Thoughts?

[Iceppl]

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Every med school has its own internal issues - be they exams, assessments, curriculum, quality of teaching and resources. These days, medical students are willing to go to the extent that they are to be subjected to those problems and get beaten by the system. NO school is perfect but some problems are simply unacceptable, knowing the enormous amount of student loan and tuition fee a student has to pay for this medical education. Is it the students who are too afraid to go against the school and ask for change? OR is it the school being ignorant and unwilling to change?

Med students are always told how grateful they should be as they are given an opportunity to study medicine, and this has caused some students not want to voice even the tiny bits of their negative opinions on their schools in the fear of getting kicked out of the program.

Who to blame?

 

[Iceppl]

Over the years, physicians lost a lot of bargaining power in healthcare vs hospitals and insurance companies. At the time, many of these moves seemed beneficial, but in reality made them susceptible. Because they were on the front lines, they're very easy scapegoats and targets for reimbursement cuts. Anytime a physician sounds an alarm, they threat getting labeled as the problem. Academia is the one place where they still have some of the power they once coveted, and are doing everything to hang on at the expense of future physicians. They tell people you should be pillaged for taking 250k loans Add in what the age of information has done, you end up with a generation of people looking up to tik tok stars, hollywood and athletes.

The scariest part of the medical school is that no one talks about this, and you know about this insider ugly information only once you are in and by then, it's too late to get out of that mess. Just to hold on to their power and position, they are not afraid to sacrifice the teaching of the next generation doctors.

 

[operaman]

I went to a pretty middle of the pack Med school and I don’t think there were any major problems. Definitely nothing in the areas listed above. There were minor quibbles here and there and the school was very responsive whenever possible.

Overall I think Students are generally the least well equipped to judge these issues, especially early on. I’ll hear preclinical students complaining about their curriculum teaching useless info and then they’ll mention some useless things that I actually use in practice all the time.

Students also lack the perspective of being on the designing and implementation side. They may dislike a required group activity with other professional students, but not realize that’s meeting an LCME requirement. Some of the quibbles we had weren’t changed because there was a good reason for the current method. Others were things that were actually changed due to student feedback but in practice weren’t quite what prior classes expected.

Probably the biggest systemic issues in Med Ed happen in the clinical years and are generally traced back to the EMR. Students are basically locked out from many of the tasks they used to do. Hospital policies have locked them out from other things like lab draws and basic bedside procedures. In the “old” days students would pre round to draw labs, retrieve films, trend vitals, pre draft the paper notes, etc. Now the computer does much of that and some places discourage pre rounding and students end up in more of a shadowing role. I don’t think much of that old school scut work was terribly educational, but the workflow around it made students a more vital and integral part of the team and they were developing valuable skills. Clinicians today also have such a documentation and in-basket burden that they have far less time for good teaching.

 

[Iceppl]

I went to a pretty middle of the pack Med school and I don’t think there were any major problems. Definitely nothing in the areas listed above. There were minor quibbles here and there and the school was very responsive whenever possible.

Overall I think Students are generally the least well equipped to judge these issues, especially early on. I’ll hear preclinical students complaining about their curriculum teaching useless info and then they’ll mention some useless things that I actually use in practice all the time.

Students also lack the perspective of being on the designing and implementation side. They may dislike a required group activity with other professional students, but not realize that’s meeting an LCME requirement. Some of the quibbles we had weren’t changed because there was a good reason for the current method. Others were things that were actually changed due to student feedback but in practice weren’t quite what prior classes expected.

Probably the biggest systemic issues in Med Ed happen in the clinical years and are generally traced back to the EMR. Students are basically locked out from many of the tasks they used to do. Hospital policies have locked them out from other things like lab draws and basic bedside procedures. In the “old” days students would pre round to draw labs, retrieve films, trend vitals, pre draft the paper notes, etc. Now the computer does much of that and some places discourage pre rounding and students end up in more of a shadowing role. I don’t think much of that old school scut work was terribly educational, but the workflow around it made students a more vital and integral part of the team and they were developing valuable skills. Clinicians today also have such a documentation and in-basket burden that they have far less time for good teaching.

I second your last point regarding the issues in the clinical years. Not sure how things are run in other hospitals. But my M3 clerkship was more like an observation-ship: med students were told to just observe and do bare minimum work in my hospitals because residents and attendings were afraid of liability if something were to happen (even from drawing blood). We rarely got good bedside teachings because everyone was busy. Yet, our med school thought we were having excellent teaching sessions in the hospital. It's sad to say that most of our learning were from reading high yield prep books, buying subscriptions of expensive online resources and watching random Youtube videos.

 

[operaman]

I second your last point regarding the issues in the clinical years. Not sure how things are run in other hospitals. But my M3 clerkship was more like an observation-ship: med students were told to just observe and do bare minimum work in my hospitals because residents and attendings were afraid of liability if something were to happen (even from drawing blood). We rarely got good bedside teachings because everyone was busy. Yet, our med school thought we were having excellent teaching sessions in the hospital. It's sad to say that most of our learning were from reading high yield prep books, buying subscriptions of expensive online resources and watching random Youtube videos.

I had a unique experience in that my M3 year was still paper charts inpatient. We had a mishmash of electronic databases for lab results and films, but the official inpatient record was all paper. Students drafted notes for the resident to edit and sign, students would prep discharge summaries, we would have to physically pre round to get numbers and look for other teams’ notes.

Then in June of M3 we switched to Epic and it was interesting to see the shift firsthand. Pre rounds made less sense, teams started table rounding, students could do less. Much if this was done in the name of education to free students from scut work, but the result was to sideline students from any meaningful clinical role.

 

[Goro]

Every med school has its own internal issues - be they exams, assessments, curriculum, quality of teaching and resources. These days, medical students are willing to go to the extent that they are to be subjected to those problems and get beaten by the system. NO school is perfect but some problems are simply unacceptable, knowing the enormous amount of student loan and tuition fee a student has to pay for this medical education. Is it the students who are too afraid to go against the school and ask for change? OR is it the school being ignorant and unwilling to change?

Med students are always told how grateful they should be as they are given an opportunity to study medicine, and this has caused some students not want to voice even the tiny bits of their negative opinions on their schools in the fear of getting kicked out of the program.

Who to blame?

Several things come to mind

1) No one is forced to go to medical school.
2) It's important to drop the consumer mentality; med students are professionals in training, not buying garden hoses at Wally World.
3) It is the obligation of the school to make sure that its curriculum works.
4) It is the obligation of the school to listen to its students and make use of constructive criticism
5) It is the obligation of the school to make sure that students can walk that stage at graduation time.
6) BUT, if students are floundering despite all the help given, it's better to cut them loose early, rather than see them go through several years of schooling and incurring a massive debt.
7) It is the obligation of the student to to be responsible for their success. That includes seeking help when its needed. You're going to have enough nonadherent patients in your career. Don't be one yourself.
8) Believe it or not, the majority of your Faculty is vested in your success.
9) As medical students, it's your job to complain. If you don't try to change what's not working, it will never change.
10) Med students should be grateful to have the opportunity to study medicine, BUT, at the same time, the school should be grateful that you decided to attend, even if it was your only choice.

These are based upon my experiences of teaching med students for >20 years, for which I am truly grateful.

 

[operaman]

Several things come to mind

1) No one is forced to go to medical school.
2) It's important to drop the consumer mentality; med students are professionals in training, not buying garden hoses at Wally World.
3) It is the obligation of the school to make sure that its curriculum works.
4) It is the obligation of the school to listen to its students and make use of constructive criticism
5) It is the obligation of the school to make sure that students can walk that stage at graduation time.
6) BUT, if students are floundering despite all the help given, it's better to cut them loose early, rather than see them go through several years of schooling and incurring a massive debt.
7) It is the obligation of the student to to be responsible for their success. That includes seeking help when its needed. You're going to have enough nonadherent patients in your career. Don't be one yourself.
8) Believe it or not, the majority of your Faculty is vested in your success.
9) As medical students, it's your job to complain. If you don't try to change what's not working, it will never change.
10) Med students should be grateful to have the opportunity to study medicine, BUT, at the same time, the school should be grateful that you decided to attend, even if it was your only choice.

These are based upon my experiences of teaching med students for >20 years, for which I am truly grateful.

I’m always amazed at how many students don’t understand your point #8. There’s so much handwringing behind the scenes as faculty work to help students struggling with the various hurdles of the process while also having to shuttle a large group of people through limited resources with limited time. Some students see the relationship as very adversarial when that’s not how faculty see it at all.

I would also add that schools are wary of graduating terrible students who will reflect poorly on the school. My program fired a resident from a Top 10 school and hasn’t interviewed another student from there since; the fact they would graduate such a terrible doctor calls their standards into question even if they are otherwise considered a top school. Those personal experiences matter and can be even harder on lower tier schools.

I would encourage students who are truly interested in reforming their own school to try and get a position on their curriculum committee or other such groups. Most schools have student slots on all their major committees and it would offer a unique insight into the thinking that goes on behind the scenes.

 

[deleted849476]

Every med school has its own internal issues - be they exams, assessments, curriculum, quality of teaching and resources. These days, medical students are willing to go to the extent that they are to be subjected to those problems and get beaten by the system. NO school is perfect but some problems are simply unacceptable, knowing the enormous amount of student loan and tuition fee a student has to pay for this medical education. Is it the students who are too afraid to go against the school and ask for change? OR is it the school being ignorant and unwilling to change?

Med students are always told how grateful they should be as they are given an opportunity to study medicine, and this has caused some students not want to voice even the tiny bits of their negative opinions on their schools in the fear of getting kicked out of the program.

Who to blame?

Medical school in general may not be perfect but imo the further along I go, the more I think that there isn’t really any big issue with it. 1) med students complain a ton. They’re in a hard time of their life so I get it, but truly they complain all the time, i think it’s an outlet because the only thing they can do besides complain is grind and be patient which can suck. 2) I thought medical school admissions was the worst thing I’ve done in my life, it felt so judgmental and prejudiced and such a game, but whatever it’s fair because everyone has to do it. School itself isn’t half as bad as that, and I even think med school day-to-day is almost as good as college, certainly more interesting. 3) a few years of suck is nothing for the lifestyle and career you get later for the rest of your life, and I do think med students should be grateful, although it is annoying when admin tells you that during a stressful time.

What would be a real testament to is med school worth it or not is if one day between DO school expansion, increasing tuition, and all the problems after med school, that we start to see people just not choosing medicine anymore. Which I do believe would happen if medical school or life thereafter got to a certain low. That would be a crazy day

 

[Deltasidearm]

This is definitely a YMMV sort of thing. While my COM certainly isn't perfect, I feel they do an excellent job collecting and actually responding to our feedback (even if it's just to explain how their hands are tied by external forces against some changes they support). Also, when I actually reflect on the minor complaints I have, I'm glad I'm not the one having to plan these things because the logistics are incredible and I don't have a clear answer on how to improve them.