Thursday, December 22, 2011

Should Medical School Be Fun?

In the New York Times, Pauline Chen reports that Vanderbilt University is making an effort to relieve the stress of medical school with games and crafts. I read the piece with mixed feelings. It’s great that the school recognizes the problems faced by med students and is trying to help. And what Vanderbilt is doing seems more appropriate than importing puppies as some law schools have done.

I was struck by this sentence in the article, “[T]here is something toxic about the medical education process.” It amazes me that we still teach medical students the same way we did when I was in school some 40+ years ago. Memorize a lot of material that a) is available in electronic media that you can carry with you and b) is useless to the everyday physician [e.g., the Kreb’s cycle].

Oh, and don’t teach synthesis of ideas or decision-making. While you’re at it, smother the students and even residents with supervision so they never have an opportunity to make an independent decision anyway.

Then I thought, what’s up with the medical students? You’d think by now they might have heard that medical school was difficult and occasionally stressful.

I’ve got bad news for medical students. Hodie peius [Latin: This day worse] Medical school and residency training are not even remotely as stressful as actually practicing medicine. Wait until you are the one responsible for all the decisions you make, some of which will be wrong and result in complications or deaths.

Do these people, who are at least 22 years old, really need the school to generate extra-curricular activities for them? What are they going to do when they start practicing medicine for real? According to, a recent survey revealed that 87% of doctors “said they feel moderately or severely stressed or burned out” EVERY DAY.

Who is going to arrange their cooking competitions and variety shows then?


ShadowfaxMD said...

We did a cooking competition -- a faux iron chef -- as the 4Q social event for our group.

Doesn't detract from your overall point, just struck me as an odd coincidence.

Skeptical Scalpel said...

I assume your group arranged it rather than your hospital or medical school.

FancyScrubs said...

Do doctors even have time for crafts and games these days with all the insurance paperwork and government regulations as well as being a doctor to their patients?

Skeptical Scalpel said...

Oh they have time for crafts and games. In fact as I blogged recently, that is their number one priority. Paste this link in your browser

Anonymous said...

I think that the ACGME threw us a bone and we started begging for more! While I do not wholly disagree with the more 'lifestyle' oriented priorities of my colleagues, I do think that plenty of us have grown increasingly entitled, and feel we 'deserve' some sort of extra consideration regardless of the fact that we only consume resources and contribute little to patient care. Med school should be hard, and students usually find their own individualized methods of 'coping'.

On my surgical rotation we had PA students alongside us for a short duration. I was impressed with the amount of hands-on knowledge they got from their education, something we lacked from being coddled to the point of losing educational relevance during my first two years of med school (my school has a traditional curriculum). I wish we could cut out the minutiae we never use from the first two years of med school and incorporate more floor time in its stead. Hell, i'm thinking about a career in psychiatry of all things!

Skeptical Scalpel said...

Great comment. I'm not sure about psychiatry though. Keep an open mind.

Anonymous said...

Good topic to pick up on and one I think the medical field will continue to debate. I think the ideas you represented are well intentioned (i.e. suck-it-up, the rest of your career in medicine will be challenging to) but misguided -- just because a career in medicine is going to be challenging doesn't mean we need to haze the future of America to get them there. That particular thinking is the reason as you say "that we still teach medical students the same way we did when I was in school some 40+ years ago.".

Something needs to change and that change starts at the level of the medical student -- when we aren't jaded and burnt out like our older colleagues. What Dr. Chen is pointing out and what I think this medical school has gotten right is that changing the medical field comes at the level of culture. As in all other fields, happy people do their job better and this is most crucial in a field where we take care of other people's lives. The idea that the rigor of medicine and a happy life with room to breathe are mutually exclusive is why so many doctors are dissatisfied later in their careers. As a current medical student, I see the inspiration to change in my colleagues and I hope that by the time we are leading the pack enough of the 'old school' physicians will have little influence. For now, all the small steps we make in changing the culture are important, inspirational and crucial to building meaningful careers in medicine.

Skeptical Scalpel said...

Well said but let's see how you feel after 20 years in practice. It will be interesting to learn whether playing "Iron Chef" in med school makes you less cynical.

Anonymous said...

As a current subject of medical experimentation... err, I mean medical student, I find that these helpful tools usually consist of a mandated activity that takes me away from my family, friends, and the few moments I have to myself each day. Those that really need the help, find a way to fall through the cracks anyway. They've already made residency easier. Make med school any easier and you may just be able to guarantee that there are no competent physicians left in 20 years. Making it more relevant, however, is an issue that no one seems to be addressing, and worries me every day as July looms large before me. Who will teach me how to dictate in the 15 minutes I'll be allowed to work every day? How many central lines will my senior have placed before he teaches me how to do one? And which cases, exactly, will I feel comfortable taking personal responsibility for after a five year surgical residency chock full of paperwork, floor-work, and quality time with my family?

Skeptical Scalpel said...

Very well said. You are appropriately concerned. I've written a blog about residents lacking confidence. Paste this in your browser

TRex said...

I am now completing my 3rd year as Chief of the Anatomy department at a medical school in the Western United States. In over 20 years as a surgeon, I think I yelled at 3 nurses for gross incompetence. I have found that, almost weekly, I am screaming at a PhD who insists "Well, the students NEED to know this!"

I believe one of the first changes to medical education should be the elimination of basic science PhD's from medical school curricula. Afterall, how many MD's are on the dissertation committees of PhD's?

I am continually coming home more stressed than I was as a surgeon because of the bull-headedness of the PhD's who INSIST students memorize the Kreb's cycle, or spend hours on membrane transport, or rare proteins having no relevance to the daily practice of medicine. Basic science, as it applies to medicine, should be taught by medical doctors to the medical students.

How many practicing physicians can ROTELY recall all the cords, trunks, branches of the brachial plexus. But my PhD colleagues insist this must be MEMORIZED as if we'll need to use it daily.

Yesterday I screamed at a PhD in a meeting who insisted she teach the students mundane minutiae of the "shapes" of the various viruses.

When it comes time for promotion, the clinicians are rarely promoted because they have no "research". . .yet, NOT A SINGLE PhD has any idea of what tail coverage is, hospital rounding is, cardiac bypass, or running a business. This is all "not academic." But when they publish a paper on some obscure and obtuse non-relevant membrane protein, that is SURE to win the Nobel-Prize, they are instantly promoted to FULL Professor.

I was once interrupted by a colleague during a lecture to point out I'd made an anatomical mistake (colleague = they aren't really a colleague). I turned to the PhD and said, "Please forgive are correct. I have made an error; however, would you be so kind now that you've corrected this egregious error to stand and tell the students what the clinical significance of this correction is?"

Dead silence.

I said, "Exactly. . .now sit down or go back to your rats in the lab."

I didn't make any friends that day.

Skeptical Scalpel said...

TRex, thanks for the interesting and entertaining comments. I could not agree more. The shape of viruses? A nice example of what's wrong with medical education.

I'm afraid your goal of eliminating PhDs from the mix will never work. There are a lot of them working at Starbucks. I think they come cheaply.

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