David Fleming, MD, MACP, immediate past-president of the American College of Physicians, and I were in Kyoto, Japan, speaking at the Japanese chapter meeting. During a delightful authentic Japanese dinner with key members of the Japan ACP chapter, we had an excellent conversation about medical education. One physician had done fellowship in the U.S. 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 U.S, 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 U.S. system. What do you think?
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.