Introduction

This blog is about medical education in the US and around the world. My interest is in education research and the process of medical education.



The lawyers have asked that I add a disclaimer that makes it clear that these are my personal opinions and do not represent any position of any University that I am affiliated with including the University of Kansas, the KU School of Medicine, Florida International University, or the FIU School of Medicine.



Thursday, January 9, 2014

Getting the right students in medical school

Are we getting the right students into the medical school?

To answer this question, we have to decide what we want students to look like when they get out of medical school. There is some debate about this but not as much as you would think. Once we decide what characteristics we want our graduates to have then we can start looking for those characteristics in the students that get admitted to medical school.  It is the most important question if we want to answer the first question. Why is it so important?

That is simple. The outcome is determined by the input. It is like the old computer adage—garbage in, garbage out.(1) Not that medical students are garbage by any means, in fact they are a pretty amazing group of young men and women. But, if we wanted all of our graduates to be black, but all of the students that were admitted were white, how much success would we have?  Not much!  In the same vein, if we wanted our graduates to all speak Spanish, what is the easiest way to accomplish this?  Clearly, admitting students that speak Spanish is far easier than teaching them Spanish during medical school.

This discussion works for a lot of the characteristics that people think are important for their personal physician to have. Take communication skills. We can teach them techniques to improve their communication skills and their techniques in taking a medical history. If the students that we admit to medical school have poor listening skills or they are very shy and do not like to talk to other people it will be much harder to end up with a graduate that has good listening skills.

Another example is professional behavior. I like to call this “not being a jerk” but it is much bigger—self-sacrifice, commitment, respect, accountability, and trust.(2) Can we teach those things? I don’t think so. I think a student either has those characteristics or they don’t. They do not learn them in medical school. We have to admit students that have the characteristics and then we can teach them how to actualize them as a medical student and physician.

The funny part of this is that we take this for granted with one attribute: the ability to do well on standardized, multiple-choice question tests. No one argues that an incoming medical student should not be good at that skill (and for sure it is a skill that is learned). So the graduating output is a physician who is good at answering multiple-choice questions. No surprise, but is that what we want. It is clearly part of what we want, right? We believe that doctors should have a basic minimum knowledge base in medicine, but is that the only key to being a good doctor?

We need to start thinking about what we want in our graduates. The US spends a lot of money on educating doctors. State tax revenue supports many schools. Federal research dollars support the infrastructure at many schools. Students pay tuition with the help of federally backed student loan programs. Even graduate education is mostly funded through federal Medicare dollars. (see the great piece on GME accountability by Kenny Lin, MD, MPH, at the Common Sense Family DoctorBut for all of this, we the people, have very little say on the output. There has been remarkably little discussion of accountability of medical schools to the tax payers for their physician graduates.

Do they have the characteristics that we need from our physicians?

Do they care for the people that need to be cared for?

Are graduates practicing in the geographic regions that we need them to be practicing in?

I think the answer to all of these questions is—no, unfortunately.  There is this idea that it is ok for medical student outcomes to be market driven. That is rubbish! The people are paying for medical education. We deserve to get the right outcome for our money.

This brings me back to my original question—are we getting the right students into medical school? If we want to change the answers to the three questions above, then we have to change the students that come into medical school.

References
1) http://www.worldwidewords.org/qa/qa-gar1.htm

2) http://www.abimfoundation.org/Professionalism/Medical-Professionalism.aspx

5 comments:

  1. Well, i have to say I agree. One way of thinking of it is, once we know what we want our graduates to "look" like, to identify what is easy to teach (e.g., medical content to smart people) and what is hard to teach (e.g., being a caring person), and recruit people who already have the "hard to teach" characteristics!

    ReplyDelete
  2. The information you have posted is very useful. The sites you have referred was good. Thanks for sharing..
    Buy Peptides

    ReplyDelete
  3. A medical student has to work as member of the health care team determined for superiority in the quality of patient care and safety. He or she must be competent to assess the results of existing practice, scrutinize the text to conclude best practice, and take action to close any gaps. They must hold talent to problem crack and settle errors and near misses. http://bit.ly/Lh7oTZ

    ReplyDelete
  4. We Hold our Tutors to a Higher Standard, and Pay our Tutors More Fairly, than nearly any other Tutoring Company.Thus, we have Better (and more Experienced) Tutors.We accept only the top tutor applicants, and will never compromise our selectivity in order to artificially inflate our ranks. In addition, every member of the Team is required to have recently scored in the 95th percentile or above on any standardized test that he/she teaches.Math Tutor Austin, Math Tutor Atlanta, Math Tutor Houston, Math Tutor Seattle.
    Science Tutor Las Vegas | Math Tutor Hawaii | Math Tutor Las Vegas | Tutor for kids Las Vegas | Math Tutor Charlotte | Math Tutor Phoenix | Math Tutor Los Angeles | Math Tutor Boston | Math Tutor New York | Math Tutor Denver | Math Tutor Chicago | Math Tutor |

    ReplyDelete
  5. As a rising medical student and student who just recently completed the med school admissions cycle, I think that schools are making steps in the right direction to identify students with the characteristics that you mentioned in your post. Through medical school interview formats such as the Multiple Mini Interview (MMI) and mock patient interviews/scenarios that are better suited for identifying traits such as compassion, integrity, and complex cultural awareness, medical schools (in my opinion) will begin to produce the sort of doctors that are competent in the areas that you discussed. We just have to give it a couple of years to see the results.

    ReplyDelete