Blog | Tuesday, May 31, 2016

Medical schools owe their students more

Readers know that I believe that servant leadership should inform leadership and management decisions. We who have the privilege of having leadership positions at medical schools therefore have as a primary responsibility to our students.

Being a medical student, while a reward and a privilege, is nonetheless a stressful experience. The first 2 years at most U.S. medical schools have the students grinding through the basic sciences related to medicine. The volume of material that our students try to absorb is massive. Then they must take a high stakes test (Step 1) and pass it so that they can progress to the clinical years.

The 3rd year of medical school for many students is the reward for the challenging basic science years. The students work hard and grow dramatically. As one who has worked with 3rd year students as a faculty member since 1980, the changes during that year are dramatic. Our students learn the culture of medical care. They experience all social strata of life; they see tragic illnesses; they experience patients dying; they see the diseases of self-abuse. They begin to understand the responsibility of our profession. Unfortunately, too often they have role models who are not great. They too often see cynicism. Too many “role models” do not exemplify the ideal.

As our students go through this experience, and then enter their 4th years, they have the additional stress of The Match. What should we do to help them? How many clinician educators really get to know the students and help them through their stress? While some do, few administrators really get to know the students.

The students pay very high tuitions. We all know how out of proportion tuitions have become. I just calculated the inflation of my tuition in 1971 (~$1,000 per year). According to the adjuster, tuition should be $5,879.80 per year. Yet we all know that almost all schools have tuition of $30,000 per year or greater.

How often do we consider how to give the students appropriate value? One could argue that we can never really provide that value, but others would argue that the return on investment makes this a good one. My stance is that we owe the students more during their medical school years.

What do we owe them? First, we need a great investment in our students. At a national level we really need a fresh look at the structure of medical education. Could we do a better job in the first 2 years? In my opinion we teach so much material, that the students too often do not really learn the most important basics because they have to learn basic science 101, 201, and 301 simultaneously. Too many students do not really learn the 101 basics that will really help them understand diagnosis and treatment.

Second, we need to help them handle the stresses of medical school. We must show our students ultimate respect. We must understand who they are and help them navigate their challenges. Students often thrive when they receive both immediate constructive criticism coupled with immediate praise. They need frequent targeted feedback given with a smile.

Our students need to understand that they have embarked on a difficulty road. They need to understand that we are supporting them, and we do not expect them to know everything. Our job is to help them grow. We can help them by showing them the way.

Most of all, they need to know and feel that they we care. Many leaders in medical schools really do care, but do we transmit those feelings to our students.

I would love to have some comments from medical students about their experiences. So that is my challenge to the students and recent students. What did I get right here, and what is off base?

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.