Why make medical school miserable?

To the best of my knowledge, we make medical schools miserable for a handful of reasons.

1: It’s much more socially acceptable to have a bean counter as your dean/president/department chair than someone who will beg, borrow, wheedle, and bargain for things to help the students. In academia, whenever someone has a new idea to try for teaching, the first two questions asked are “How much will it cost? And, has it worked somewhere else?” My thought is the response should be consideration of merit and testing. Loss 1 for the scientific principle (no testing of a hypothesis)

2: With the USMLE Step 1 exam that must be passed at the end of the basic sciences, there is a test to teach to. This is great because it codifies goals, but the goals are externally codified, and also the process of a black box. Loss 2 for the scientific method (no possibility of refinement of the question because it’s from a black box)

3: There is still a goal in each medical school administration I have met to “enhance the prestige of our institution” which is usually treated in the same way that a publicly traded company will trade long-term success for short-term profits. I have yet to hear of a dean saying “We’re in a university, so we shall raise our prestige by teaching, dammit!” Hearing about that would be a good day. Loss 3 for the scientific principle (not testing the hypothesis, but couching the argument aesthetically)

I don’t really see there being a big change in medical education until the thrust changes from numbers and concepts back to the students. Students have fewer advocates in this equation than many think. Ask your students sometime, how many people really advocated for them, in comparison to how many people were ready to hamstring them. It might be enlightening.

-j

Zelda, you do touch on an interesting note. My sister-in-law is a dentist, and I was going to undergrad in the same city she was going to dental school in the same period. We spoke about many of her classes, and starting early, she had classes and symposia running a business, medico-legal issues, ethics, accounting, how to get a loan, etc.

I think if I brought up to my administration that this is not only good, but necessary, they’d put me on probation for the mere suggestion.

Different worlds, but I don’t understand why. Americans don’t live in an amonetary reality, and the legalities and monetary requirements of starting practice are real, codified, and necessary to process through when getting out of school. But there’s not a whiff of them at my school.

I wonder if that’s academic malpractice?

-j

Deirdre, I looked at your blog entry, and there are good points to it, but it does beg the question: what is the point of recording and podcasting a badly organized or poorly presented lecture? Doesn’t this defeat the purpose?

-j

I’m about to enter 2nd year and I am not looking forward to it! I can feel the depression sinking in already, and classes are still 2 weeks away! How the hell am I going to get through this year?

Well said Summer. I agree.

Medical schools provide information about the basic sciences integral to diagnosis and evidence based treatments of disease. Some of them add a smidgen of statistics or experimental design. If you are lucky, your school has you summarize literature in reports and deliver formal presentations before your peers. Unfortunately, the teaching is hit or miss, and my experience is that is has largely been a miss. But medical school points you the direction of the appropriate textbooks. Unfortunately, you don’t have time to read all of them, so your classmates may point you in the direction of the appropriate abridged textbooks and study questions. There are ample opportunities to participate in research, but the extent of your participation will be limited by your preexisting knowledge of the basic sciences and laboratory etiquette. If you saw this coming or had relatives who saw this coming for you, then you were probably fortunate enough to learn the prerequisite science along with the ins and outs of a laboratory before coming to medical school. Your clinical clerkships provide you with solid opportunities to shadow physicians and other healthcare professionals. You may perform procedures and make decisions, but these opportunities are rare for even the most motivated student. Some attendings and residents avoid you in order to get out of work at a reasonable hour. Others will painstakingly sacrifice their time to make sure you get something out of the experience. Those kind souls are rare unfortunately, and under appreciated. Still, there are other attendings and house officers who will treat you poorly and mockingly because, frankly, the same happened to them when they rotated through their clerkships. Grading is largely subjective in the third year, so many students will pathetically resort to backstabbing and sycophancy. Some services will make good use of you as free labor. You will feel like you are working a 14 hour a day job during your surgery clerkship that interferes with your ability to learn about surgery. You will read instead of sleep for most of that clerkship and feel cheated that you are actually paying tuition. Fourth year is largely a waste of time and money. You will be astonished by the dramatic increase in your tuition despite spending fewer hours at the hospital and in the process forgetting most of what you have taught yourself over the past three years. You will age ungracefully throughout months of having to deal with applications, interviews, and the match. The games programs will play if you’re any sort of desirable candidate will make you wonder if you are going to be dicked around for the next three to seven years like you were in medical school. Sub-Internship is the closest thing you will have to learning what it is like to take care of patients, except that most students are not the least bit prepared for it. Some are forced to make decisions that they are not ready to make. Still, it is a month that I would keep in the curriculum. The board exams are a racket. Why does a graduating medical student have to jump aboard a plane and drop a grand on an examination that makes sure that she or he can communicate effectively with patients, treat patients with dignity, and work up simple complaints? You would think that people in danger of failing such an exam wouldn’t be able to slip through the cracks at an accredited medical school; hence, the accreditation. The truth is that people do fail the exam and often, nobody has the slightest clue why they fail. They are not even told why they fail. They simply must fork over another grand and suffer through the indignity a second examination. Nobody has a clue whether or not the exam and all 12 hours of preparation it entails makes for better physicians. But until the data telling the world that it is all a crock of shit is presented, they will keep charging us a solid G and making us sweat for a long afternoon of examining fake patients at some remote testing facility.

So, what are we gonna do about this?

Doctors who have made it through medical school often feel so relieved that medical school is behind them that they could care less about improving the system. After all, they become interns and residents, and move on to bigger concerns. Medical students are afraid of speaking up because they do not want to draw undue attention to themselves. The system can make or break them. Attendings have it hard when they start out. It’s scary. It’s also a lot of pressure to have waited so long to make money realizing that you must try to make as much of it as possible if you want to pay off loans, own a home, and start a family. Many people stick within the cozy confines of academia and compete for grants and tenure. If that is the life you are chasing, then you can at least find a preview of coming attractions while completing medical school and residency. Those entering the world of private practice become acutely aware of how little their medical school has taught them about running a business and the law. Most medical students are so type A and hell-bent on being the best in their class, that they spend not a second of their time acquainting with economics, finance, and politics. If it is not on the exam or on tap at the bar, then it is not in their interest. The less they know about these subjects, the easier it is for the rest of the world to exploit them when they begin to practice. And that happens to most of them.

So, what are we gonna do about it?