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.
In a recent article posted on this site, the author (a radiologist) waxed rhapsodic about a young medical student that was convinced to pursue primary care. When the author asked the student about the economic downsides to primary care, he responded by saying, “I’m not in it for the money … What matters to me isn’t the money — it’s making a difference in my patients’ lives.”
Long gone are the purgatory stints of library study, slaving to solve esoteric problems relating to planks and pulleys. Innumerable several-day exams have been conquered and tucked far away in our memories, hopefully never to haunt us again. The last of our forced smiles and faux-eager nods have been displayed toward ambivalent instructors and medical teams during the throes of our student rotations.
Every third-year has heard it: “When I was in your position, I was taking 24-hour calls every other night. If my resident was there, I was there …”
We’re regaled about the glory days, without shelf exams, without phlebotomists, and — by God — without those work-hour restrictions. The days when medical students wouldn’t dare ask their residents for help, or residents their chiefs, or chiefs their attendings, and so on. …
I admire Paul Tierstein, MD’s honest attempt to create a greatly simplified alternative to the ABMS’s Maintenance of Certification (MOC) program called the National Board of Physicians and Surgeons (NBPAS). I hope he’s successful, but I sense there will be large headwinds for the effort ahead.
Here’s why.
The Affordable Care Act (ACA) modified Sections 1848 (k) and 1848 (m) of the Social Security Act, which defines how CMS pays physicians for their services. …
It’s that time of year again. Bright-eyed fourth years have begun wandering our hospital in uncomfortable shoes and fancy suits. They look equal parts nervous and excited, ready to embark on the insane adventure that is being an intern. But first, they have to survive interview season and Match Day: a stressful, expensive, hoop-jumping endeavor that culminates with an envelope containing the result of eight years of hard work. Wouldn’t …
In respectful memories of Benson, Rose, and Sandy. I want to thank each one of them for helping me become a better physician.
I stepped into the intensive care unit with a feeling of apprehension. I knew deep down, the patients I was going to care for were sick patients. Their status could change at any time. This was my first week on the ICU as a resident physician.
We recently had a session hosted by the medical education staff at our school where we were encouraged to share any difficult situations encountered in clerkship (submitted anonymously beforehand if that was preferred) and discussed them as a class. Issues regarding ageism, sexism and racism were brought up and addressed with the group. While I have not encountered any of the …
We have met the enemy, and he is us.
-Pogo (a comic strip character of Walt Kelly)
I doubt that physicians would have supported the creation of the American Board of Medical Specialties (ABMS) in the early 1900s if they had known that eventual maintenance of certification (MOC) might be used as requirements for re-licensure.
In my state of Connecticut, we already have continuing …
As a faculty member, I’ve encountered many medical students excelling inside and outside of the classroom. Students can be recognized for their contributions through scholarships, awards, and grants. Whenever I can, I try to direct students to these opportunities. It’s been a great joy for me to help students win scholarships, and here’s what I’ve learned from award recipients.
1. Your ability to develop strong relationships with faculty mentors is crucial …
When my husband started medical school, we immediately got hooked on getting student loans. After spending years of being broke all through undergrad, we felt like we were getting “magic” checks in the mail. Life was good. We could go out to dinner, buy our son the toys we wanted him to have, go shopping. We were enjoying all the luxuries …
How many of you have heard a flight attendant or pilot announce, “We know you have a choice of airlines when you fly, and we want to thank you for flying with us”? Over the years, many other industries have adopted similar statements. Continuing medical education (CME) …
Do physicians in training take better care of patients or perform better on their exams when their work hours are restricted? Two recent studies in the Journal of the American Medical Association suggest that the answer is no. In one, patients of surgery residents showed no difference in morality or postoperative outcomes after duty hour restrictions were implemented. Their test scores …
A while ago, I wrote about a medical student whose school tried to dismiss him just prior to graduation for unprofessional behavior.
A judge ruled that the school could not do so because it had tolerated some similar behavior earlier in his medical school career and had not considered it important enough to mention in his letters of recommendation.
In that post, I said, “‘Professionalism’ is difficult to define, especially when trying to …
You’ve made it. Four years of college, four years of medical school, and three years (sometimes four or five) of residency, depending on the specialty you chose. You’ve earned a prestigious title.
You are a doctor.
But wait, you are not done yet.
Want to be a cardiologist, oncologist, or gastroenterologist? Add another three years to the eleven spent to become an independent practitioner. Another three years of interest accruing on that six-figure …
He was known to the hospital as someone who would try to manipulate his caregivers. And I fell for it anyway.
Frequently admitted for pain crises associated with a chronic illness, he spent most of his hospital course avoiding eye contact with the team. So, too, were avoided answers that involved more than a few words. Providing care for him was business-like; we knew better than to expect pleasantries.
In our transition to medical school as first-year medical students, one significant part of our learning has been adopting the dress of the medical profession. Twice a week, in our first-year practice of medicine course, we wear professional attire and don our white coats, the famous symbol of the medical profession. As we learn how to interview and interact with patients, …
Despite the changes around us, the training of physicians has stayed much the same. Sure, there are new work hour limitations and a push to move towards competency-based assessments, but the overall structure of our training remains largely untouched. We spend the vast majority of our time training in hospitals, with the remaining time spent practicing in traditional outpatient clinics.
However, health care is being increasingly delivered outside these two arenas. …
The issues around race and how it plays out in modern day American society are numerous, deeply personal to many and utterly complex to most. The incidents in Ferguson, Mo., which began in August and erupted late November in nationwide protests, are an example of the many problems with race relations that persist in our country. While I believe we have made significant progress since the civil rights movement began, …
“All of you want to help people and save the world now. But, by the end of medical school, only two of you — if we’re lucky — will remain idealistic.”
Within the first three days of medical school, I had heard three different lecturers tell me that I would lose my compassion and empathy. By the end of the first three weeks, that number had grown to six. During the …
