MD NEJM: Dean responds to MD student suicides / expectations

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Dean Muller at Icahn/Mt Sinai calls it a "paradigm shift"......

“…..we have also committed ourselves to a genuine paradigm shift in the way we define performance and achievement. We must minimize the importance of MCAT scores and grade point averages in admissions, pull out of school ranking systems that are neither valid nor holistic, stop pretending that high scores on standardized exams can be equated with clinical or scientific excellence, and take other bold steps to relieve the pressure that we know is contributing at least to distress, if not to mental illness, among our students."

http://www.nejm.org/doi/full/10.1056/NEJMp1615141

article is available for free on NEJM link

Kathryn
David Muller, M.D.

N Engl J Med 2017; 376:1101-1103
March 23, 2017
DOI: 10.1056/NEJMp1615141

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Dean Muller at Icahn/Mt Sinai calls it a "paradigm shift"......

“…..we have also committed ourselves to a genuine paradigm shift in the way we define performance and achievement. We must minimize the importance of MCAT scores and grade point averages in admissions, pull out of school ranking systems that are neither valid nor holistic, stop pretending that high scores on standardized exams can be equated with clinical or scientific excellence, and take other bold steps to relieve the pressure that we know is contributing at least to distress, if not to mental illness, among our students."

http://www.nejm.org/doi/full/10.1056/NEJMp1615141

article is available for free on NEJM link

Kathryn
David Muller, M.D.

N Engl J Med 2017; 376:1101-1103
March 23, 2017
DOI: 10.1056/NEJMp1615141

I don't understand.

A long anecdote about a fourth year medical student's suicide followed by an unsubstantiated argument that we should move away from mcat and gpa as admission criteria.

So is the solution to pull names out of a hat?
To subjectively measure "compassion?"
More weight to the completely biased process of interviewing?

How does any of this prevent her suicide?

It sounds like a crappy attempt to shift attention away from any toxicity or malignancy present in this school's culture, and to instead blame a "medical school" culture and the applicants/students themselves
 
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Lol. And lets keep working these residents 28 hours a shift huh...
 
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I don't understand.

A long anecdote about a fourth year medical student's suicide followed by an unsubstantiated argument that we should move away from mcat and gpa as admission criteria.

So is the solution to pull names out of a hat?
To subjectively measure "compassion?"
More weight to the completely biased process of interviewing?

How does any of this prevent her suicide?

It sounds like a crappy attempt to shift attention away from any toxicity or malignancy present in this school's culture, and to instead blame a "medical school" culture and the applicants/students themselves

thought the same exact thing. I wish my stuff got published in NEJM this easy
 
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Very
Dean Muller at Icahn/Mt Sinai calls it a "paradigm shift"......

“…..we have also committed ourselves to a genuine paradigm shift in the way we define performance and achievement. We must minimize the importance of MCAT scores and grade point averages in admissions, pull out of school ranking systems that are neither valid nor holistic, stop pretending that high scores on standardized exams can be equated with clinical or scientific excellence, and take other bold steps to relieve the pressure that we know is contributing at least to distress, if not to mental illness, among our students."

http://www.nejm.org/doi/full/10.1056/NEJMp1615141

article is available for free on NEJM link

Kathryn
David Muller, M.D.

N Engl J Med 2017; 376:1101-1103
March 23, 2017
DOI: 10.1056/NEJMp1615141
Very sad.
Hopefully, schools will learn something after this sort of issues, help more those in need, and change the cut-throat culture of medical education.

Medical school can be brutal, and it’s making many of us suicidal
 
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I don't understand.

A long anecdote about a fourth year medical student's suicide followed by an unsubstantiated argument that we should move away from mcat and gpa as admission criteria.

So is the solution to pull names out of a hat?
To subjectively measure "compassion?"
More weight to the completely biased process of interviewing?

How does any of this prevent her suicide?

It sounds like a crappy attempt to shift attention away from any toxicity or malignancy present in this school's culture, and to instead blame a "medical school" culture and the applicants/students themselves

I get what he's trying to say, medical school is frankly an awful experience for too many people (myself included) on a number of levels, which can lead to some serious problems for students, and schools do a sh-t job of dealing with their cultural problems (I don't have a lot of kind things to say about my own former institution on this)

...but yeah, that was a really dumb paragraph.
 
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Medical education places far too much of an emphasis on who can get 1-5 more questions correct than the next student. We need to incorporate more clinical and research skills in the curriculum for M1s and M2s. It shouldn't be all about Step 1.
 
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I think what the school should focus on is on the quality of life of their current medical students. They can't really change the competitiveness of the process, since no matter what, they are still selecting a small class and rejecting the majority of applicants. Focus on their current students. I'm sure the most recent factors that led to the suicide was not the MCAT that the student took 4-6 years ago.

How available are counseling services?
How high is the quality of counseling provided?
Is the school student centered and prioritizes the success and well-being of the students?
Is the curriculum and grading structure optimized to be as least stressful as possible?
How is the culture and environment for each year of medical students?
How much student feedback actually gets implemented into the system?

In my opinion, these are the types of questions and issues the school should be focusing on, not on some vague, inefficient, and ineffective way to revamp the medical school admissions process.
 
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His mouth to God's ears....

Dean Muller at Icahn/Mt Sinai calls it a "paradigm shift"......

“…..we have also committed ourselves to a genuine paradigm shift in the way we define performance and achievement. We must minimize the importance of MCAT scores and grade point averages in admissions, pull out of school ranking systems that are neither valid nor holistic, stop pretending that high scores on standardized exams can be equated with clinical or scientific excellence, and take other bold steps to relieve the pressure that we know is contributing at least to distress, if not to mental illness, among our students."

http://www.nejm.org/doi/full/10.1056/NEJMp1615141

article is available for free on NEJM link

Kathryn
David Muller, M.D.

N Engl J Med 2017; 376:1101-1103
March 23, 2017
DOI: 10.1056/NEJMp1615141
 
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Just a couple of my ideas on how to make students/residents happier. None of this will ever happen though.

End the A+/B-/C/D/F grading system. Everything is Pass/Fail, including 3rd year grades (with subjective narrative evaluations included).
Introduce clinical training early-on during medical student education, and deemphasize areas of the curriculum which have little to no clinical relevance (certain parts of histology, anatomy, and biochemistry)
Eliminate all school or professor-created exams and require all schools to use NBME-created exams which most closely mimic board exams and require less rote memorization of worthless powerpoint factoids.
Make all lecture attendance completely optional. No school may be allowed to force students to be physically present for lectures (looking @ you osteopathic schools).
Specifically require schools to let students participate in patient care activities during M3/M4 clinical years and place on probation any institution where students are paying to shadow. Schools that cannot afford to pay clinical faculty responsible for supervising medical students will be forced to fire administrators to make room in the budget or immediately shut-down.
Eliminate all funding for "diversity" initiatives and programs, and redirect these funds toward higher quality clinical training.
Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking.
Eliminate Step II CS as an exam and require US medical schools to train students in modern evidence-based physical exam skills, including basic POC ultrasound.
Require all students be screened for depression and anxiety disorders as part of the entrance (post-acceptance) physical exam required to matriculate - the results of which are not shared with the school, but may result in earlier treatment for kids with undiagnosed or untreated (or undertreated) mental illness.
Provide free (school paid-for) 3rd-party clinical psychologists or counselors up to 8-10 appointments free per year per student, if needed. Fire as many administrators as possible to make room in the budget for this.
Require all residency programs to cover health insurance for every resident and their dependents at no cost to the resident. If they are going to underpay residents via their Match monopoly, they're going to at least make sure their own physicians can get decent health care for their immediate family (who they'll probably rarely ever see). For single residents or those without dependents, they should get increased salary to (at least partially) make-up for the discrepancy.
Eliminate all "professionalism" committees or at the very least purge them of all non-physician administrators.
Stop admitting insufferable social justice warriors and rat-racers with cluster B-personality disorders to medical school.
 
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Just a couple of my ideas on how to make students/residents happier. None of this will ever happen though.

End the A+/B-/C/D/F grading system. Everything is Pass/Fail, including 3rd year grades (with subjective narrative evaluations included).
Introduce clinical training early-on during medical student education, and deemphasize areas of the curriculum which have little to no clinical relevance (certain parts of histology, anatomy, and biochemistry)
Eliminate all school or professor-created exams and require all schools to use NBME-created exams which most closely mimic board exams and require less rote memorization of worthless powerpoint factoids.
Make all lecture attendance completely optional. No school may be allowed to force students to be physically present for lectures (looking @ you osteopathic schools).
Specifically require schools to let students participate in patient care activities during M3/M4 clinical years and place on probation any institution where students are paying to shadow. Schools that cannot afford to pay clinical faculty responsible for supervising medical students will be forced to fire administrators to make room in the budget or immediately shut-down.
Eliminate all funding for "diversity" initiatives and programs, and redirect these funds toward higher quality clinical training.
Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking.
Eliminate Step II CS as an exam and require US medical schools to train students in modern evidence-based physical exam skills, including basic POC ultrasound.
Require all students be screened for depression and anxiety disorders as part of the entrance physical exam to medical school
Provide free (school paid-for) 3rd-party clinical psychologists or counselors up to 8-10 appointments free per year per student, if needed. Fire as many administrators as possible to make room in the budget for this.
Require all residency programs to cover health insurance for every resident and their dependents at no cost to the resident. If they are going to underpay residents via their Match monopoly, they're going to at least make sure their own physicians can get decent health care for their immediate family (who they'll probably rarely ever see). For single residents or those without dependents, they should get increased salary to (at least partially) make-up for the discrepancy.
Eliminate all "professionalism" committees or at the very least purge them of all non-physician administrators.
Stop admitting insufferable social justice warriors and rat-racers with cluster B-personality disorders to medical school.

Please head the LCME one day.
 
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I don't have a solution to the issue at hand, but I sense part of the problem is the trapped feeling. That is, say you hit your burnout threshold and are still in the meat grinder. There is no support system, or if there is, not a great one. Even so, the ability to take time off or reset mentally and emotionally is non-existent. Combine that with the mounting student debt and literally no marketable skills. Perhaps a better exit plan (loan forgiveness, masters level degree at completion of MS2), or parallel pathway that is on a less brisk pace (e.g. fluidity to moving to PA/NP or prolonged graduation pathway that is accepted) would be an alternative.
 
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I don't have a solution to the issue at hand, but I sense part of the problem is the trapped feeling. That is, say you hit your burnout threshold and are still in the meat grinder. There is no support system, or if there is, not a great one. Even so, the ability to take time off or reset mentally and emotionally is non-existent. Combine that with the mounting student debt and literally no marketable skills. Perhaps a better exit plan (loan forgiveness, masters level degree at completion of MS2), or parallel pathway that is on a less brisk pace (e.g. fluidity to moving to PA/NP or prolonged graduation pathway that is accepted) would be an alternative.

Hit the nail on the head, missed a true calling in ortho.

Trapped (debt, time)
No other marketable skills
No chances for relenting
No chances for redemption (or very few)
Little time or tolerance for outside interests

It might even be nice to have a lateral pathway with the option to return to residency eventually (work as mid level for 2-3 years followed by return to school, board exams, residency app). It wouldn't have to be an option that stayed open forever, but maybe for people who wanted to try it for 1-2 years it would be an option.
 
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It's unfortunate to see so many people taking their own lives because of medicine. Are there warning signs that predispose these students to take their own lives or are they "normal" . I'm genuinely curious if someone has looked into this to create a profile( for lack of a better term) of a student who is more likely to take their own life. It would be scary to think that this could happen to anyone
 
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Medical education places far too much of an emphasis on who can get 1-5 more questions correct than the next student. We need to incorporate more clinical and research skills in the curriculum for M1s and M2s. It shouldn't be all about Step 1.

So true. We become professional test takers, and if we're slightly worse than our peers we might end up with crippling debt instead of a residency spot. There is a lot of pressure in this process, which is why clinical involvement is crucial to keep students grounded by regularly seeing the end goal.
 
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I've talked way too much this week about the match and prestige, but it's ridiculously relevant here. Getting rid of MCAT, GPA, or med school grades does absolutely nothing to help this problem. All this does is invalidate the hard work of those who performed the best in college or med school by the only metrics we have, and the alternative is mindless wandering in a sea of uncertainty, resume buffing, and ass-kissing.

As long as there are methods for determining who can match where, this dynamic will exist. As long as top tier residents are deified and as long as employers and fellowships continue to favor those who trained at top tier residencies to the point severely limited career mobility beyond med school, we will have this mentality. The best thing for medical students' sanity is to get rid of ranking lists, stop deifying those at the top, and allow for more career mobility past residency training.

It doesn't have to be this way, and you only have to look towards business school to see that. Grades mean very little, and we are indeed left with immeasurable ass-kissing. However, look at how they choose their first jobs out of school. Some go into industries where there is a "prestige" factor (e.g. consulting), but even then decisions on where they go are often just as much about the position, trajectory, and the compensation package. A "top" grad from a "top" school wouldn't hesitate to turn down McKinsey if he/she thought that a boutique company was offering something better, or that they could start their own company, and no one would assume that he/she "couldn't get into McKinsey." Then, if they do a fantastic job at the first company, they can always get back into the big name companies, rise in the ranks, etc... Not to mention, this freedom on the part of fresh grads earns them far more options. In this scenario, the students all win.

If the match didn't exist, we could field offers from anywhere we thought would provide good enough training for our goals. Take away mindless prestige wh*ring and suddenly we're not so worried that doximity ranked UPMC ten spots lower than MGH. We see it for what it is, which is two world class institutions of essentially equal quality, and we can decide if it's "worth it" to go to one or the other based on what experience they are providing. With all that bargaining power, suddenly students are able to choose residency based on where they will actually be happy, and programs will have to cave to demands of humane treatment and avoid malignancy rather than resting on their laurels of online rankings. Further, if anyone in medicine actually cared about performance after training, career mobility would exist and not matching your dream residency wouldn't be such a death sentence (and we wouldn't be relying on multiple choice tests to choose the future leaders of medicine).

tl;dr Competition does not subside because you changed the judging criteria. If we stopped prestige whoring students would worry less about matching to top institutions. If we allowed for any career mobility at all in medicine, less pressure would be put on these "career defining" years.

This is one of the realest things I have ever read on here.:claps:
 
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Require all students be screened for depression and anxiety disorders as part of the entrance physical exam to medical school
Before I write a whole long post, let me ask a point of clarification: when you say "entrance physical exam" you mean post acceptance, correct? If so, all my complaints are moot. I've heard people propose psych evals as part of the actual application process and that terrifies me for a host of reasons.
 
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I've talked way too much this week about the match and prestige, but it's ridiculously relevant here. Getting rid of MCAT, GPA, or med school grades does absolutely nothing to help this problem. All this does is invalidate the hard work of those who performed the best in college or med school by the only metrics we have, and the alternative is mindless wandering in a sea of uncertainty, resume buffing, and ass-kissing.
This is an important point. There are problems with the MCAT, and it's pertinence to medical school performance is questionable. All of that aside, we don't have another way to assess the aptitude of medical school applicants. It's not enough to say, "Oh let's get rid of that nasty old MCAT because it stresses students out." You need an actual solution. Until such time as one is available, the Dean is simply screaming at the wind. (Effort which would be better spent delving into alternative ways to assess applicants to medical school.)
 
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Require all students be screened for depression and anxiety disorders as part of the entrance physical exam to medical school

An interesting idea.
Some potential problems (curious about your thoughts on these)

1. what happens if you find an issue?
2. how do you protect students? - there will be a concern that anything found from the school could have the potential to appear on a student's transcript, especially if it's a mandatory screening process.
3. how would you scale problems? (I'm a baby first year and haven't had psych, so I don't understand how depression/suicidal ideation is scaled). Like...is someone that's a 1 out of a 1-10 a concern, does that not meet the mark for concern?
4. how would you measure the success of a screening process? Do you simply track suicide rates beyond it's implementation? (anxiety and depression might be harder to measure, and there's the possibility that standard screenings might increase the stigma of mental health issues in medicine and further decrease self reporting).
5. could any kind of protection be offered to students who DO have an issue? How can students be reassured that their anxiety disorder won't be reported to a residency program or a preceptor?
 
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Just a couple of my ideas on how to make students/residents happier. None of this will ever happen though.

End the A+/B-/C/D/F grading system. Everything is Pass/Fail, including 3rd year grades (with subjective narrative evaluations included).
Introduce clinical training early-on during medical student education, and deemphasize areas of the curriculum which have little to no clinical relevance (certain parts of histology, anatomy, and biochemistry)
Eliminate all school or professor-created exams and require all schools to use NBME-created exams which most closely mimic board exams and require less rote memorization of worthless powerpoint factoids.
Make all lecture attendance completely optional. No school may be allowed to force students to be physically present for lectures (looking @ you osteopathic schools).
Specifically require schools to let students participate in patient care activities during M3/M4 clinical years and place on probation any institution where students are paying to shadow. Schools that cannot afford to pay clinical faculty responsible for supervising medical students will be forced to fire administrators to make room in the budget or immediately shut-down.
Eliminate all funding for "diversity" initiatives and programs, and redirect these funds toward higher quality clinical training.
Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking.
Eliminate Step II CS as an exam and require US medical schools to train students in modern evidence-based physical exam skills, including basic POC ultrasound.
Require all students be screened for depression and anxiety disorders as part of the entrance physical exam to medical school
Provide free (school paid-for) 3rd-party clinical psychologists or counselors up to 8-10 appointments free per year per student, if needed. Fire as many administrators as possible to make room in the budget for this.
Require all residency programs to cover health insurance for every resident and their dependents at no cost to the resident. If they are going to underpay residents via their Match monopoly, they're going to at least make sure their own physicians can get decent health care for their immediate family (who they'll probably rarely ever see). For single residents or those without dependents, they should get increased salary to (at least partially) make-up for the discrepancy.
Eliminate all "professionalism" committees or at the very least purge them of all non-physician administrators.
Stop admitting insufferable social justice warriors and rat-racers with cluster B-personality disorders to medical school.

Nice suggestions. Although i'm surprised to see medical education suffering from too much red tape and bureaucratic nonsense
 
I don't have a solution to the issue at hand, but I sense part of the problem is the trapped feeling. That is, say you hit your burnout threshold and are still in the meat grinder. There is no support system, or if there is, not a great one. Even so, the ability to take time off or reset mentally and emotionally is non-existent. Combine that with the mounting student debt and literally no marketable skills. Perhaps a better exit plan (loan forgiveness, masters level degree at completion of MS2), or parallel pathway that is on a less brisk pace (e.g. fluidity to moving to PA/NP or prolonged graduation pathway that is accepted) would be an alternative.
100% agree. This article hits too close to home for me having been on leave for depression. It wasn't so much the bad grades that bothered me but the "trapped" feeling hurt me the most. I knew no matter how painful the process got, leaving could financially cripple me because of the debt and no marketable skills to reasonably be able to pay it off.

If I suck at this, I'm willing to leave...but give me a way out then. Don't just leave me in the pressure cooker to get crushed.
 
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Require all students be screened for depression and anxiety disorders as part of the entrance physical exam to medical school
agree with the entire post except this.

Unless this screening is to identify at-risk applicants and allow them to be monitored and supported. I doubt you'd get away with screening out applicants based on their mental health...
 
Sooooooo..... I really don't like being a wet blanket, but let's break this down a bit.

Just a couple of my ideas on how to make students/residents happier. None of this will ever happen though.

End the A+/B-/C/D/F grading system. Everything is Pass/Fail, including 3rd year grades (with subjective narrative evaluations included).

I'm with you on P/F for rotations, and I'm glad that schools are starting to to this. The harsh reality is that there's a boatload of subjectivity that goes into clinical evaluations and evaluators are poorly aware of their own biases. I actually care less about tiered grading in pre-clinicals because quite frankly your answers are either right or wrong, can't get much more objective than that. The reality of competition for residency spots isn't going away after all. Back in med school I asked my dean why Penn, across the river from us was able to have P/F but we didn't feel it was something we should be pursuing. She gave a long-winded circumstantial answer that basically could be summed up by "Penn can get away with it because they're Penn. We can't".

Introduce clinical training early-on during medical student education, and deemphasize areas of the curriculum which have little to no clinical relevance (certain parts of histology, anatomy, and biochemistry)
The former sounds great in theory but I'm not sure what more people are asking. Early on, we're basically focused on getting students to not drool on themselves during history-taking while asking twenty consecutive questions about sexual history while the standardized patient comes in with a CC of a sinus infection. As for the latter: we can't be on these boards bitching about the superior knowledge base of MDs over NPs or whoever then bitch that the knowledge base isn't important.
Eliminate all school or professor-created exams and require all schools to use NBME-created exams which most closely mimic board exams and require less rote memorization of worthless powerpoint factoids.
is this really a problem in a lot of places? I don't really think it needs to be the NBME's responsibility to design medical school curriculum and exams for them.
Make all lecture attendance completely optional. No school may be allowed to force students to be physically present for lectures (looking @ you osteopathic schools).
not going to argue with you on this one.
Specifically require schools to let students participate in patient care activities during M3/M4 clinical years and place on probation any institution where students are paying to shadow. Schools that cannot afford to pay clinical faculty responsible for supervising medical students will be forced to fire administrators to make room in the budget or immediately shut-down.
I know you've posted a lot on this topic over the last year or so so there isn't a lot that I can say that hasn't already been said for you on this. I will say that not every shadowing experience lacks educational value, particularly in specialized settings. I had a couple rotations and sub-rotations where my job was to sit and watch that I still consider extremely valuable today because I learned a ton. Also whether or not a hospital/med school's faculty are having your shadow vs doing whatever else isn't really about the faculty compensation. It's sadly far more complicated. See the Wayne State/DMC debacle that's been ongoing for a decade now.
Eliminate all funding for "diversity" initiatives and programs, and redirect these funds toward higher quality clinical training.
StopLikingWhatIDontLike.jpg
Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking.
uhh, it is. Sorry, this fact isn't going away. I've found programs trying to promote interdisciplinary learning, usually in the preclinical years, to be pretty useless, mostly because no one actually has the clinical experience to actually benefit from the interactions. However, I can't say I'm not amused when I see alumni of the allo board who spent their time complaining about other health professions starting threads about how the nurses are mean to them. As for making students believe in their profession, if you can't validate yourself and what you're doing, that's on you, bro.
Eliminate Step II CS as an exam and require US medical schools to train students in modern evidence-based physical exam skills, including basic POC ultrasound.
:thumbup:
Require all students be screened for depression and anxiety disorders as part of the entrance physical exam to medical school
eh, it ain't that simple. The stuff that pops up in med school MH problems are usually aren't going to be picked up in the PHQ that your PCP is running through.
Provide free (school paid-for) 3rd-party clinical psychologists or counselors up to 8-10 appointments free per year per student, if needed. Fire as many administrators as possible to make room in the budget for this.
IIRC, the LCME requires more or less requires this. 3rd party isn't going to make a huge difference to be honest, though the treating clinician shouldn't have any connection to a student's evaluation or advancement. As for your repeated, and rather immature suggestion that they simply "fire administrators," I anxiously await the resulting SDN threads of "w,x,y, at school z is disorganized and no one is there to fix it!"
Require all residency programs to cover health insurance for every resident and their dependents at no cost to the resident. If they are going to underpay residents via their Match monopoly, they're going to at least make sure their own physicians can get decent health care for their immediate family (who they'll probably rarely ever see). For single residents or those without dependents, they should get increased salary to (at least partially) make-up for the discrepancy.
Meh, we've already had enough threads in the last year about the "horrible extortion" that is the match and how residents are living in poverty and other hyperbolic nonsense. My health insurance in residency was reasonably affordable and pretty comprehensive. And sorry, no one is going to give you extra cash because you're single.
Eliminate all "professionalism" committees or at the very least purge them of all non-physician administrators.
If this board should tell you one thing, it's that far too many med students never got the message of "You're in professional school now. It's time to grow up." I'd love to hear people's alternative system of discipline and oversight for when students display professionalism problems.
Stop admitting insufferable social justice warriors and rat-racers with cluster B-personality disorders to medical school.
Whatever floats your boat, dude.
 
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It isnt the people who have mental issues who acknowledge them that concern me but those who think eveeyone else has them except for themselves.
Really? In med school, my concern has been for the ones who suspect a mental health issue but are too time-crunched and/or afraid of being stigmatized that they don't seek the help they need.

I also think a fair amount of medical students would have passed a basic mental health screening pre-medical school but may show signs of depression once they're here. I don't think "screen out the mentally ill!" would actually provide any type of solution, but revamping the environment of medical school might.
 
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Also...P/F brings it's own problems.

Most programs I know that are pass-fail do not have 70% as the break point. The "pass" grade shifts based on overall class performance. Lets say the majority of your class really rocks at renal, and you don't. sucks to suck, the passing grade isn't simply a 70% now it's an 84%.
 
Before I write a whole long post, let me ask a point of clarification: when you say "entrance physical exam" you mean post acceptance, correct? If so, all my complaints are moot. I've heard people propose psych evals as part of the actual application process and that terrifies me for a host of reasons.
I mean after you are accepted. The results dont need to be shared with the school, just the fact that it was completed. This may allow kids to get earlier treatment for untreated mental health issues.
 
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An interesting idea.
Some potential problems (curious about your thoughts on these)

1. what happens if you find an issue?
2. how do you protect students? - there will be a concern that anything found from the school could have the potential to appear on a student's transcript, especially if it's a mandatory screening process.
3. how would you scale problems? (I'm a baby first year and haven't had psych, so I don't understand how depression/suicidal ideation is scaled). Like...is someone that's a 1 out of a 1-10 a concern, does that not meet the mark for concern?
4. how would you measure the success of a screening process? Do you simply track suicide rates beyond it's implementation? (anxiety and depression might be harder to measure, and there's the possibility that standard screenings might increase the stigma of mental health issues in medicine and further decrease self reporting).
5. could any kind of protection be offered to students who DO have an issue? How can students be reassured that their anxiety disorder won't be reported to a residency program or a preceptor?
Read above. None of the results would be reported to the school in the first place.
 
Require all students be screened for depression and anxiety disorders as part of the entrance physical exam to medical school

This can make the issue worse, potentially. I would still stick to encouraging resources to be used rather than do something like this.

A good chunk of medical students and doctors are vulnerable to developing mental illness throughout the course of their life, so it's not like pre-existing conditions are the only thing that's going to be an issue.

Eliminate all funding for "diversity" initiatives and programs, and redirect these funds toward higher quality clinical training.

As someone who personally knows people who have benefited from these initiatives, I'll agree to disagree.
 
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Just a couple of my ideas on how to make students/residents happier. None of this will ever happen though.

End the A+/B-/C/D/F grading system. Everything is Pass/Fail, including 3rd year grades (with subjective narrative evaluations included).
Introduce clinical training early-on during medical student education, and deemphasize areas of the curriculum which have little to no clinical relevance (certain parts of histology, anatomy, and biochemistry)
Eliminate all school or professor-created exams and require all schools to use NBME-created exams which most closely mimic board exams and require less rote memorization of worthless powerpoint factoids.

Make all lecture attendance completely optional. No school may be allowed to force students to be physically present for lectures (looking @ you osteopathic schools).
Specifically require schools to let students participate in patient care activities during M3/M4 clinical years and place on probation any institution where students are paying to shadow. Schools that cannot afford to pay clinical faculty responsible for supervising medical students will be forced to fire administrators to make room in the budget or immediately shut-down.
Eliminate all funding for "diversity" initiatives and programs, and redirect these funds toward higher quality clinical training.
Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking.
Eliminate Step II CS as an exam and require US medical schools to train students in modern evidence-based physical exam skills, including basic POC ultrasound.
Require all students be screened for depression and anxiety disorders as part of the entrance physical exam to medical school
Provide free (school paid-for) 3rd-party clinical psychologists or counselors up to 8-10 appointments free per year per student, if needed. Fire as many administrators as possible to make room in the budget for this.
Require all residency programs to cover health insurance for every resident and their dependents at no cost to the resident. If they are going to underpay residents via their Match monopoly, they're going to at least make sure their own physicians can get decent health care for their immediate family (who they'll probably rarely ever see). For single residents or those without dependents, they should get increased salary to (at least partially) make-up for the discrepancy.
Eliminate all "professionalism" committees or at the very least purge them of all non-physician administrators.
Stop admitting insufferable social justice warriors and rat-racers with cluster B-personality disorders to medical school.

I think if they just did the first 3 bolded things you mentioned it would alleviate the problem for 95% of med students...
 
First 4 things. Too much scheduled time is not conducive to wellness.
Yes, but I think it depends on the number of mandatory hours a day. Having 3-4 hours of mandatory lecture is nbd imo. Especially if you can just plug in headphones and do your own thing. I get where you're coming from though, and some of the policies that have come up in threads recently blow my mind.
 
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Just a couple of my ideas on how to make students/residents happier. None of this will ever happen though.

End the A+/B-/C/D/F grading system. Everything is Pass/Fail, including 3rd year grades (with subjective narrative evaluations included).
I agree. This is already happening at many schools.

Introduce clinical training early-on during medical student education, and deemphasize areas of the curriculum which have little to no clinical relevance (certain parts of histology, anatomy, and biochemistry)
Curriculums can always use improvement. Schools generally try to update what they are teaching, but a certain amount of inertia is always to be expected. I am all for the streamlining of education. A side point, one of the biggest "PA/NPs are so far beneath arguments" is about how inferior their education is because they don't learn this kind of background information.

Eliminate all school or professor-created exams and require all schools to use NBME-created exams which most closely mimic board exams and require less rote memorization of worthless powerpoint factoids.
This sounds great in theory, but this would backfire quickly. Medical school should be about teaching you medicine, not teaching you for tests. Again, while I agree that there are massive areas that could be improved, educators should be the ones driving curriculum and testing, not a governing body.

Make all lecture attendance completely optional. No school may be allowed to force students to be physically present for lectures (looking @ you osteopathic schools).
There are plenty of schools that attendance is optional. Forced attendance works for some people. Don't apply to schools that won't fit you. While personally, I have a hard time imagining that attendance policies make a difference one way or another, trying to force schools to adopt one way or the other is a little authoritative to me.

Specifically require schools to let students participate in patient care activities during M3/M4 clinical years and place on probation any institution where students are paying to shadow. Schools that cannot afford to pay clinical faculty responsible for supervising medical students will be forced to fire administrators to make room in the budget or immediately shut-down.
Get ready for a lot of schools to close down. I am not arguing that watering down of education isn't a problem. But, this is next to impossible to measure and impossible to legislate.

Eliminate all funding for "diversity" initiatives and programs, and redirect these funds toward higher quality clinical training.
Virtually every program can be improved upon, but this is like blaming the EPA for the federal deficit.

Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking.
I can't remember where you are at exactly in your medical education (MS4?), but how much clinical experience do you have exactly? This is a pretty big claim and at least from where I sit, the physicians that have the hardest time in the real world are the ones that have the attitude that healthcare isn't a team sport. This goes for both residents and attendings. They are by far the ones that cause problems that directly impact patient care and outcomes.

Eliminate Step II CS as an exam and require US medical schools to train students in modern evidence-based physical exam skills, including basic POC ultrasound.
Sure. Sounds good.

Require all students be screened for depression and anxiety disorders as part of the entrance physical exam to medical school
I agree. From a practical standpoint and to make everyone happy... I would require every school to make an appointment in the first month of MS1/MS2/MS3 for every single student with a mental health specialist. The students could opt out if they want to, but it would have to be an opt out system, NOT an opt in system. As with all health care, I would not allow the providers to share any results with the school. But, the most important thing is to get at risk people plugged in early.

Provide free (school paid-for) 3rd-party clinical psychologists or counselors up to 8-10 appointments free per year per student, if needed. Fire as many administrators as possible to make room in the budget for this.
I agree with the mental health care, and at least the few that I have kept up with recently do offer something similar to what you suggest. It is always easy to say, "fire administrators", the reality is that good administrators are hard to come by and without them schools would fall apart. Again, like everything, things can be more efficient, but schools don't carry a ton of extra weight for ****s and giggles.

Require all residency programs to cover health insurance for every resident and their dependents at no cost to the resident. If they are going to underpay residents via their Match monopoly, they're going to at least make sure their own physicians can get decent health care for their immediate family (who they'll probably rarely ever see). For single residents or those without dependents, they should get increased salary to (at least partially) make-up for the discrepancy.
This hinges on the concept that residents are underpaid, which I would argue is not true. Residents are not pure employees. They are employees and trainees. Part of the compensation is required education and training. Now, some programs provide poor education/training, which is a separate issue. Resident median salary is almost exactly the same as median household income in the United States. It is hard to argue that you are being underpaid, when you add the training on top of that salary. Look, I'm not blind to the finances of being a resident. I make an hourly wage the equivalent to a grocery store bagger (of course my benefits are much better and have a guaranteed 80+ hours of work per week). I have had to deal with large unexpected family medical expenses and the shenanigans that we call our insurance market in the US. I won't go into the details, but I also had my annual salary cut by 10% suddenly and without warning in the middle of my residency. You bet that I was furious and wish that I was being paid more. But, from an outside looking in perspective, it is a pretty hard sell.

The NRMP has nothing to do with resident compensation. Funding is a CMS/medicare issue.


Eliminate all "professionalism" committees or at the very least purge them of all non-physician administrators.
Find me enough MDs to fill the committees and aren't more interested in spending their time making money and then we'll talk.

Stop admitting insufferable social justice warriors and rat-racers with cluster B-personality disorders to medical school.
I'm not sure how to to do this, but all ears on how you propose going about it.
 
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Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking.
I can't remember where you are at exactly in your medical education (MS4?), but how much clinical experience do you have exactly? This is a pretty big claim and at least from where I sit, the physicians that have the hardest time in the real world are the ones that have the attitude that healthcare isn't a team sport. This goes for both residents and attendings. They are by far the ones that cause problems that directly impact patient care and outcomes.
.

QFT :thumbup:

(also your formatting was way better than how I did it)
 
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It doesn't have to be this way, and you only have to look towards business school to see that. Grades mean very little, and we are indeed left with immeasurable ass-kissing. However, look at how they choose their first jobs out of school. Some go into industries where there is a "prestige" factor (e.g. consulting), but even then decisions on where they go are often just as much about the position, trajectory, and the compensation package. A "top" grad from a "top" school wouldn't hesitate to turn down McKinsey if he/she thought that a boutique company was offering something better, or that they could start their own company, and no one would assume that he/she "couldn't get into McKinsey." Then, if they do a fantastic job at the first company, they can always get back into the big name companies, rise in the ranks, etc... Not to mention, this freedom on the part of fresh grads earns them far more options. In this scenario, the students all win.

I graduated into the great recession with an MBA from an unquestionably elite program. I don't agree that you can always get back into big name companies and rise in the ranks. Fortunately, I had worked in technology prior to B-school and was able to land on my feet. But the 40% of the class who was hoping to end up I-Banking on Wall Street found themselves scrambling for something else. The lucky ones found ho-hum corporate jobs at airlines, retailers and even consultancies, while the less fortunate lived off their spouses, moved in with their parents, or returned to their home country clinging to their banking pipe dream. Even the lucky ones now openly muse that the great recession was a death sentence for their I-banking career. Goldman Sachs does not want to take on some Wharton grad who crushed it for three years at Frito Lay any more than Mayo wants to offer an attending position to an HMS grad who was the best resident Sioux Falls VA Hospital ever had. The newest, shiniest models are always more appealing. Fortunately, almost everyone has found their way into something that has afforded them a decent living. But their dreams of partnership at a bulge bracket i-bank are long gone. Trajectory is everything at the top.

However, I believe you are correct in the sense that the elite MBA students all (eventually) win. Like I mentioned, everyone has found their way into something financially and professionally rewarding. There are simply more options. This is quite unlike the situation for those pursuing medical education, the sole purpose of which is to land membership in a monopoly profession. We all understand this professional monopoly is created by artificially limiting the number of people who can earn medical degrees, and the number of people who can obtain residencies in particular specialties. But the flip side of the outstanding economic benefits the monopoly system provides to doctors, is that the gatekeepers hold all of the power over trainees until residency completion. The prestige "arms race" you describe only seems to magnify the importance of the right residency match. At least those with an elite MBA, even in the absence of a McKinsey on their resume, have a piece of paper that signals general intelligence to employers outside the narrow confines of a single gilded industry.
 
Also...P/F brings it's own problems.

Most programs I know that are pass-fail do not have 70% as the break point. The "pass" grade shifts based on overall class performance. Lets say the majority of your class really rocks at renal, and you don't. sucks to suck, the passing grade isn't simply a 70% now it's an 84%.

Is this really that common? That's effectively a downward curve which seems really odd to me. If the goal of implementing P/F is to reduce stress, I would expect that admin would know to keep it set at a reasonable cutoff
 
Is this really that common? That's effectively a downward curve which seems really odd to me. If the goal of implementing P/F is to reduce stress, I would expect that admin would know to keep it set at a reasonable cutoff

I've never heard of that either when it comes to P/F. My school does implement a curve for your actual letter grade, but as long as you hit a 70% you're always guaranteed to pass.
 
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Is this really that common? That's effectively a downward curve which seems really odd to me. If the goal of implementing P/F is to reduce stress, I would expect that admin would know to keep it set at a reasonable cutoff
I don't know how common it is (my school is P/F pre-clinical with minimum cutoff or 2SDs below average, whichever is lower so the bar won't rise if everyone does well, but it will drop if everyone does poorly) but they must exist because there are also schools that are "P/F" but use what would have been your grade if it weren't P/F to rank people's pre-clinical performance (or factor into overall academic rank).
 
I don't know how common it is (my school is P/F pre-clinical with minimum cutoff or 2SDs below average, whichever is lower so the bar won't rise if everyone does well, but it will drop if everyone does poorly) but they must exist because there are also schools that are "P/F" but use what would have been your grade if it weren't P/F to rank people's pre-clinical performance (or factor into overall academic rank).

True, but P/F with ranking is different from variable fail cutoffs. A mediocre student in one might get all passes and a low quartile, but could get several fails in the other case.
 
Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking.
I can't remember where you are at exactly in your medical education (MS4?), but how much clinical experience do you have exactly? This is a pretty big claim and at least from where I sit, the physicians that have the hardest time in the real world are the ones that have the attitude that healthcare isn't a team sport. This goes for both residents and attendings. They are by far the ones that cause problems that directly impact patient care and outcomes.
I'm finished with medical school. But what I was referring to here was the various seminars that medical students are forced to attend about interprofessional cooperation and all the associated non-sense, whose sole purpose at least for medical students is to prime them to buy into the "everyone is a provider" paradigm and diminish the importance of medical education and physician-led healthcare.

Require all residency programs to cover health insurance for every resident and their dependents at no cost to the resident. If they are going to underpay residents via their Match monopoly, they're going to at least make sure their own physicians can get decent health care for their immediate family (who they'll probably rarely ever see). For single residents or those without dependents, they should get increased salary to (at least partially) make-up for the discrepancy.
This hinges on the concept that residents are underpaid, which I would argue is not true. Residents are not pure employees. They are employees and trainees. Part of the compensation is required education and training. Now, some programs provide poor education/training, which is a separate issue. Resident median salary is almost exactly the same as median household income in the United States. It is hard to argue that you are being underpaid, when you add the training on top of that salary. Look, I'm not blind to the finances of being a resident. I make an hourly wage the equivalent to a grocery store bagger (of course my benefits are much better and have a guaranteed 80+ hours of work per week). I have had to deal with large unexpected family medical expenses and the shenanigans that we call our insurance market in the US. I won't go into the details, but I also had my annual salary cut by 10% suddenly and without warning in the middle of my residency. You bet that I was furious and wish that I was being paid more. But, from an outside looking in perspective, it is a pretty hard sell.

The NRMP has nothing to do with resident compensation. Funding is a CMS/medicare issu
If you think you are paid fairly, then that's cool (just an opinion, no use arguing about it). The monopoly-nature of the Match system absolutely depresses resident wages.

http://economics.mit.edu/files/10627
Why So Many Young Doctors Work Such Awful Hours

While residency-program administrators no doubt take their educational obligations seriously, residents are also a cheap source of skilled labor that can fill gaps in coverage. They are paid a fixed, modest salary that, on an hourly basis, is on par with that paid to hospital cleaning staff—and even, on an absolute basis, about half of what nurse practitioners typically earn, while working more than twice as many hours.*remained essentially unchanged for the last 40 years.
 
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I'm finished with medical school. But what I was referring to here was the various seminars that medical students are forced to attend about interprofessional cooperation and all the associated non-sense, whose sole purpose at least for medical students is to prime them to buy into the "everyone is a provider" paradigm and diminish the importance of medical education and physician-led healthcare.


I'm not going to blow sunshine up your ass and tell you that those seminars are helpful. They aren't. They are poorly taught, poorly run and frankly, the people that need the help aren't going to be paying attention anyways. But, frankly, medicine is a team sport and a huge problem with physicians is that we assume that we have all the answers and that nobody else can possibly figure out how to do things. Then when asked to play an active role, we are too busy with our practices to actually take ownership of it. Try sitting on a hospital committee or two, notice the interest level of physicians. Complaining? Sure. But, actually spending time, energy and resources, pretty hard to come by. The lion's share want to graduate residency, open or join a practice and make their hard earned money, the hell with everything else.


If you think you are paid fairly, then that's cool (just an opinion, no use arguing about it). The monopoly-nature of the Match system absolutely depresses resident wages.

http://economics.mit.edu/files/10627
Why So Many Young Doctors Work Such Awful Hours

No offense dude, but you really should read the links before you post them. The first one is incredibly technical, but shows that the match INCREASES salaries. The second is a lay article that despite spending most of it's space ranting about the decreased pay admits that this is far from clear (and even reference the first article). It's evidence that wages are depressed is because someone sued, which is crap.
 
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Lol. And lets keep working these residents 28 hours a shift huh...

If the medical community were seriously concerned about trainees' mental health, rather than only talking about it after tragedy, then the discussion of shift hours would have revolved more around how these shifts affect residents and not only about how the shifts affect patients. Why does suffering, high stress, and little sleep have to be compulsory to be trained in medicine?
 
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This thread again...
I'm finished with medical school. But what I was referring to here was the various seminars that medical students are forced to attend about interprofessional cooperation and all the associated non-sense, whose sole purpose at least for medical students is to prime them to buy into the "everyone is a provider" paradigm and diminish the importance of medical education and physician-led healthcare.

It's amazing how many physicians in training feel the need to put effort into feeling emasculated.
If you think you are paid fairly, then that's cool (just an opinion, no use arguing about it). The monopoly-nature of the Match system absolutely depresses resident wages.

http://economics.mit.edu/files/10627
Why So Many Young Doctors Work Such Awful Hours

As for this, we had long and detailed thread about this last year.

The takeaway: careful what you wish for. An unrestricted market for salaries wouldn't give you the result you think it would. You're paid what you are because you are otherwise completely unemployable.
 
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The takeaway: careful what you wish for. An unrestricted market for salaries wouldn't give you the result you think it would. You're paid what you are because you are otherwise completely unemployable.

I don't mean to derail this thread, but what are your thoughts on a minimum salary for residents (if the federal government ever actually made a move on such a thing)?
 
It is truly a **** day for medicine when meritocracy is being publicly assassinated in NEJM.

You want to do something for med students ? Lower it's duration - make it a grand total of 5 years instead of stretching a somewhat thin slice of knowledge over the course of 8 years.
Also the fact that residency programs worth a dam would never accept students that have a record of simple things like a temporary episode of depression, insomnia, ADHD or anxiety is only adding insult to injury.
 
Really? In med school, my concern has been for the ones who suspect a mental health issue but are too time-crunched and/or afraid of being stigmatized that they don't seek the help they need.

I have zero problems with someone who has a dx as to mental illness just like I have zero problems with someone having a dx due to physical illness. The body needs a regular checkup, as does the mind/psyche. As for time crunch, people always find time for the things they deem important, e.g. Facebook, Netflix, SDN, Tinder, etc. While the medical profession is very judgmental and harsh towards their own, it is possible to see a therapist, social worker, across or out of town professional, etc. for most issues.
 
From a practical standpoint and to make everyone happy... I would require every school to make an appointment in the first month of MS1/MS2/MS3 for every single student with a mental health specialist. The students could opt out if they want to, but it would have to be an opt out system, NOT an opt in system. As with all health care, I would not allow the providers to share any results with the school. But, the most important thing is to get at risk people plugged in early.

I am curious what you make of the +50% burnout rate of physicians in today's medical profession? Are these people who "were at risk" and slipped through the cracks? Do they lack the "right stuff"? Are they not "cut out for medicine"?

my 2 cents: we've all got potential mental health problems. It is not a question of whether we have issues but rather do we have a handle of our issues; in other words: "do you manage your problems or do the problems manage you?"

As an aside, the comments posted by subscribers to the article on the NEJM website are all glowing. Unlike many here on SDN, NEJM physician subscribers/commenters concur with the Dean's above quote. The most recent one follows:

ALIYA HASAN, MD | Physician - GASTROENTEROLOGY | Disclosure: None
DENVER CO
March 23, 2017

Thank you
Thank you for sharing. My condolences to Kathryn's family, friends, and all of you. I really appreciated the point you made in the end about moving away from test scores and taking a different approach. I hope other medical schools, graduate schools, and colleges come to the same conclusion. We need to let kids be kids.
 
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