ACP Japan – what I learned about medical education

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Category : Medical Rants

David Fleming (immediate past-president) and I are currently in Kyoto. Today David speaks at ACP Japan meeting and tomorrow we both speak.

Last night we had a delightful authentic Japanese dinner with key members of the Japan ACP chapter.

We had an excellent conversation about medical education over dinner. One physician had done fellowship in the US and thus could provide a wonderful comparison.

The discussion of medical student preparation was particularly enlightening. In Japan, as in many other countries, students get accepted to medical school directly after high school. He opined that their students get into medical school based on test results, but they have not had enough life experience in his opinion. He bemoaned the students lack of communication skills.

We are sometimes better in the US, but not always. Medical schools have focused primarily on MCAT scores and college grades. Some schools are actively trying to get liberal arts majors to apply to medical school.

Our problem, like other countries, is that we focus very heavily on test taking ability. We need satisfactory scores on tests to get into the “right” college, medical school and the “right” residency. We need to pass a variety of multiple choice tests.

The problem, as I see it, is that doctoring requires many dimensions of expertise. We need to know facts, but just as important we need to be able to glean information from the patient. We need to work with patients to help them understand their diagnoses and how we recommend treating those diagnoses. We need to have appropriate humility, understanding that our first conceptualization of the patient’s problems may be incorrect. We need to know when to ask other physicians for help.

Our reliance on multiple choice testing means that we only really measure one dimension. We who teach students and residents can all recall learners who do great on multiple choice tests but fail at the bedside. Likewise we know learners who struggle with the multiple choice but make excellent decisions at the bedside.

Can we develop a system for picking the right medical students and the right residents? We fall back on standardized tests because this strategy is rather straightforward and hard to criticize. But are we using testing as a crutch rather than working through a much more complex screening process.

My Japanese colleague’s questions about how their students matriculate raised similar questions about the US system. What do you think?

Comments (3)

Dr. Centor, you have summarized an excellent argument against MOC: “reliance on multiple choice testing means that we only measure one dimension.” It it truly pathetic ABIM will not respond to Newsweek charges or to diplomates concerns about these charges. Amazing that physicians cannot accept a pen from a drug company, but ABIM CEO can walk away with an alleged $1.8 million payday in one year while preaching stewardship and choosing wisely to the peons forced to participate in her game. Where is the outrage? It amazes me that ACP is so quiet on this issue. Diplomates are entitled to an answer about these serious charges; boilerplate denials are truly insufficient. What do the Japanese physicians think about this nonsense?

I think this has been going on since I was in medical school and in the generation before I went to medical school.
So it’s still a problem after at least 70 years. You’ll excuse me if I have my doubts about solving the problem.
In fact, while I can’t be sure, i think the liberal arts and humanities background of students is, if anything getting worse.

I just want to point out that the necessary skills of surgeons, radiologists, psychiatrists, pathologists, pediatricians, internists etc all differ to some degree. Some are less dependent on communication skills than others.

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