AAMC Trying To Improve Med

[Premed315U]

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I received this message as part of an e-mail list, and I thought I'd pass it on for everyone to see.

"Dr. Cohen, President of the AAMC, gave a fairly provocative keynote address, as he usually does. He stressed the two ways to improve the quality of humanistic physicians we are producing - alter the selection process for entry to medical school, and make the training process more humane (see above). He had some specific thoughts on how to improve the selection process:

1. Use MCATs and GPAs as threshold measures only, and not to give them weight beyond that.
2. Use personal characteristics as the initial screen, rather than MCAT and GPA as is currently done
3. Do more to encourage 'non-traditional' student
4. Stop using MCAT scores and GPAs of students as measures of institutional quality (there's an article in this months Academic Medicine about this)
5. Identify star students, and then look at their applications. What hints were there that they would turn out well? Can we use these when accepting other students?
6. Devise better objective tools for evaluating personal characteristics

The audience applauded after each one of these... the question, of course, is what will happen when all these people return to their institutions. It is up to us to put keep the pressure on, by being on admission committees and making sure that the Deans know that we agree with these 6 points of J.J. Cohen's. "

 

[none]

Really...how important is humanism in medicine? I mean sure, for a few specialities it's totally needed, but for most...I'd prefer to have a doctor more knowledgeable about his actual job than one who was nice to me. I personally think we really should work on perfecting the MCAT and using GPA to determine future success, not trying to get away from them and move to completely qualitative variables where you're accepted just because the adcom thought you were a nice person.

 

[bujji13]

Really...how important is humanism in medicine? I mean sure, for a few specialities it's totally needed, but for most...I'd prefer to have a doctor more knowledgeable about his actual job than one who was nice to me. I personally think we really should work on perfecting the MCAT and using GPA to determine future success, not trying to get away from them and move to completely qualitative variables where you're accepted just because the adcom thought you were a nice person

I agree. I think personal qualities are extremely important, but doctors have to be willing to work and study very hard. A really nice and well-rounded doctor can still be sued really badly for malpractice. Although lots of schools seem to disagree with being evaluated in terms of their numbers (like on usnews), I don't think I'll be hearing about Harvard or Hopkins reporting 3.0 average gpas and 25 MCATs anytime soon. Besides, there are already lots of applicants with good grades/scores and good activities/recs/interviews who are also really nice.....

 

[CoffeeCat]

I really don't think the point here is that people want a "nice" doctor but that they want one who can relate to them and discuss their medical problems in a suitable manner. I've heard dozens of stories of doctors who are plain rude to their patients, including one doctor who told his patient to "make another appointment" when she had a question about a problem not directly related to the original one (he didn't even listen to the problem). Who wants a doctor like this? This can cause as many problems as solve them, creating patients who dislike and distrust their doctors. Ever wonder why so many people seem unwilling to head to a hospital/doctor when they have a problem?

I agree with the speaker who wanted well-rounded and more non-traditional students. Why does everyone assume that a well-rounded applicant with maybe less than stellar grades would not "know their stuff" or make a great doctor? I think most doctors are suitably knowledgeable and I'd take a caring one over an ass anyday.

 

[uncwalley]

But isn't a more humanistic doctor one that is going to do all he can for his patients, while one more into the science of it all may see each patient only as a neat puzzle to play with. Humanism is crucial in a physician because then the outcome of his work matters to him personally.

 

[EMDrMoe]

I can see both sides here. Ideally we could have the best of both worlds.

First off, if we are looking for more non-traditional applicants, then MCAT and GPA may not be the most accurate predictor of academic performance in medical school. For example, my undergrad science GPA (from 1995)was a 3.03. That does NOT reflect my current work ethic. I was fortunate enough that someone saw the "new and improved me" and believed enough to accept me.

Secondly, humanism is very important in medicine, IMHO. If we forget the human side of medicine, we forget medicine. As I teach my kids in sports med class - who is the most important member of the sports med team? The athlete. Why? No athletes = no sports medicine!

Now, on the flip side - I would rather have a cocky, know it all surgeon than a nice, wishy washy one. However, I believe that a balance between the two is what makes a great physician.

So, I think MCAT and GPA are very important. But, instead of looking at them first, I think schools should look at them in concert with the applicant's life, which is reflected in their essays and experiences. There should be a parallel line, not steps. But, would this make the process too time-consuming for schools? How can you subjectively judge someone like that and defend your choice? Do the committees have to defend their choice? Hmmmm......

 

[bujji13]

I agree that is extremely important for doctors to be humanistic, caring, and well-rounded, but Cohen's ideas just seemed to be in favor of another type of one-dimensionality. Let's not forget that someone with poor/mediocre academic credentials but amazing activities, etc. is also one-dimensional. As far as "rude" doctors are concerned, how can one be certain that these people seemed rude / uncaring when they got in? Or better yet, how can one be certain that they didn't seem at one time exceptionally well-rounded or mature? One can never tell, and I think that many pre-meds change their "warm and fuzzy" attitude towards medicine once they get into med school. This is unfortunate, but placing much more emphasis on non-academic credentials than academic would open up a gateway of possible problems for future physicians, many of which would be worse than rude consultations. Also, I'm not sure science and humanism are mutually exclusive-it really just has to do with the person, and one can never tell (especially in medicine) what kind of doctor someone will be. Good students who are genuinely interested in medicine and who are motivated enough to learn what they need to in order to treat people is a promising start.

 

[mtnbke]

nullI think everyone is forgetting that there already exists a branch of doctors that don't emphasize the MCAT or GPA as heavily and instead focus on the complete person: the osteopathic school.

A doctor is not your social worker, a doctor is not your nurse. Healing may be a spiritual process and require emotive connections to the health providers, I don't know if this can be intellegently debated. This is not a concept that can be empirically quantified, and data would be antedoctal in nature.

My thought would be that the GPA and MCAT are CRUCIAL signalling devices to measure the success of wanna be physicians. The GPA is a perfect reflection of a students ability to learn and perform in an academic environment. No one wants a doctor who had trouble being motivated to learn while in med school, or had personal issues that interfered with the learning process. The MCAT is important as a measure of retention of material learned.

When I have an unusual illness I want to be seen by a damn smart doc that studied her ass off in med school. Considering I've never seen a doctor in my life go to reference materials before offering a diagnosis I want my doctor to have a very high MCAT score and to come from one of the top schools.

The responsibility that a physician bears is that of the very lives of the patients. This is not a place for life stories or late bloomers. I don't give a damn how nice the surgeon was if his incompetence or ignorance caused the death of a family member "on the table."

People very simply life is not some post-modern fantasy wherein we all have some fundamental right to pursue some notion of personal grandiosity. Those members of our society that are allowed to study medicine and practice clinically should be a representation of the best and brightest as they will quite literally in a life and death struggle as a matter of vocation.

Take your mediocrity and go pursue a MSW. The language and empathy might be home to those arguments.

As for me when my little girl gets sick she'll never see a D.O. or even some local schmoe. Gimme' the Mayo Clinic, Johns Hopkins, or MGH and check the life story, low GPA and mediocre MCAT at the nurses station 😕

 

[md2be06]

hey mtnbke, how's that slacker girlfriend of yours doing? did she ever get those secondaries in, or is she still too busy publishing in "real" journals? Your attitude towards other healthcare professionals is pretty sad. Moreover, I don't think your hmo is going to give a damn where your doctor went to med school, and how high he scored on the MCAT or any other standardized test. God forbid your physician only went to a top 25 school and scored around a 30 on their MCAT's.

 

[EMDrMoe]

Wow.

 

[gooloogooloo]

mtnbke,

I definitely will quote your words! That was the most strongly stated incorrectness I have ever seen on SDN since then. For those who want to learn how to defend a subject in one's interview really shall learn from you!

no humanistic = no doctor = no medecine 😡

I want to quote you last page from the book- Dr. Folkman's War. Folkman broke several records of Harvard Medical School. 1. He was expectionally granted enrollment at age 19. 2. He was the first person enrolled into Harvard Medecine from OSU. 3. He was the youngest full professor of Surgery at Harvard. He also served as the chief resident of Mass General.
I want to quote you this great doctor's words, words that he speaks to his students today at the very best medical school in this very world.

+++++++++++++++++++++++++++++++++++++

?You are their doctor,? Folkman tells the studnets. ?There?s a certain point at which they begin to trust you, and you won?t abandon them. You won?t go on vacation and disappear. Or they can?t reach you. They?re scared to begin with, and if they get that sense, then they?re very scared.? Folkman would never have his patients fell disconnected from their doctor. He always made sure they had his home telephone number and pager number. ?Here is my telephone number; here is my beeper numner,? he would said. ?I never want to hear that you couldn?t get hold of me.? He found that patient almost never abused his extraordinary solicitousness. ?They don?t have to test it,? he said. ?They only abuse it when they can?t get hold of you.? When young residents in training objected to that idea, groaning about never having any time of their own about being awakened late at night, Folkman?s answer was blunt: ?You chose medicine. It?s a service career. Long hours are part of the job. If you want a different kind of life, think about becoming a banker.?

Another fundamental lesson Folkman always tried to impart to medical students was never to destroy hope. There are moments when hope is all that remains for a patient to cling to. Although many doctors worry about raising false hopes, Folkman found that patients don?t really punistheir doctors for that. There are desperate moments when even false hope is better than no hope. He recalled the case of a young medical student who was himself burdened with a brain tumor. The young man said he didn?t like ti when people used the term ?false hope.? ?They have no right to do that,? he told Folkman. ?They don?t have this tumor.?

Everyone has an obituary date, Folkman would tell his students, and then he would ask: ?Suppose we knew you date?? He would pull out a list of the students and feign reading. ?Jones, you?re in the year of 2000, March 31, at three P.M.,? and on down the list. After a few names, sensing the students had had enough, he would look up and say, ?you don?t want ot hear any more? So what are going to do in the meantime if you know the date? You?ve destroyed hope. So now if a patient asks you, ?how long do I have to live, Doctor?,? are you going to tell him two weeks, two months, or two years? You put a time on it, and it just destroys hope.? He urged his students never to utter the words ?I can?t do anything more fr you.? They could always do something. They could make a patient feel more comfortable. Or go to the window of his or her hospital room and point outside. ?Do you see that building over there? That?s the research building. We?re working on it.?
Even when Folkman was in hot pursuit of the secrets of angiogenesis, he had time for people. Traveling often, he would carry a list of some two hundred cancer patient who had called seeking his advice. They weren?t necessarily his patients, but he made a commitment to call at least ten of them every night, wherever he was, to discuss their concerns and offer what advice he could. As a doctor, he felt he could do no less.


🙂

 

[jdub]

hey all,

here is a link to whole statement Dr. Cohen released. tomorrow' doctors

if one really reads through the statement, i don't see how they could disagree with most of what he has to say. something that was even more interesting was his suggested "compact between teachers and learners of medicine".

we could always use more caring and compassionate doctors. there are plenty of people who could understand the science of medicine, but how many of those people can understand the art of medicine?

something else to think about:

what is the real difference in inteligence with somebody that has a gpa of 3.4 and another person that has a gpa of 3.6?

how many more questions overall did somebody miss on the mcat that scored a 29 and compared with somebody that scored a 34?

i just don't understand how somebody could be considered stupid or far less inteligent than anyone else because they answered a few less questions correctly on a standardized test, or because they got a couple more b's and c's than somebody else.

there is so much more to each and every one of us that it is absurd to let those two indices determine so much.

 

[csgirl]

I think medical schools should accept a variety of students. They should accept some students just for their really high stats (like 3.9 and 37 MCAT) and some students based on personality and personal characteristics. If schools accept a total variety of students they can't go wrong.