 30 years. Since it is one of the largest medical schools in the city, this means that somewhere between 10-30 percent of London-trained doctors have seen at least some of the series.

I introduced the Up series in my teaching when I redesigned it around the theme of the life course, to give living examples of individual continuity and change. In this aim it proved so successful that the series quickly became one of the favorite and longest remembered parts of the curriculum.

I have showed my students the series because they can identify with the characters’ aging process. When my students watch Seven Upthe interviewees at age seven—the children are engaging, and my students can just about remember what it was like when they were that age—when 50 pence (77 cents) was a lot of money, a weekend was a long time, and the summer vacation lasted forever.

Next I have showed them 21 because by then my medical students are about the same age as the interviewees. Although, as it was 1977, the cast looks like they are from another country, in terms of clothes and hair and so forth, my students recognize in them the same concerns they have: Who am I? What is love? What is sex? How do I cope with the adult world?

In the final part of my five-week course I showed them 42: Forty Two Up when these same individuals are more or less the same age as my students’ parents. There is stunned silence. They think, is this what I will become?

The Up seriesSeven Up, 7 Plus Seven, 21, 28 Up, 35 Up, 42: Forty Two Up, 49 Up, 56 Up—that’s a long-term commitment, for which I will always be grateful to the documentary’s participants and to Michael Apted who directed the majority of the series. It’s an amazing achievement.

In 49 Up the interviewees were asked to reflect on their participation in the series. For some it was a source of distinction. It puts them at center stage for a change. For most it seemed to be a public duty delivered stoically but with some fascination. Every seven years they think, What have I done since last time? For others it was an unpleasant experience bravely endured, like a drop of poison every seven years.

The Up series is similar in certain ways to a group of national epidemiologic studies called the British Birth Cohort Studies, comprising principal studies of people born in 1946, 1958, 1970 and 2000, which started at birth and visited their participants every few years across life. The National Child Development Study (NCDS) cohort members, for example, were born in 1958 and re-visited at ages 7, 11, 16, 23, 33, 42, 45, 50 and 55 years. These cohort studies differ from the Up series in having directors who have been replaced over time and, most importantly, in the anonymity of their participants—in contrast to the Up series participants who, if you have watched the series, you would recognize in the street as someone you have known since childhood. But they are similar in that they give insight to how people change over time.

After I introduced the series in my classes, its benefits quickly became apparent. It taught my students to think of their patients’ past and futures, as well as their present, giving life and lived experience to medicine’s traditional concern with etiology (past causes) and prognosis (future outcomes) as well as the diagnosis and treatment of presenting symptoms and disease. It showed how disease is intertwined with life: the profound effect it can have on one’s personal and social development, the range of ways a person can respond to such misfortune, and how people think about their illnesses not in terms of the medical name of their disease but in terms of what the disease prevents from doing.

The Seven Up series also is an excellent aid to teaching longitudinal data analysis.  My colleague Dr. Gopalakrishnan Netuveli, a professor of public health at the University of East London, in his classes discusses the coincidence that the Seven Up participants more or less share their birth year with the 1958 British Birth Cohort Study (NCDS) members. First he introduces his students to NCDS data and teaches them how to analyze the NCDS birth data cross-sectionally. Next he shows them Seven Up and challenges them to generate hypotheses about change and continuity between birth and age seven years which, after he has taught them how to analyze change data from two time points, they test on NCDS birth and age seven year data.  Finally he shows them 21, teaches them the analysis of change data from three time points and asks them to test their hypotheses on NCDS birth, age seven, and age 23 data.

In short, the Up series is a tribute to its participants and director, a humanizer of medical students and a valuable teaching resource.

Edited by Dana March and Elaine Meyer.

Images courtesy of First Run Features.