A new book, In-Training: Stories from Tomorrow’s Physicians, is a collection of essays by medical students that originally appeared online. The book’s editors, Ajay Major and Aleena Paul, created the In-Training website as a place where students could express their thoughts and feelings about life in the pressure cooker that is medical school.
The 111 essays are brief and as is true of any collection of writings from diverse individuals, are of somewhat uneven quality. Some are good. Some are fair. Some are meh.
One of my favorite pieces was one by a doctor who had received his diploma 10 days before a flight home. During the flight, a woman collapsed—prompting the dreaded “Are there any physicians on board” announcement. The new grad was the only responder. Having experienced this myself a couple of times, I had no trouble identifying with the author who described his predicament well.
I learned something from another of the essays which described a novel intervention for wandering patients with dementia.
A unique feature of the book is that every story is accompanied by a few “reflection questions” prompting the readers to think about what they just read. The questions add value and could serve as the basis for stimulating group discussions.
Ezekiel Emanuel, the University of Pennsylvania physician and ethicist, has written an opinion piece suggesting many changes in both pre-medical education and the medical school curriculum.
He would do away with many of our hallowed medical school prerequisites such as calculus, physics, and organic chemistry, feeling that those subjects are simply used to "weed out" certain students. I confess I once believed that such subjects were worthwhile. However, Emanuel makes a convincing argument that rigorous college courses in more relevant disciplines such as statistics, genetics, ethics, and psychology with a special focus on human behavior would suffice.
Regarding medical school, Emanuel points out he was taught the Krebs cycle on four different occasions in college and medical school and never used it once in practice or research. I have made a similar observation in a previous blog post.
He considers pathology, cytology, and pharmacology to be largely irrelevant to medical practice but concedes that some may disagree.
Many medical schools are either requiring or highly recommending that applicants show evidence of “shadowing” [following a doctor around] for varying periods of time. This supposedly gives a pre-med student an idea of what doctors do. I guess the schools assume that if someone has shadowed a doctor and still wants to become one, that individual is a better candidate for medical school than someone who hasn't done any shadowing.
A recent incident at a hospital in Syracuse, New York raised some serious concerns about shadowing. An anesthesiologist allowed a college student to endotracheally intubate a patient in the operating room. This was a problem on many levels. Students who are shadowing are not supposed to touch or examine patients. The patient who was intubated likely did not know that an unlicensed college student would be doing a procedure on him. And of course, there's HIPAA.
According to the article, the director of Consumers Union's Safe Patient Project, called the incident an "egregious violation of patient-doctor trust."
I've had a problem with shadowing for many years, and I'm not the first to say so. Dr. Elizabeth Kitsis, director of bioethics education at Albert Einstein College of Medicine in New York, has blogged about the topic.
She told of a male pre-med student who was introduced to patients as a "student doctor" and watched a gynecologist perform pelvic exams. The student himself said he felt a little awkward. One wonders how the unsuspecting patients would have felt had it been known he was a college student thinking about becoming a doctor.
There were many comments pro and con on both Dr. Kitsis's blog and a follow-up piece that appeared on another Einstein blog.
Dr. Kitsis co-authored a paper which found that few studies have looked at shadowing by pre-med students. She called for guidelines and a code of conduct for this activity.
Several questions come to mind.
With all the information available on the Internet, is shadowing really an effective way for college students to decide whether to become physicians or not?
Is there any research comparing career outcomes of pre-med students who shadowed doctors to those who did not?
What about the patients? Do they have any say in this? Are students who shadow introduced as who they really are?
How does a student choose a doctor to shadow? As far as I can tell, there is no quality control for this aspect of shadowing.
Is shadowing mandatory in other fields? Must one shadow before becoming an engineer [civil, railroad, or sanitation], an accountant, a fighter pilot, a shepherd, or an exotic dancer?
