"You do not have, because you do not ask God. When you ask, you do not receive, because you ask with wrong motives, that you may spend what you get on your pleasures."
Simplified
In a perfect medical school the basic science education would be cut down. What I mean is that the focus on minute ‘physiologic’ biological processes would be limited. The basic sciences, especially in the first year, have become too complex and unnecessary. Too often what students are introduced to is influenced by the research of the faculty of the school. At the perfect medical school such would be limited with strict curriculum oversight. Further cutting of the basic science years would be limited by the National Board of Medical Examiners and their continued insistence that memorizing a host of biochemical pathways is somehow imperative for a single test day, somehow is imperative to becoming a physician. If that obstacle was removed the perfect medical school would significantly cut down on the traditional ‘first year’ material.
Early Clinical Exposure
The perfect medical school would also compress the basic science years. Already there are schools which do the first “two years” in eighteen months. An applause to such schools. The perfect medical school would do the same. The key is to get the medical student out of the classroom as soon as possible.
As I’ll discuss in the clinical sciences post, clinical exposure would be early in the first year and often. The 18 months at the beginning of the perfect medical school could hardly be called ‘basic science,’ despite the title of this post.
Integrated Curriculum
The perfect medical school would have a truly integrated curriculum. There would be no distinction between ‘first’ and ’second’ year. You would progress through the 18 months of basic science in modules focusing on various topics (i.e. cellular metabolism, cardiovascular system, GI system, etc.) in which you would cover the physiology, anatomy, pathology, related pharmacology, etc. The basics, which are hard to integrate, would be covered in the first two months in the classroom and then it would be off.
Despite the abandonment of the anatomy lab by some schools, gross anatomy and human dissection would remain a strong component of the perfect medical school.
Technology
The perfect medical school would be the most integrated school in the country, technology wise. The obvious things, done in most schools nowadays, would include virtual microscopy (no student should ever have to fix a path or histo slide), online lectures, online grades, online syllabi, computerized test taking.
Summary
Remove frivolous basic science minutia
Condense the basic science education to 18 months of less
Early clinical exposure
Strongly integrated curriculum with no distinction between ‘first’ and ’second’ year
Can something be both annoying and touching at the same time? The story I came into the hospital to this morning certainly comes close.
I went in to pre-round this morning on my gyn patients. Getting report from the nurse and reading the notes on one particular patient revealed a rather strange call the OB/Gyn resident had taken last night.
It seems sometime in the early, early morning the patient had started complaining to her nurse that her “heart hurt.” The patient has a history of these vague complaints without elaborating. She’s been in the hospital a long time and craves attention.
In anycase, apparently without further assessment the nurse pages the on-call resident at about 2 am and relates “chest pain.”
The resident shows up at the patient’s bedside and the patient denies “chest pain” but tells the resident she wanted to see a doctor because her “heart is breaking,” because her children haven’t come and visited her in the hospital.
Sigh. I think everyone can agree having the doc (or anyone) woken up at 2 am so you can tell them something like this is inappropriate and inconsiderate. But boy is that a sad story.
The above is an ad for americandreamabroad.com, which seems like a front to place Americans in a questionable medical school in China. Still a pretty funny ad.
Pre-Requisites
Pre-requisites for medical school admission should be extremely limited. Indeed, I think in the perfect school, they would not exist at all. Completion of say an undergraduate biochemistry has absolutely no independent predictive value of medical school success. A reliance on standardized tests to assess the pre-medical school basic science knowledge base in appropriate and required pre-requisite classes are simply redundant. Indeed the MCAT is an excellent predictor of medical school success; probably the best single predictor.
As many medical schools there would be no specific requirement for an undergraduate degree. Indeed, I would propose allowing mature high school students sure of their future to study for and take the MCAT without any college preparation and to enter medical school immediately following high school. And I’m not talking about an extended course here (like the 6 year European programs).
Admissions Criteria
As above, great emphasis would be placed on standardized measures (i.e. the MCAT). True, there are anecdotes of those who are merely poor standardized test takers and otherwise excellent students and perform as excellent physicians but in general the MCAT is an excellent predictor, not only of future standardized test performance, but of performance in medical school in general.
Very little weight would be put on prior GPA, which is entirely impossible to standardize versus other applicants. Such would probably help the pre-med attitude a bit.
More than lip service would be given to the intangibles that make a good physician and a demonstration of the right motives for going into medicine, a commitment to research, etc. would be elicited in part through self reporting, letters of recommendation and the unique interview process.
Interview Process
The admissions committee interview team would be entirely limited to physicians and current medical students and basic science faculty would be barred. The idea is that the interview process should solely serve in trying to determine the intangibles which make a good clinician. Hopefully things like a dedication to research can be derived from the applicants’ previous activities.
The interview process would be given a huge amount of weight, as a measuring tool of applicants’ intangibles as mentioned above. I imagine a full day ‘interview’ or perhaps two half day ‘interviews’ to standardize the rankings the admission committee members give to the applicants they interview.
What I mean, is that the admissions committee members would give an entire half day to interact with the applicant. Your a clinician in clinic then the applicant comes along or he scrubs into that surgery. The applicant and interviewer sit down for lunch together and then perhaps dinner with a second interviewer.
Summary
No pre-requisite courses
Potential for admission directly from high school in unique circumstances
If I was creating a medical school from scratch there are some specific things I would incorporate. Many of these ideas exist at various medical schools here or across the world. Some of these ideas are wholly new. This is essentially just a random collection of thoughts and not exactly an outline of how to start a school (no duh). For obvious reasons these ideas ignore current accreditation standards.
This series was inspired by a lengthy conversation I participated in (admittedly over drinks) concerning the perfect medical school. It was a group discussion amongst second and third year medical students from schools all across the country. It obviously focuses largely on ‘undergraduate’ medical education, which should be the primary focus of any medical school (many medical schools lose sight of this).
I’ll be honest, I think something like political connections has a place (a small place) in a medical school admissions decision. Distinguishing students for admission becomes almost a crap shoot once you reach those essentially qualified academically. I’m sure the applications and CVs and awards and service commitments all blend together. Political connections are, in perhaps an unfortunate reality, something that may benefit the school and thus arguably community health. Why not put them into consideration?
Whatever my controversial opinion above, in this instance the weight of such connections appears to have been overvalued. And more stunning is the backdoor method by which the admission went down.
[The father] is a known fundraiser in the medical community. In 2005, he held a fundraiser in his own home where more than 150 physicians raised more than $100,000 for [Florida governor] Crist, according to a news release from the Florida Medical Political Action Committee.
Kone said he thought he was within his rights to admit a student absent committee support, but the move breaks with procedures described by the Liaison Committee on Medical Education, which provides accreditation to UF and medical schools throughout the U.S. and Canada.
“The final responsibility for selecting students to be admitted for medical study must reside with a duly constituted faculty committee,” according to the accrediting body’s standards.
[…]
Dr. Craig Tisher, former dean of UF’s College of Medicine, said he never broke with Ira Gessner, chairman of the Medical Selection Committee.
“During the five years that I was dean, I did not go against the wishes of the admissions committee,” Tisher said. “I let them make the selections, and I relied upon the judgment of the people who were interviewing the students and the chairman of the admissions committee, Dr. Gessner. All I can tell you is I didn’t exercise that prerogative (to overrule the committee), if in fact that prerogative exists.”
This is a drawing from a lecture today. Actually a very good lecture and not just because we got a kick out of the drawing. Any guesses as to what condition is being…crudely…illustrated?
Today an obstetrics patient came in a month out from being treated for chlamydia. In non-pregnant women you treat and let it slide but rip-roaring chlamydia in a pregnant woman can have some bad effects. Pregnant women with active chlamydia infections are more likely to go into pre-term labor and during delivery it ain’t so good for the little fella to be passing through an infected vaginal canal. Because of that we need to actually test for cure and that calls for a speculum exam.
I’m more than comfortable with pelvic exams now and as in the one I had done earlier in the day, everything went relatively smoothly in this one. I do what needs to be done, pull out and reach across myself to throw the disposable speculum into the biohazard can when a big honking glob of…well, I’ll spare you the details; it is enough to say something dripped off the speculum and onto my slacks. Something that might make you consider incinerating those pants rather than taking them to the dry cleaners.
There are much worse stories of pelvic exams out there, so I’m hoping this relatively tiny mishap will be enough to appease the Ob/Gyn gods. And it was kind’ve funny and my resident got a kick out of it.
The U.S. went more than 30 years without a new med school (not counting osteopathic schools, which grant the D.O. degree). But in the last few years, a dozen or so institutions have set out to create new schools to mint MDs.
If I was creating a medical school from scratch what would it be like? I’m gonna take a look at what I think would be the perfect medical school in the next few days:
1. Pre-requisites and Admissions
2. Basic Science Education
3. Clinical Education
4. Special Topics
Dr. Jerome Goopman, author of How Doctors Think, has an upcoming webinar on the subject next month. The web broadcast is intended for medical students, residents and academic faculty at various medical schools across the country.
Patients need to be advocates for themselves. They often aren’t enough. But there is a very clear, may I say bright and flashing, line between advocating for your care and complaining when you’re in the hospital. And if there’s one complaint I think many roll their eyes at it is the uninsured patient who thinks they’ve been in the hospital too long. I heard a story about a resident giving a patient with just such a complaint a mildly apt analogy.
“If McDonald’s was giving away hamburgers for free you’d take one right? And don’t you think there would be a line for those hamburgers? Everyone would want one for free, right? And would you complain about the line?”
Tastes Even Better Because It Is Free
No doubt no one likes their time being wasted. No doubt, from all I’ve seen and heard, public hospitals are a helluva lot less efficient than the rest of healthcare. But, unless such a wait is actively and significantly endangering a patient and absolutely opposed to the concrete standard of care then I don’t think many want to hear the complaint of inconvenience from a patient for who the taxpayers are picking up the tab.
At the bedside it’s a sigh and a nod of the head but maybe someday I’ll have the gall to repeat the analogy above and kind’ve put the situation in perspective for a patient.
I’m on a surgical rotation right now with one other medical student and, on this particular day, only one operating room for the service. It’s near Spring Break, so many faculty have taken some time off, and so the service only had two cases scheduled for the day. Anyone who knows the speed at which public hospitals move knows that doesn’t guarantee a quick and easy day.
In anycase, the other medical student had scrubbed into the early case. That one finished up around 4 in the afternoon. Well, it turns out that a bunch of scrub techs and circulators called in sick and there isn’t enough hospital staff for our next case to go right away and they can’t tell us when the case will be able to go.
Now, my service has two interns, a junior resident and a fellow. I’m hanging out with the junior resident, helping to put in a chest tube. He tells me I should probably stick around and scrub into the next case and then he lets the other medical student go. An hour passes and I’m literally just twiddling my thumbs, admittedly just slightly annoyed I’m still up at the hospital.
My resident is a good guy, don’t get me wrong. But he’s made it clear I should stick around and I’m not thrilled about it. I’m hanging out at the hospital despite the case being indefinitely delayed and despite the fact I have my NBME shelf exam in a week and I could be studying. The patient isn’t even in the holding area and although the OR is clean, even if the patient was sent for right now it’ll be at least an hour before they make an incision. Add at least two hours for the operation (it ended up taking longer from what I understand), and I’m probably looking at getting out of the hospital at 8:00 or 9:00 at night. Not totally unexpected as a medical student, but to just be sitting around waiting and the fact my exam is so near makes the experience a little miserable.
I go down to see if the patient is in pre-op holding and I run into my fellow, who will be doing the operation. He wants to know what I’m still doing at the hospital and tells me to scram. I obviously jump at the chance.
It isn’t like I went looking for the privilege to leave. The fellow, the man both I and my resident answer to, told me to leave without me even mentioning it. But clearly my resident thought it was my responsibility, as part of my surgical education, to stick around and scrub into this last surgery. My fellow is in charge of the service, the one the residents and I answer to but it still seemed a little sketchy to just bolt without even going and finding my resident.
Not sketchy enough that I didn’t get to my car and home as quick as I could. And as far as I can tell the next day my resident didn’t care; but getting conflicting instructions from two of your superiors on any service makes things a little bit awkward.
So someone new will come to head the none too shabby UT system.
There was speculation that current U.S. Senator Kay Bailey Hutchinson was the Governor’s immediate choice to fill the office of Chancellor, although I’m sure such would’ve been formalized with a “search.” The idea of Senator Hutchinson leaving public service to take the reigns of the UT system was a short lived one apparently. Her office is saying she isn’t interested.
Hutchison, who may run for governor in 2010, quickly stepped on the idea that she’d return to her alma mater. Her press secretary, Matt Mackowiak, said:
“Sen. Hutchison will not be a candidate for Chancellor; she is focused on serving Texas in the U.S. Senate. Sen. Hutchison believes Chancellor Yudof has done an oustanding job as Chancellor of the UT System and wishes him well.”
OK, she doesn’t want to be a candidate, but would she be interested in being coronated as chancellor? He said, no:
“Not interested. Period.”
The University of Texas system has had one physician hold the position of Chancellor in its history. Any chance we could hope for that again; I could only imagine such would be a good thing for the Health Science Centers.
“We Have Transformed Our Energy State Into Something Different. That Is The Definition of Disease”
Much thanks to the blog Bad Science for publicizing the homeopathic weirdness of optometrist Charlene Werner (I can’t even bring myself to put the title Dr. in front of her name). It is funny to watch though.
I did my undergrad work in USC's School of Cinema-Television Cinematic Arts. I have a Bachelors of Fine Arts in Writing for Screen & Television. I loved it, but a future of waiting tables and taking meetings with B-List producers was not for me.
This blog is ostensibly to discuss healthcare policy and maybe educate a few of my fellow medical students. But it will stray into current events, politics, and other science topics when they draw my interest
Other odd notes about me:
I've skied half the resorts on this list (Squaw Valley/Lake Tahoe, Snowbird/Park City, Whistler, Taos, Vail)
I "played" lacrosse in high school and through a club level team in college
Nothing on this website is to be taken as medical advice. I am not a physician. Please consult a physician concerning any health related questions.
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Endorsements
"Please be more precise in your practice of medicine than you are in your blogging!"
- Mark Lanier
