In this extra post, Colette Revadillo, David Geddes, and Anya Tan showcase  APEX 7, an upcoming student-led medical research expedition to Bolivia that seeks to advance the field of high-altitude medicine. Colette, David and Anya are currently undergraduate Medical Students at the Edinburgh Medical School and are all part of the APEX Committee

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What can medical students achieve during their time in medical school? It’s easy to assume that our journey is all about mastering anatomy, perfecting clinical skills, and keeping up with exams. But what if we could go beyond this? What if, during our time as students, we could lead international research expeditions, contribute to groundbreaking discoveries, and push the frontiers of global health—all while balancing our studies?

This is precisely what Altitude Physiology Expeditions (APEX), a Scottish charity founded by University of Edinburgh medical students, has made possible for over two decades. Established in 2001, APEX has organized six successful high-altitude research expeditions, with the seventh—APEX 7—scheduled for the summer of 2025. Each expedition is student-led, giving participants an unparalleled opportunity to engage in research, build leadership skills, and make tangible contributions to science while still in medical school.

APEX: A unique blend of education and innovation

The core mission of APEX is to study the effects of hypoxia—reduced oxygen levels at high altitudes—on the human body. While this may seem relevant only to mountaineers or elite athletes, hypoxia research has far-reaching applications in healthcare, especially for conditions like chronic obstructive pulmonary disease (COPD) and heart failure. By understanding how the body adapts to low-oxygen environments, we can develop better treatments for patients suffering from oxygen deprivation.

What makes APEX truly exceptional is its commitment to student leadership. Medical students organise every aspect of the expeditions, from research design and fundraising to logistics and safety management. This level of responsibility gives us the chance to take what we learn in the classroom and apply it in a high-stakes, real-world setting.

APEX 7: The most ambitious expedition yet

APEX 7, planned for June and July 2025, promises to be the largest and most ambitious expedition in APEX’s history. With a team of 80 to 100 volunteers from the University of Edinburgh, we will travel to Bolivia, where we’ll spend 16 days conducting research at high altitudes. The journey will take us to La Paz (3,800 meters) for acclimatisation before moving to the Huayna Potosi Base Camp at 4,700 meters, where most of the research will occur.

One of the most exciting aspects of APEX 7 is its scale – it will be the largest controlled ascent ever conducted in medical research. The expedition is being led by eight senior medical students who previously participated in APEX 6. Balancing their academic commitments with the demanding task of organising this expedition, these students have been working for months to plan research projects, secure funding, and ensure the safety of all participants.

Among the student leaders are:

• Ben Harrison (Head of Funding, Grants, and Sponsorship)
• Ella McElnea (Head of Volunteers and Well-being)
• Cami Maezelle (Head of Funding, Grants, and Sponsorship)
• Anya Tan (Head of Research)
• Cameron Norton (Expedition Leader)
• David Geddes (Expedition Leader)

As part of this team, I can say firsthand that organising APEX 7 has been an incredible learning experience. We’ve gained skills in project management, teamwork, and research that go far beyond traditional medical training.

Research at high altitude: A hands-on learning experience

The heart of APEX lies in its research. Some of the exciting research projects planned for APEX 7 include:

• Gene expression at high altitude: This study will analyse how certain genetic variants regulate gene expression in response to hypoxia. By identifying these genetic markers, we can better understand why some individuals are more susceptible to altitude sickness or hypoxia-related conditions.
• Altitude and eczema: This project will explore whether high-altitude environments can alleviate symptoms of eczema, a condition often worsened by allergens and humidity. We will compare eczema severity in participants at different altitudes to see if there’s a correlation.
• Cortisol variation: Using a novel device to measure cortisol levels in the interstitial fluid over 24 hours, we will study how hypoxia affects the body’s stress response. Understanding this could lead to better management of stress in patients experiencing hypoxia.
• Cognitive performance under hypoxia: We will also assess how cognitive abilities are affected by altitude, testing participants at various points during the expedition to determine how decision-making and problem-solving skills are impacted by reduced oxygen levels.

These projects not only allow us to contribute to cutting-edge medical research but also give us hands-on experience of the scientific process—from study design and data collection to analysis and publication. It’s a rare opportunity to be directly involved in research that could have real-world medical applications, all while still in medical school.

What APEX teaches us: Lessons beyond the classroom

APEX is more than just a research expedition; it’s a powerful learning experience. Organising and leading an expedition of this scale requires skills that we don’t always develop in traditional medical education—leadership, problem-solving, and interdisciplinary collaboration. These are the kinds of skills that will serve us well throughout our medical careers, whether we pursue clinical practice, research, or other paths.

Being part of APEX also reminds us that medical school is about more than just learning from textbooks and lectures. It’s about exploring new areas of interest, taking on challenges, and pushing ourselves to make meaningful contributions to the field of medicine. Through initiatives like APEX, students have the chance to take ownership of their education and create opportunities that will shape their future careers.

Getting involved: A call to action

If you’re a student at the University of Edinburgh interested in medical research, global health, or expedition medicine, APEX is an unparalleled opportunity to get involved. Recruitment for APEX 7 volunteers will begin this autumn, with information sessions and workshops available for those who want to learn more. Whether you’re interested in scientific research, logistics, or volunteer coordination, there’s a role for you in APEX. Please email: apex7@altitude.org to register your interest!

In short, APEX 7 is a testament to what medical students can achieve when given the opportunity to lead, innovate, and explore. We’re not just learning medicine—we’re making discoveries that could change it. And that, I believe, is what makes APEX so special.

Read previous Teaching Matters blog posts on APEX expeditions:

• The APEX 5 Expedition: The Peak of Altitude Research
• APEX 6: Student-led learning in the Andes

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Colette Revadillo

Colette is a 5th Year Medical Student, and Head of Communications of APEX 7.

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David Geddes

David is a 4th Year Medical Student, and Expedition Leader of APEX 7.

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Anya Tan

Anya is a 6th Year Medical Student, and Head of Research of APEX 7.

In this extra post, Dr Adan Chew, Dr Jess Gurney, and Dr Magdalena Cerbin-Koczorowska, from Edinburgh Medical School, explore the concept of student-centred education through the lens of medical education and clinical practice. In considering different learning theories, they foreground the importance of social and cultural influences, and the uniqueness of the individual, on learning.

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A superficial understanding of a student-centred approach to education may falsely lead to the belief that standardisation of teaching activities can become a source of high-quality education.

The concept of student-centred education (SCE) has existed in literature for many years. It entails a shift in focus of the educational process from the teacher to the student. Higher education institutions have to find their place in the commercial and competitive market of educational services. which can result in a risk of misinterpretation and a superficial understanding of the SCE approach ​(Fawns et al., 2021; Trinidad, 2020)​.

Identifying a ‘competent student’ as a product of robust teaching activities without acknowledging the philosophy behind it, the power of the student-teacher relationship, and the nature of the learning process, may falsely lead to the belief that the standardisation and detailed evaluation of teaching activities leads to outstanding education ​(Trinidad, 2020).​ On the contrary, it has the potential to negatively affect teachers’ creativity and self-esteem ​(Fawns et al., 2021)​. Additionally, this belief opposes the concept of students as co-creators, which has been suggested as a future direction for higher education ​(Bovill, 2020; Stoddard et al., 2024)​.

At the decision-makers’ level, a superficial approach could be adopted due to a misunderstanding of the concept of standardisation as promoted by the World Health Organization and the World Federation of Medical Education (Weisz & Nannestad, 2021). The movement toward the “market model of the university” results in higher education institutions imitating behaviours and elements of organisational culture from large corporations ​(Jongbloed, 2003)​. Although standardised measurements of students’ knowledge and clinical competencies are seen as a driver for high-quality medical education ​(Scoville & Bisson, 2018), some institutions have attempted to standardise the delivery of educational interventions in response to the challenges of mass education ​(Mierzwa & Mierzwa, 2020)​.

This approach seems to contradict what is understood about learning. As we outline here, an exploration of the predominant learning theories demonstrates that not only should each learner be treated as an individual with their unique learning readiness and abilities, but the dynamic and multifactorial nature of the educational environment cannot be ignored.

Starting from the behaviourist approach, which suggests that learning is underpinned by habit formation, the response to a standardised stimulus will differ across individuals (Hull, 1943). The response is shaped by learners’ unique biological features (such as the number and sensitivity of receptors) and previous experiences which shape neural structures and cognitive abilities. Even if it could be widely agreed on how one defined the intended effect, the type of reinforcements and punishments considered more or less effective and the time of stimulation needed to achieve the intended effect will vary across learners.

Analysing the nature of learning through the lens of constructivism requires considering the importance of prior knowledge and existing mental frameworks. As these vary among our learners, the same information is perceived differently based on aspects such as cultural background and prior learning experiences. Clinical practice is varied and uncertain, meaning each learning event is a unique experience. Moreover, learner motivation to reflect upon experiences and actively construct their own understanding might differ based on temporary psychosomatic conditions, which in turn impact factors that affect intrinsic motivation, such as perceived control and task value (Eccles & Wigfield, 2002). This ultimately influences how learning messages are interpreted.

Finally, the social aspect of learning cannot be omitted. Clinical practice and training often occur in various learning settings, with different mentors and peers, forming communities of practice (Lave & Wenger, 1991). Furthermore, learners assume different identities – some are mentors themselves, or some may be guided to different extents by teaching fellows, professors or clinical supervisors. This in turn brings their unique experiences and cognition perception into the shared repertoire in varying settings.

Indeed, this is also dependent on the extent of engagement learners have integrated with their respective communities of practice (ibid.), coined by Lave and Wenger as “peripheral participation” (1991). It is simply too easy for standardised educational practices to disregard the multifaceted aspect of learners’ experiences. Since each learner has unique interactions and interpersonal experiences, the learning process becomes personalised and distinct for each individual.

Considering the above models that foreground the importance of social and cultural influences on learning, the pursuit of standardising the delivery of teaching activities may not only fail to bring the intended results but is also literally impossible. This is especially the case for a clinical teaching environment, where the social aspect is even more dynamic.

Finally, keeping in mind the above-mentioned importance of observational learning, we need to be aware that how different members of higher education institutions approach various aspects of the educational process may stimulate but also distort its true nurturing value. Bates et al. ​(2019)​ state that, “The inevitable diversity of contexts for learning and practice renders any absolute standardisation of programs, experiences, or outcomes an impossibility.”

There is simply no ‘one size fits all’ approach to student-centred education. Even though, as humans, we strive to minimise uncertainty by categorising our observations and generalising them, educators (including decision-makers) must acknowledge and become equipped to deal with this uncertainty. Instead of confining teaching activities to uniform and limited parameters, utilising pedagogical expertise in combination with creativity and courage allows us to embrace the precious uniqueness of learning.

References

​​Bates, J., Schrewe, B., Ellaway, R. H., Teunissen, P. W., & Watling, C. (2019). Embracing standardisation and contextualisation in medical education. Medical Education, 53(1), 15–24. https://doi.org/10.1111/medu.13740

​Bovill, C. (2020). Co-creating learning and teaching: towards relational pedagogy in higher education. Critical Publishing.

​Eccles, J. S., & Wigfield, A. (2002). Motivational beliefs, values, and goals. Annual Review of Psychology, 53(1), 109–132. https://doi.org/10.1146/annurev.psych.53.100901.135153

​Fawns, T., Aitken, G., & Jones, D. (2021). Ecological Teaching Evaluation vs the Datafication of Quality: Understanding Education with, and Around, Data. Postdigital Science and Education, 3(1), 65–82. https://doi.org/10.1007/s42438-020-00109-4

​Hull, C. L. (1943). Principles of behavior: An introduction to behavior theory. Appleton-Century.

​Jongbloed, B. (2003). Marketisation in Higher Education, Clark’s Triangle and the Essential Ingredients of Markets. Higher Education Quarterly, 57(2), 110–135. https://doi.org/10.1111/1468-2273.00238

​Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge University Press.

​Mierzwa, D., & Mierzwa, D. (2020). Organisational culture of higher education institutions in the process of implementing changes–case study. Journal of Decision Systems, 29(sup1), 190–203. https://doi.org/10.1080/12460125.2020.1848377

​Scoville, J. P., & Bisson, E. F. (2018). Quality and standardization of medical education. In Quality Spine Care: Healthcare Systems, Quality Reporting, and Risk Adjustment (pp. 15–28). Springer International Publishing. https://doi.org/10.1007/978-3-319-97990-8_2

​Stoddard, H. A., Lee, A. C., & Gooding, H. C. (2024). Empowerment of Learners through Curriculum Co-Creation: Practical Implications of a Radical Educational Theory. Teaching and Learning in Medicine. https://doi.org/10.1080/10401334.2024.2313212

​Trinidad, J. E. (2020). Understanding student-centred learning in higher education: students’ and teachers’ perceptions, challenges, and cognitive gaps. Journal of Further and Higher Education, 44(8), 1013–1023. https://doi.org/10.1080/0309877X.2019.1636214

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Adan Chew

Dr Adan Chew is an academic foundation doctor and a student in the MSc Clinical Education Programme at Edinburgh Medical School. She has a keen interest in medical education, and also enjoys hiking and running in her spare time.

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Magdalena Cerbin-Koczorowska

Dr Magdalena Cerbin-Koczorowska directs the MSc Clinical Education Programme at Edinburgh Medical School.

 

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Jess Gurney

Dr Jess Gurney is a Lecturer on the MSc Clinical Education, and works clinically as a doctor in Medicine of the Elderly.

In this post, Dr Avita Rath explores the topic of emotional labour, and its impact for those working in Higher Education. Avita is a year 3 distance learning student (MSc Clinical Education) at Edinburgh Medical School. This post belongs to the Hot Topic theme: Critical insights into contemporary issues in Higher Education.

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Beyond the “Service Smile”

Behind the carefully crafted smiles, the reassuring words, and the meticulously managed demeanour lies a silent toll, a heavy burden we carry. In academia, we’re often expected to suppress our true selves, conform to a narrow definition of “professionalism,” and mask the real emotions that shape our experiences. This unseen, rarely acknowledged labour is a storm brewing beneath the surface of our work, threatening to drown us in a sea of burnout and exhaustion.

As sociologist Arlie Russell Hochschild (1983) famously coined it, emotional labour is the invisible work of managing our emotions to meet the demands of our job. It’s about regulating our feelings and expressions, often at the cost of our well-being.

While emotional labour has been studied extensively in various fields, it’s often overlooked in higher education. Why? Because we tend to conflate it with professionalism, viewing it as a natural and expected part of the job rather than a form of labour that needs to be recognised and compensated. This is particularly true in the context of marketisation, which has transformed universities into “service institutions,” where academics are increasingly expected to cater to the needs of students and stakeholders.

This “professionalism,” however, can be a double-edged sword. It often involves suppressing genuine emotions and conforming to a set of unrealistic expectations. As Ogbonna and Harris (2004) noted, the “professional” persona academics are expected to project can create a “gap” between their true selves and their public performances.

A personal journey and a broader truth

As a neurodivergent woman in a predominantly Asian academic setting, I’ve experienced this gap firsthand. The cultural taboo surrounding emotional expression, particularly for women, combined with the pressure to conform to a narrow definition of “professionalism,” created a sense of alienation and isolation. I often felt like I was performing a role, hiding my true self behind a carefully constructed mask.

Imagine, for a moment, the demanding life of a dental academic like myself, or any academic for that matter: you’re expected to be a skilled clinician, a mentor, a teacher, a researcher, and a leader – all at once. This constant pressure to excel in multiple areas fuels the need for emotional management, often at a significant cost.

This emotional strain is not simply a personal experience. It’s a pervasive issue within academia. A recent Nature poll and HEPI policy papers (Forrester, 2023; Morrish, 2021) found that 67% of academics are burned out, with counselling and occupational referrals rising by more than 100% over the past two years. This suggests that emotional labour is not just a personal challenge but a systemic problem within academia that affects our wellbeing and our ability to thrive. Moreover, the rise of “quiet quitting” – where academics are disengaging from their work by reducing their output and limiting their involvement – is another alarming sign of the impact of emotional labour in academia.

As Shuler (2007) aptly points out, “[as] scholars and practitioners… we often write as if WE are not also engaging in emotional labor” (p. 255). This is the core of the issue. Emotional labour is often seen as an intrinsic part of “caring” professions (Grandey et. al., 2013), yet it’s rarely acknowledged or valued. It is treated as an expected part of the job rather than a form of labour that needs to be recognised and compensated.

The consequences of ignoring this ‘work’ in academia appear to be significant. It can lead to burnout, decreased job satisfaction, and even mental and physical health problems that eventually affect the quality of teaching and student well-being (Berry & Cassidy, 2013; Abery & Gunson 2016). We need to change how we think about emotional labour, recognise its impact, and stop this cascade of worrying reactions.

Moreover, as Bellas and Krupnick (2007) found, this burden is disproportionately weighted on women. Women are often socialised to be more emotionally expressive and nurturing. These societal expectations can lead to a “double bind” for women in academia, who are expected to be both caring and competent but are often penalised for displaying their genuine emotions. This double bind is further intensified for neurodivergent women in academia, who may face additional pressures and stigmas due to the often pervasive cultural taboos against neurodiversity.

A call to action: Valuing emotional well-being in academia

To create a more sustainable and equitable academic environment, we need to:

• Acknowledge emotional labour: Universities need to openly acknowledge the emotional labour that academics undertake and recognise its importance in the performance of educators.
• Promote well-being: Universities should offer programs and workshops focusing on emotional intelligence, self-care, and academic stress management.
• Foster open dialogue: Encouraging open communication and fostering a culture of mutual respect and understanding among faculty members can create a more supportive environment that helps to alleviate emotional distress.
• Reduce administrative burdens: Universities should strive to reduce the administrative burden on academics, allowing them to focus more on teaching and research.
• Embrace neurodiversity: Universities should actively promote neurodiversity and create a more inclusive and supportive environment for neurodivergent academics.

Embracing change for a “hopeful” future

We can move towards a future where academic institutions recognise the human cost of emotional labour. A future where universities prioritise the emotional well-being of their faculty, creating a more supportive and inclusive environment for all. A future where we can move beyond the “service smile” and embrace the full range of our emotions, bringing our authentic selves to our work.

This future is within reach. By demanding change, fostering a more empathetic and compassionate approach to academia, and advocating for a world where emotional labour is recognised, valued, and addressed, we can begin to create a more just and equitable academic environment.

References

Abery, B., & Gunson, C. (2016). This paper applies Berry and Cassidy’s Higher Education Emotional Labour model to the management of extension requests in a short space of time in a large, first year Health Sciences topic. International Journal of Allied Health Sciences Education, 6(1), 22–26.

Bellas, M. L., & Krupnick, C. G. (2007). The Costs of Caring: Examining the Relationship Between Gender, Emotional Labor, and Burnout. Journal of Women and Social Work, 22(4), 381-395.

Berry, K., & Cassidy, S. (2013). Emotional Labour in University Lecturers: Considerations for Higher Education Institutions. International Journal of Curriculum and Teaching, 2, 1-21.

Forrester, V. (2023). Fed up and burnt out: ‘quiet quitting’ hits academia. Nature, 615, 751-753.

Grandey, A., Rupp, D. E. & Diefendorff, J. 2013. Emotional labor in the 21st century: diverse perspectives on the psychology of emotion regulation at work, Routledge.

Morrish, L. 2021. Emotional Labour in the Post-Pandemic Academy. Available from: https://postpandemicuniversity.net/2021/10/31/emotional-labour-in-the-post-pandemic-academy/.

Ogbonna, E., & Harris, L. C. (2004). Work Intensification and Emotional Labour among UK University Lecturers: An Exploratory Study. Organization Studies, 25, 1185-1203.

Shuler, S. (2007). Autoethnographic Emotion: Studying and Living Emotional Labor in the Scholarly Life. Women’s Studies in Communication, 30, 255-283.

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Avita Rath

Dr Avita Rath is a year 3 distance learning student (MSc Clinical Education) at Edinburgh Medical School, The University of Edinburgh. She is also a senior lecturer, academic coordinator and periodontist at the Faculty of Dentistry, SEGi University, Malaysia. She is a Common Wealth scholar, a Fellow in Advance Higher Education, UK (FHEA), and an Association of Medication Education in Europe (AMEE) member. Some of her research interests include equity, diversity and inclusivity issues in health professional education, mindfulness in dental education, and student engagement concepts. . She would like to thank Professor Gill Aitken, her Master’s supervisor, without who she would never been acquainted of this ‘invisible’ work that led to this blog post.