Students, residents, and educators writing on KevinMD about how physicians are made: medical school, the match, residency, duty hours, supervision, assessment, mistreatment, and the path from student to practicing physician. Many contributors write while still in training, and many write anonymously. For a maintained record of what students and physicians have said about medical school since 2004, see Medical school: what students and physicians say, in their own words. For what residents and attendings have said about residency itself, see Residency: what residents and attendings say, in their own words.
I still remember the heavy silence of the psychiatric unit during the peak of COVID-19. No family visitors, no group therapy, just the low hum of monitors and the crushing weight of isolation. One of my patients had survived a suicide attempt after losing his wife and daughter in a car accident. His grief filled the room like something physical.
As a registered nurse, my role was clear: manage crises, deliver …
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How moving from nursing to medicine improves oncology care
The momentous annual occasion known as Match Day was recently upon us. Thousands of medical students across the country opened envelopes that revealed their academic destiny for the next several years. What medical students learn during several intense years of study and practical application has evolved over time, with increased recognition that biomedical knowledge is necessary but not sufficient to develop humanistic, person-centered physicians. Noticeably missing from the curriculum, however, …
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Medical education needs diversity and true excellence
While excellent guides exist for research topic discovery or planning, and finding suitable journals for publication, a short practical checklist to help trainees determine if a project proposal is a great fit is useful (see the checklist below). Here, I outline items to consider before you commit to a project and provide my take on two main categories of topics: 1) those where a single NO generally should lead to …
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A 20-item checklist for trainee research projects
If you are a physician, you have likely heard the question: “What would you do?” Increasingly, the answer is shaped before you have the chance to speak.
Patients assume that the physician responsible for their care is the one making the decisions. In many cases, that assumption no longer holds.
Modern health care is organized around teams, protocols, and layers of oversight that shape decisions before they reach the bedside. These structures …
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Physician autonomy and the hidden curriculum of medicine
Meet the standards. Demonstrate competence. Move forward. That is the promise medical students are told to trust.
But a federal lawsuit filed against a private medical school puts that promise to the test. What happens when academic standards, professionalism judgments, and disability accommodations collide?
At the center of that lawsuit is a fourth-year medical student who, according to public court filings, was dismissed amid allegations of disability discrimination, failure to accommodate, …
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A medical school dismissal highlights disability discrimination
Medical students are often told that third-year clerkships are their place to shine because they will be evaluated as future physicians. Unfortunately, the evaluation systems themselves frequently undermine that goal. During an internal medicine rotation, I was told that my performance was “excellent,” to merit top marks, but awarding the highest grade would be inappropriate because it was my first rotation. In another clerkship, evaluations seemed driven less by clinical …
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Why tiered clerkship grading fails medical students today
I have watched the U.S. News & World Report “Best Medical Schools” rankings shape behavior in American medicine for decades. As a physician, educator, and someone who has mentored trainees at different stages of their careers, I have seen the rankings function both as a compass and as a distortion. They promise clarity in a complex landscape. Too often, they deliver something closer to a mirage.
The appeal is obvious. Medical …
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Medical school rankings reshape what they measure
For three months, I searched for a preceptor. I reached out to clinics, private practices, and community providers. I emailed offices, followed up, and posted in professional forums and Facebook groups. I approached the process with persistence and respect for the clinicians whose time I was requesting. Most of the time, I received no response. When I did, the answer was typically the same: not accepting students, already at capacity, …
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The rising cost of clinical placements for nursing students
This month, 53 medical schools committed to requiring 40 hours of nutrition education. As the physician who co-taught the first U.S. medical school class in culinary medicine, with Mike Roizen, MD, founding director of the Cleveland Clinic Wellness Institute, I am proud that culinary medicine is now taught in roughly 80 percent of U.S. medical schools. I recognize this as a genuine win. But I have watched this story before, …
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Why nature-based medicine is the future of health care
It was March 9, 2026. I remember the moment vividly. I woke up with a mix of excitement and hope, about to open the email that would determine whether I had matched into residency. Deep down, I believed I had done everything right. During my external rotations, I gave more than 100 percent. If I was asked for one thing, I delivered two, and I made sure they were done …
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Failing the residency match: What I learned from not matching
In 1900, life expectancy in the U.S. was 47 years for men and women combined. By 2025, the figure had risen by about 32 years. Many U.S. citizens attribute this increase to the development of modern medicine and widespread availability of antibiotics. However, while antibiotics have indeed contributed, they are overshadowed by changes that most of us take for granted and simply do not think about.
Treatment of public water supplies, …
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25 of 32 years of life expectancy came from this
During a conversation between classes one afternoon at my medical school, two classmates were discussing where they planned to train after graduation. One had already mapped out a pathway toward the USMLE and residency in the United States. The other hesitated. His hesitation had little to do with grades, ambition, or even finances. It was language. The first had studied medicine entirely in English; the second mostly in French and …
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How language shapes physician migration and medical training
I. Intake notes
Subject presents as a high-functioning adult with a long history of academic success and an unusual number of existential questions for someone who technically has their life together. Primary characteristics include intellectual curiosity, restlessness, and a persistent suspicion that the conventional path laid before them (while impressive) might also be some kind of elaborate trap. The subject is not failing by any objective metric. In fact, the opposite …
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The reluctant achiever: Navigating identity in medical training
We are nearing the end of the academic year, and I recently found myself standing in front of a room of first-year medical students offering what I called “observations.” Not punishments. Not a lecture. Observations. And an invitation. Because what I had been seeing was concerning: academic dishonesty, inappropriate use of artificial intelligence (AI), emotional volatility, and a level of disengagement that felt at odds with a curriculum intentionally designed …
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Driving medical education reform through intellectual honesty
The American education system was not designed to produce scientists; it was designed to produce “interchangeable parts.” Frederick Gates, the architect of the Rockefeller-funded General Education Board, famously stated: “I do not want a nation of thinkers, I want a nation of workers.” While we like to imagine medical education has evolved, the reality is that our high-stakes testing, from the GRE to the USMLE, serves as a high-fidelity filter …
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Why standardized medical exams filter for compliant workers
What does it really mean to care for someone? I asked myself that question during my first months in medical school, when I realized that medicine was not only about science or protocols. It was about people, each one carrying their own culture, beliefs, and stories. And sometimes those stories mattered as much as the diagnosis itself.
One of my earliest experiences was with a woman from a rural community who …
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Cultural humility in medicine: Why respect matters as much as science
For students matching into orthopedic surgery, Match Day is both an achievement and an invitation. I matched 36 years ago. I still remember the anxiety of not knowing where on my list I would match. Orthopedic surgery was exclusive then. It still is. Recent analyses show that orthopedic surgery offered 916 residency positions across 218 programs in 2024, with a 74.3 percent match rate for U.S. allopathic seniors. That is …
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Navigating your orthopedic surgery residency after Match Day
As a third-year medical student, I always carried three essentials during my emergency medicine clerkship: a stethoscope, a Celsius, and at my fingertips, MDCalc. With a few taps, I could translate uncertainty into structure: the Wells criteria for pulmonary embolism, NEXUS for cervical spine imaging, CAM for delirium, COWS for opioid withdrawal. These tools did not replace my clinical reasoning, but they scaffolded it. They allowed me to justify and …
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Evidence-based medicine vs. clinical judgment: a medical student’s perspective
There are moments in life when everything you imagined for yourself fits inside a single envelope. This week, every fourth-year medical student in the United States will open the same one at the same moment. Some people scream. Some people cry. And a few people quietly realize their life just went somewhere they never planned to go. Match Day is the moment medical students learn where their futures begin. Last …
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What Match Day teaches us about unexpected life paths
In medical school, we only learn a fraction of what we need to know to succeed as doctors. The rest, we learn serendipitously through role modeling, trial and error, and other venues. Without luck, however, we may not learn these factors at all. It turns out that unspoken forces, the so-called “hidden curriculum,” may have a greater impact on our personal and professional outcomes than most people realize. As educators …
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The hidden curriculum: What medical school does not teach you
