We frequently hear medical students and residents say that the medical education system is broken
and needs to be changed, but what about it is broken?
How exactly is medical education failing students?
Let’s talk about it.
Dr. Jubbal, Medschoolinsiders.com.
In an ideal world, the goal of medical education would be to mold students into the best, most
competent, and most caring physicians they can be.
Curriculums and clinical experiences would be optimized for learning and systems would
exist to support students who are struggling.
Unfortunately, this is not often the case with medical education in the United States.
It is estimated that nearly half of all medical students suffer from anxiety and nearly a
third from depression.
Moreover, according to the American Foundation for Suicide Prevention, 28% of residents experience
a major depressive episode during training compared to only 7-8% of similar-aged individuals
in the U.S. population.
Given these unsettling trends, it is clear that there are deeply-rooted problems within
medical education that need to be addressed.
Here are 5 ways that medical education is failing students.
Let’s start with the elephant in the room: the culture of medical education.
Becoming a doctor requires countless hours of studying and hard work.
Although many argue that medical education should be difficult given the responsibilities
that come with being a physician, others believe that the current system places too heavy of
a mental and physical burden on students and residents.
Aspiring physicians must regularly endure sleep deprivation, long nights, and work after
hours and on days off.
According to a recent Medscape survey, two-thirds of residents work greater than 50 hours per
week with a large percentage of residents exceeding 70-80 hours per week.
Although duty hour restrictions exist that limit residents to 80 hours and require at
least one day off per week, this is averaged over 4 weeks.
And even then, many programs violate these restrictions.
As such, there are many residents working in excess of 80 hours per week, which translates
to 13 to 14 hours per day, 6 days per week.
In addition, the environment during medical school is often extremely competitive.
Everyone is trying to achieve the highest grades, the best test scores, and the most
research to match into their desired specialty.
Not only does this immense pressure to perform often lead to feelings of inadequacy and impostor
syndrome, but it can also lead to fierce competition between students as well – which some students
take too far.
Some overly-competitive students will throw their peers under the bus in order to elevate
themselves in class or in rotations.
Instead of fostering a collaborative environment where students work together to maximize their
learning, the competitive nature of medical school can sometimes pit students against
one another.
This has many consequences.
To start, it causes many students to feel inadequate – like their peers are always
doing more than them – which ultimately leads to feelings of inferiority and impostor
syndrome.
Over time, these feelings can develop into more serious mental health issues such as
anxiety, depression, and even suicide.
Next, this competition between students perpetuates the culture of overwork.
It’s not uncommon for students to brag about how much they study, how little they sleep,
and how much they’ve sacrificed to excel in medical school and residency.
As a result, many students are pushed further and further to excel academically, often sacrificing
things like self-care and hobbies in the pursuit of performance.
Lastly, it can strain the relationships that students build with their peers and instructors
and make medical school feel like an “every person for themself” experience.
Although this isn’t the case at every medical school and the transition to pass-fail curriculums
during the first two preclinical years has helped to address some of these issues, it
is still an unfortunate reality for many students today.
The next reason that medical education is failing students is that it relies too heavily
on standardized tests.
Prior to January 2022, USMLE Step 1 was considered the most important exam that future physicians
took during their training.
The reason was that your score on Step 1 was a major determinant of your competitiveness
for residency applications.
As a result, a low score on Step 1 often prohibited students from pursuing highly competitive
specialties.
If you wanted to become a dermatologist or a plastic surgeon, for instance, but you didn’t
score high enough on Step 1, you could pretty much kiss your dream specialty goodbye – all
because of a single, 8-hour test.
Although Step 1 has officially transitioned to pass-fail as of January 2022, this still
doesn’t change the overreliance on standardized tests.
Step 2CK is still graded on a numerical scale and will likely become the new Step 1 in terms
of its weight on residency applications.
The pressure to perform is just being shifted from one standardized test to another.
The problem is that standardized tests aren’t necessarily reflective of a student’s ability
to be a good physician, but rather their ability to take standardized tests.
There are many other factors that play into being a great physician beyond test scores
such as integrity, compassion, empathy, and other soft skills that cannot be evaluated
effectively with a computer-based exam.
Speaking of components of a medical student’s residency application, the overemphasis on
research is another way that medical education is failing students.
Although it is important to have the skills to analyze and understand research as a physician,
playing the “research game” in medical school often consumes time that students could
spend developing skills that will make them better physicians instead.
Research in medical school is a numbers game and quantity is prioritized over quality.
If you’re trying to match into a competitive specialty, you are encouraged to get your
name on as many research projects as possible to pad your CV.
The result is that many students end up spending large amounts of time producing research,
most of which is of little impact and doesn’t meaningfully progress the body of scientific
literature or our understanding of medicine.
The reality is that most physicians will not continue to do research once they have completed
their training, so why then do medical students have to commit so much time to research during
medical school?
That time could be better spent studying, seeing patients, and developing the skills
and knowledge necessary to become a competent physician.
Next are subjective evaluations.
During the third year of medical school, students must complete a series of rotations in a variety
of specialties.
At the end of each rotation, they are given a grade that is determined by two things:
their shelf scores and their subjective evaluations by their supervising resident and attending
physicians.
The weight given to shelf scores and subjective evaluations varies depending on the program
and the rotation; however, there are some clerkships that are predominantly determined
by subjective evaluations.
This is problematic as it puts the focus on trying to impress your preceptors as opposed
to trying to learn.
You may just get lucky or unlucky that you click or don’t with your preceptor.
If you both bond over your shared love of Formula 1, you’re likely to get a stronger
evaluation than if you have nothing in common.
Additionally, many students will avoid asking questions when they don’t know something
just to avoid looking bad in front of their preceptors.
As such, these subjective evaluations may disincentivize students from asking questions
and addressing their gaps in knowledge.
Clinical rotations sometimes feel like they’re no longer about learning but rather about
politics and the fear of getting a bad grade instead.
Lastly, mistreatment and discrimination are not uncommon, both in terms of getting into
medical school and throughout the medical training process.
When you look at medical school admissions data, it is evident that students from certain
racial backgrounds have a much more difficult time getting into medical school than others.
Although affirmative action in medical school admissions aims to help increase diversity
among medical students, one of the unintended consequences is that it has made it significantly
more difficult for some students to get into medical school.
Asian students in particular are hurt the most by affirmative action policies.
The average Asian matriculant during the 2021-2022 application cycle had an average GPA of 3.79
and MCAT score of 514.5.
If we compare this to the average Black matriculant during this same year, the average Asian matriculant
achieved a GPA that was nearly 0.25 points higher and an MCAT score that was nearly 8
points higher.
For perspective, a 506 on the MCAT is a 65th percentile score and a 515 is a 90th percentile
score.
Ask anyone who has taken the MCAT, and they’ll tell you how big of a difference this is.
Asian matriculants, despite being minorities in the US and facing discrimination beyond
academics, averaged a GPA and MCAT that was higher than even Caucasian matriculants.
Each year these differences vary, but recently Asians have averaged a GPA close to 0.1 points
higher and an MCAT more than 2 points higher than their Caucasian colleagues.
We cover this topic in depth in our Affirmative Action in Medical School Admissions video
- link in the description.
Unfortunately, discrimination and mistreatment don’t end once one gets into medical school
either.
According to a 2022 study published in JAMA, students from underrepresented groups who
reported mistreatment or discriminatory behavior had the highest attrition rates of any group.
Students who reported recurrent experiences of mistreatment had attrition rates of 4.1%
compared to 1.2% of students who reported no mistreatment.
In addition, students reporting recurrent experiences of discrimination had attrition
rates of 1.9% compared to 1.3% for students reporting no discrimination.
From this research, it is evident that there are issues with mistreatment and discrimination
within medical education that are causing some students to leave their medical training
altogether.
This comes at a time when we are facing looming physician shortages across a wide variety
of specialties as well.
These reasons just scratch the surface of the bigger issues in medical education.
We could go all day talking about issues of the rising costs of medical education, the
stigma of mental health among physicians and trainees, and burnout; however, we have covered
these topics in depth in previous videos.
We also plan to cover the topic of the residency bottleneck and unmatched residents in a comprehensive
future video, so make sure you’re subscribed so you don’t miss out.
Although medical education has its flaws, it’s not all doom and gloom.
There are many things that medical education does well to prepare students for careers
in medicine.
That being said, it is still important to be aware of its shortcomings to better prepare
yourself for what to expect.
At Med School Insiders, our goal is to empower a generation of happier, healthier, and more
effective future doctors, and part of that is managing expectations.
Whereas others are hesitant to talk about the issues in medicine and medical education,
we believe it is important to understand these issues so you can better prepare yourself
to tackle them.
Although medical education in the U.S. has its issues, if your dream is to become a doctor,
it is a necessary hurdle to overcome – and we’re here to help you at each step of the
way.
From MCAT tutoring and medical school admissions to USMLE tutoring and residency applications,
we have a variety of resources to help you along your path to becoming a doctor.
Our team is made up of top-performing doctors who received merit-based scholarships and
matched into the best and most sought-after residency programs, even when the odds were
stacked against them.
Despite coming from financially disadvantaged backgrounds or ethnic groups that made the
process more challenging, these are real doctors who beat the odds, got to the top of their
class, and can show you how to do the same.
You’re not going to find this level of expertise and value anywhere else, because, simply put,
other companies weren’t built by and comprised of elite performing doctors.
You can’t learn how to become a top performer and have medical schools fighting over you,
trying to win you over with full-ride merit-based scholarships from someone who wasn’t able
to do that themself.
And be careful, as several companies are comprised of and built by people who never went to medical
school and never served on medical school admissions committees.
Some of these bad actors will mislead you into thinking they did by calling themselves
doctors when in reality they earned a Ph.D., which is completely different from the medical
school process.
If you want to be a stellar applicant and receive one-on-one advising, tutoring, interview
preparation, personal statement or secondary editing, mentorship, and more to become the
strongest applicant you can be, visit MedSchoolInsiders.com.
Thank you all so much for watching, if you enjoyed this video be sure to check out Affirmative
Action in Medical School Admissions or Surprising Facts From the 2022 Match over on the Kevin
Jubbal, M.D.
channel.
Much love, and I’ll see you guys there.