This letter was received and edited for clarity by Pamela Wible, MD.
Dear Dr. Wible,
This will be my last email to you because I am giving up on my dream of being a doctor.
I’ve contacted so many colleges and medical schools hoping to find one that would help me become a doctor for my tribe. Today, I finally got a response from the …
Is medical school just for rich kids?
KevinMD.com recently published the article “It’s time to make the Match disappear” written by medical student Amy Ho. I firmly agree with her that the current match system is wildly inefficient and needs fixing. However, she is throwing the baby out with the bath water in abandoning the algorithm which yields an extremely effective system.
Firstly, when one examines her data, which in itself is correct, one also …
Defending the residency Match and its algorithm
Many friends from my original medical school class will graduate and officially become doctors in just a few weeks. I can’t believe I’ll be at that point in only a year, and I’m incredibly proud of my soon-to-be-doctor friends. This time of year there’s always a lot of talk surrounding graduation, and in light of that I have a …
Stop calling medical school graduates newly minted doctors
Don’t wear the white coat; it scares the kids.
Most children stare at me with that wide-eyed look. Thinking from their perspective, the six-foot something curly headed giant with big round glasses probably appears very strange to the little human that barely scrapes my knee. They do not cry. They just stare. I smile, and they gape. Parents laugh as I grin sheepishly. Towering over the patients, I likely appear more …
The white coat can be an inadvertent barrier to care
My family has always expressed that they’re proud of what I’m doing — the funny thing is, they go on to say that they’re unsure of exactly what I do.
My parents know I’m studying medicine and that this means I’ll be a doctor. What they don’t get is where in the process I am, what specializing means or what I’m talking about most of the time when I share stories …
Bridging the disconnect: Why this student entered medicine
“Are you more or less cynical than when you started residency?”
This was the question my program director asked our senior internal medicine residents at a recent dinner with Dr. Bob Wachter. If you aren’t familiar with Dr. Wachter, he is widely acclaimed as the “father of hospital medicine” and a renowned champion of patient safety and quality. His blog, Wachter’s World, is chock full of insightful commentary on the American health …
Residents need to feel empowered by their hospitals
Before the 1980s, drug testing was uncommon. It was widely viewed as an invasion of privacy and an infringement on fourth amendment rights. Today, a medical student is likely to be drug tested before entering medical school, before clinical rotations, and/or before residency. If preventing drug use among medical students is the goal of these tests, they have failed miserably. Urinalysis drug tests are ineffective. But more importantly, they are …
Medical school drug testing is a moral and scientific failure
An American poet and political activist, Muriel Rukeyser, said the universe is made of stories, not of atoms. I believe her.
As a seasoned storywriter and storyteller, I walked gingerly into the adult emergency services for my first shift as a volunteer at a legendary New York City public hospital. I sported a crisply ironed red polo with “emergency department volunteer” embroidered in white stitch.
Armed with a pocket notebook and a …
A dire need for narrators in medicine
A newly minted physician, one who has just graduated from medical school, is not yet ready (or licensed) to practice medicine. The next phase in medical training is called residency, a 3 to 5 year span of time during which the new doctor is given teaching, supervision, and increasingly allowed to function independently in his or her chosen specialty.
Since 2003 residents have been limited to working 80 hours per week, averaged over …
Are today’s newly graduated residents ready to practice medicine?
“You will have 15 minutes to take a full medical history,” the moderator says in a plain, mechanical voice. We stand at our assigned exam room doors ready to embark on a mission that will be recorded, reviewed, and graded as part of an OSCE (objective structured clinical examination).
“You may begin!”
I knock, enter, and make a b-line to the soap dispenser — check. I take the history in record time …
Can I listen to your history or must I take it?
Congratulations, student doctor, you studied hard and scored well on your exams — not only on your MCAT but in your organic chemistry classes as well. You mastered anatomy as well as pharmacology, neurology and more “ologies” than you care to remember. Now it is time to get hands-on learning experience, without being able to hide in the library while preparing for your clerkship shelf exams or showcasing your talents …
It’s time to reverse the standardized patient experience
I am an imposter in a white coat. I’m not sure if anyone knows yet, I hope I am good at hiding it. It’s a well-kept secret amongst all medical students. In the hospital, I am at the bottom. I know the least and have the least power. Most patients don’t realize this and look up to me like I’m an all-knowing, wise muse or something of that nature. Sometimes, …
To medical students: We’re all in the same boat
As a medical student seeking to learn the principles of entrepreneurship, I have found Steve Blank’s insight to be a great guide and resource. His Harvard Business Review article, entitled “Why the Lean Start-Up Changes Everything,” was my first exposure to the idea of customer discovery.
The idea of customer discovery is a simple practice — listening intimately to multiple customers’ needs and pain points and using it to inform …
Medical students can rebuild our broken system from within
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In the 2012 National Residency Match Program survey, which is sent out to residency program directors around the country by the NRMP, the factor that was ranked highest with regards to criteria considered for receiving an interview — higher than honors in clinical clerkships, higher than extracurricular experiences or AOA election, and even higher than evidence of professionalism, interpersonal skills, and humanistic qualities — was the USMLE Step 1 score.
When …
Should medical schools start teaching to USMLE Step 1?
As physicians-in-training, medical students suppress feelings and mask them under the veil of professionalism. Sometimes however, medical training requires us to manufacture emotions. During the third year of medical school, the majority of student grades are derived from the subjective evaluations of the residents and attendings that work with us. To achieve the highest marks, students must appear to be “engaged” and “excited” at all times. While most of us …
Is authenticity a luxury in medicine?
A loyal reader, who agrees with me that we may be teaching and testing medical students and residents the wrong way, asks why aren’t all board recertification examinations given orally. She correctly asserts that oral examinations are better because they assess how people think rather than how much they have memorized.
Here’s why it would be difficult to do.
The initial surgery board exam is given in two parts. First a written …
The problems with making oral board recertification universal
Perhaps one of our greatest assets and strongest detriments in medicine is our ability to look at a patient and make a quick, thorough assessment of his or her condition and state of distress. Certainly, a good clinician is able to triage and provide greater quality of care in the emergency room if he or she can use the intangibles of a patient’s presentation to provide them better quality of …
Like any other industry, in health care, the books and schooling don’t always match the “real world.” Patients everywhere have the same complaints about physicians and their bedside manner. “I feel like she’s talking at me, not to me.” “He said I had cancer like it was just another sentence.” “He walked in, looked at my meds, and walked right out of the room without saying a word.”
Those training tomorrow’s …
My school is trying to make me an empathic physician
Becoming a doctor takes time, but those outside of medicine do not always realize how convoluted the process can be. Central to the perversion is the National Resident Matching Program (or “the Match”).
After college and the two years of classroom-based training in medical school, students are ushered into clinical training through third year core rotations in predetermined specialties. In the spring of their third year, students must decide on their …
It’s time to make the Match disappear
A year ago in a post about law school applications decreasing, I speculated about whether a similar phenomenon would occur with medical schools.
In that post, I commented on the impending problem of too many medical school graduates and not enough residency training positions. I cited an article that appeared in the New England Journal of Medicine in 2011 in which the CEO of the Accreditation Council for Graduate Medical Education …
The residency chances of offshore medical school graduates
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