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.

Abortion: Caught between an oath and beliefs

Medical Education
April 11, 2015

Medicine is an area of study that is bursting with countless gut-wrenching ethical debates. Throughout our medical training, even in some medical school interviews, we are asked and tested on how we would personally navigate the delicate tightrope of right and wrong.

Trying to maintain equilibrium between our personal beliefs and those that are best for our patients can often be difficult. On one side of our acrobatic act, we are …

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Abortion: Caught between an oath and beliefs

The Match 2015: A grim prognosis for international medical graduates

Medical Education
April 7, 2015

There were a lot of happy faces on March 20th as depicted in this brief video of the excitement on the campus of the University of Rochester School of Medicine. Similar scenes took place at every U.S. medical school because 93.9 percent of the 18,025 graduates of U.S. allopathic medical schools matched in a specialty.

But for the 1,093 (6.1 percent) U.S. graduates who didn’t match things were not so bright. …

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The Match 2015: A grim prognosis for international medical graduates

Projection.  From an unlikely source.

Medical Education
April 7, 2015

The patient was hacking sputum into a tissue when the resident and I entered his room.

“How long have you had that cough?”

“Oh this? As long as I can remember.”

“But it’s been worse lately?”

“Yeah.”

“Worse how?”

“More stuff coming out each time. See?”

He opens the tissue.

“How much sputum is there?”

“Sputum?”

“The stuff you cough up.”

“I don’t look that close.”

“More than two spoonfuls?”

“Oh yes. Definitely.”

“And the color?”

“White-ish.”

“Ever see any streaks of blood?”

“Never.”

“And how long have …

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Projection.  From an unlikely source.

I don’t know: The honest answer that patients need to hear

Medical Education
April 3, 2015

As I reflect back on the last four years of medical school, I am reminded of the ghosts of patients past. Those of you already entrenched in the dredges of patient care know what I mean. The images of their faces burned on your brain: the ones you couldn’t help, the promises you never meant to break, and the hope you weren’t able to give.

Those ghosts take on several shapes …

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I don’t know: The honest answer that patients need to hear

Boarded to death: When will testing for doctors ever end?

Medical Education
April 2, 2015

I am relieved and proud to report that I passed my boards: I am officially a diplomate of the American Board of Obstetrics and Gynecology. While the oddly formal “diplomate” is a term in common use with physicians, I didn’t understand what “diplomate” and its sister phrase “board-certified physician” meant until I undertook my own board preparation.

The Medical College Admission Test (MCAT) is a memorably stressful element of applying to …

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Boarded to death: When will testing for doctors ever end?

As a doctor, I need to understand power, trust, and pain

Medical Education
March 31, 2015

“You have the nurse hand you the equipment, that way she doesn’t just stand and stare like a chaperone,” my doctoring mentor explained to me before we entered the room to do a pap smear on a young, 35-year-old woman. My doctoring mentor is a middle-aged, 6-foot-5, exceptionally hairy, broad-shouldered man that carries a warm, jovial presence. Yet the reality of the fallen world is that no matter how sweet, happily …

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As a doctor, I need to understand power, trust, and pain

The medical student catch-22: Preparedness for residency vs. patient safety

Medical Education
March 28, 2015

The July Effect is a relatively well-known reference to the influx of new trainees entering hospital systems annually on the first of the month. Researchers have attempted to investigate the impact of the new trainees on patient outcomes with divergent conclusions. Despite the ongoing debate, educators in medicine recognized the need to prepare medical students for day 1 of residency training, by establishing core competencies to evaluate the preparedness of students. One such example …

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The medical student catch-22: Preparedness for residency vs. patient safety

Can introverts survive in medicine?

Medical Education
March 27, 2015

Does the profession of medicine favor certain personality types over others?

When I was younger, it seemed like all of my doctors were gregarious, self-confident, and humorous, leaving me to wonder if one can “make it” in medicine without being outgoing. This seemed a natural consequence of the fact that so much of medicine is team-based and demands constant interpersonal interaction with colleagues and patients. For many introverts, a career in …

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Can introverts survive in medicine?

Digital natives: Implications on physician evaluation

Medical Education
March 26, 2015

I recently had an interesting conversation with several co-residents about how our health care system should evaluate physician performance. If nothing else, the discussion highlighted how challenging this issue has been for almost all medical specialties, including internal medicine, where the controversy has been punctuated by debates about maintenance of certification (MOC) and licensure. It remains to be seen what will develop after the American Board of Internal Medicine recently …

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Digital natives: Implications on physician evaluation

A therapy program for medical students

Medical Education
March 23, 2015

I am wearing my favorite scrubs, the teal ones a friend gave to me while I was volunteering in the aftermath of the Haitian earthquake. My first-year classmates and I are in front of the anatomy lab, waiting to see our cadaver for the first time. Our group enters, and we stand around the blue-plastic-cloaked body for a few minutes, preparing ourselves and discussing the task at hand. My anatomy …

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A therapy program for medical students

The physician distribution problem shouldn’t be a surprise

Medical Education
March 22, 2015

In news to absolutely no one with an iota of common sense, the purported physician shortage isn’t actually one of numbers, but rather a problem of distribution. Per this article by in the Washington Post:

Critics of doctor shortage projections have argued for years that the problem is actually poor distribution of physicians, with too many clustered in urban and affluent areas and too few in poor and rural areas.

Doctors prefer to …

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The physician distribution problem shouldn’t be a surprise

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The insufferable patient: You know the one

Medical Education
March 14, 2015

He is that new patient to the clinic.

You know the one.

He is the “multiple chronic conditions” patient.  Diabetes, hypertension, COPD, chronic kidney disease, congestive heart failure, arthritis — it would probably be quicker to name the conditions he doesn’t have. You let out a deep sigh before entering the room.

You know the one.

He is the “non-native English speaker.” English isn’t his first language, perhaps not even his second. You try …

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The insufferable patient: You know the one

What does it take to collaborate in health care? Here are 3 ideas.

Medical Education
March 11, 2015

Recently, I had the honor and pleasure of introducing my book, Women and Cardiovascular Disease, in London. During the event, I was able to meet with many of my European colleagues from both the media as well as the health care space. I spoke with countless bright and motivated attendees who are excited to be part of a wave of change in cardiac care for women. We identified many ways …

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What does it take to collaborate in health care? Here are 3 ideas.

Leadership on a medical rotation: The dichotomy of accountability

Medical Education
March 11, 2015

At the end of one of my earlier rotations where I first worked with a team consisting of residents and an attending physician, I sat down with the senior resident for feedback. Much of our final grade for each rotation in medical school comes from a subjective assessment of our abilities, ranging from clinical competence to professionalism.

She told me I had done a good job with taking ownership of my …

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Leadership on a medical rotation: The dichotomy of accountability

How to make outpatient population health more exciting

Medical Education
March 8, 2015

In a recent grand rounds on the future of medicine, the buzzwords were “collaboration” and “managing of the health of populations.” The same day, a group of ten residents were presented with their patient data about cancer screening rates. In both venues, the call to “population health” elicited sighs of exasperation. It’s just another checkbox we are being asked to click off. How can we be assessed on that as …

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How to make outpatient population health more exciting

An alcoholic patient, and his effect on a medical student

Medical Education
March 6, 2015

Once an alcoholic, always an alcoholic.

This is one of the main tenets of Alcoholics Anonymous, and it serves to encourage its members to commit to absolute abstinence. It is also a belief, I have come to realize, held by the many medical residents I have encountered.

When an alcoholic patient is admitted to the hospital, it is no secret that he (or she) is an alcoholic. This is because it feels …

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An alcoholic patient, and his effect on a medical student

Does medical student debt lead to suicide?

Medical Education
March 6, 2015

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Every year 300 to 400 physicians commit suicide. More than 10 percent of doctors are thought to have depression, a frequent precursor to suicide. Rates of depression and suicide among physicians are higher than in the general population. Many reasons including stress, heavy workload, sleep deprivation, lack of autonomy, and lack of outlets for personal care may contribute to higher vulnerability in doctors. …

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Does medical student debt lead to suicide?

Are we sacrificing our humanism in medicine?

Medical Education
March 5, 2015

To most physicians my illness is a routine incident in their rounds, while for me it’s the crisis of my life.  I would feel better if I had a doctor who at least perceived this incongruity. 
– Anatole Broyard

For medical students to treat illnesses of all kinds, we must first fill our brains with thousands of facts, everything from anatomy, to physiology, to microbiology, and biochemistry. We essentially become robots, pounding …

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Are we sacrificing our humanism in medicine?

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