Why make medical school miserable?
Medical Rants October 31st. 2007, 3:20amReaders know that I love medicine. Like many physicians, I really disliked the first two years of medical school, but the third year was very good.
What do we do to medical students during their basic science years? How does that experience influence their choice of specialty?
Not all students have great experiences during their clinical years.
Medical schools unfortunately do not always focus on medical education. They emphasize research and clinical practice because those activities pay the bills. While some faculty focus on medical student education, such faculty seem to be in the minority these days.
Medical school faculty often pride themselves in having a scientific approach, yet how often do we see careful analyses of how we teach our students.
I believe we need a new Flexner report. We need to reinvent medical school. We can do better.
October 31st, 2007 at 4:13 am
In The Netherlands recently colleges for the bachelor phase of education were started and they are very successful. Selection before start of the education nor high grades were predictive for excellent outcome of appreciation by the students but the context of the education was explanatory for the success. Success in the sense of good study results as well as appreciation of the study by the students. Good context means small classes of 25 students, input from teachers in study material, good facilities and taking the opinion and comments of the students on their education seriously.
Also on Universities selection at the start of the study was not predictive of success.
Regards Dr Shock
October 31st, 2007 at 5:42 am
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
October 31st, 2007 at 10:33 am
Med school sucks. I am in the middle of my second year and I am so tired of being tested on boring crap by PhDs who have never seen a real patient. The curriculum at my school keeps all the basic science in the first six months, and the next 18 months involve going into each organ system as a whole and discussing physiology and pathology of that system. However, the people who write my exams always seem more focused on meaningless minutiae…and not anything relevant to evaluation, diagnosis and treatment.
Boring boring boring. I feel like a rat on a wheel. There’s never a break and never anything fun. We have exams on Mondays from 9 til noon and class starts promptly at 1:00 for the next organ module.
THe only light at the end of the tunnel is every other Thursday, when we go into the hospital and do H&Ps and get a little peek of what life will be like for us in the clinical years.
I wish they would scrap the 6 months of basic science and teach us about medical malpractice, insurance, medicare and medicaid, how to run a successful practice, how to negotiate contracts, etc. That would certainly be more useful. There’s not a practicing physician who could tell you (or who cares) any details about the pentose phosphate pathway or the purine synthesis pathways. Because it doesn’t matter.
October 31st, 2007 at 10:56 am
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
November 1st, 2007 at 3:57 am
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November 1st, 2007 at 12:27 pm
I have written extensively about these issues in the . Faculty development is a huge issue when you hire physicians and scientists with no knowledge of educational research to teach. see the article Teaching medicine as if we were scientists for more information http://blogs.usask.ca/medical_education/archive/2007/06/teaching_medici.html
November 1st, 2007 at 2:10 pm
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
November 1st, 2007 at 3:12 pm
So what’s the problem?
I’m not sure why you call for a new Flexner report to re-invent medical school. Just because the first two years of medical school “suck” and are not the most enjoyable, does that mean there needs to be a re-invention? You ask, “What do we do to medical students during their basic science years? ” Yes, I agree that the first two years of medical schools are a little miserable, but the great thing about those first two years is that it provides a scientific foundation with rigorous training—it keeps us from being quacks. Sure, we forget most of what we learn, but isn’t that the case with most education anyway (anyone remember L’Hopital’s rule in calculus, or which is Boyle’s or Charle’s law in physic or who fought the battle of Hasting; does that mean calculus, physics, and history are useless)? There can be fine tweaking here and there, but I’m not sure that medical schools in the U.S. need to be re-invented if we are consistently producing the best doctors in the world. Whether we have the best medical system is a different story.
You ask “How does that experience [in the basic science years] influence their [medical student’s] choice of specialty?” I say probably not much at all—it’s the clinical year experience and perceptions of physician happiness that determines that, assuming they choose clinical medicine rather than research medicine. I remember in medical school (1995-1999) and shortly thereafter hearing that most students choose their specialties based in 3rd year experience with those specialties, and/or perceived lifestyle/compensation of those specialties. I honestly doubt that the first two years influence specialty choice. In fact, I remember how there were many students who liked a certain subject or focus taught in the first two years, and then disliked its clinical practice.
I think that it rather than focus on the internal workings of medical school and medical student happiness to improve medical schools, I think that looking at how medical schools influence the health care system is a lot more important. Medical school can and should be improved to improve health care (which is exactly what the Flexner report did). Most health care in the U.S. is delivered in the private sector, and medical school and residency graduates are ill prepared (if at all) to enter private sector—this is one aspect that medical schools fail at. But most importantly, the health care system is not broken because of students who are unhappy with the first two years of medical school, but rather because of the compensation system which rewards physicians for doing things (i.e. ordering tests, procedures, consults) and which is overly influenced by pharmaceutical companies (i.e. “CME” they provide and the abundance of “me too” drugs for dubious indications).
November 28th, 2007 at 8:18 am
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