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 stood right beside them as they slowly slid your head into a plastic bag, looped the coarse twine about your neck and tied it tightly. Like the amateurs they were, they double-knotted it to make sure nothing came loose or dripped out. Then they casually walked away, chatting about what would come next.
Within minutes the bag fogged up, and a clear red liquid pooled at the bottom.
That was just …
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Those who watch a spectacle share in the guilt of those who create it
I know where America’s future primary care physicians are, and more importantly, where we are losing them. I am one of them, and I almost got lost.
Maybe I was naïve. I’d had no math or science classes as an undergraduate, and I’d never really thought about the mechanics of medical education. Even while jumping through all the prerequisite hoops before applying, it never occurred to me how inadequate my non-traditional …
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Where are we losing America’s future primary care physicians?
From an early age, I was encouraged by my family to consider a career in medicine. I was told it was a well-respected profession, offering financial security and community respect. Seeing the white coats, stethoscopes, and grateful patients at my childhood doctors’ visits made the field mysterious and intriguing, and these stuck with me as I grew older. I also developed a love for music at an early age; I …
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Being a whole doctor serves patients best
In my transition from pure learner (i.e., the med student role) to teacher-learner (i.e., the attending), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence. Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra meta-cognition, that is, learning to learn in new ways.
Learning to unlearn
In med school, learners amass an …
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Teaching doctors: Learning to learn in new ways
If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, “the entire education sector, including college and mid-career training, represents nearly 9 …
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Testing doctors is big business
It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery.
Do you know where you are right now?
Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon …
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Post-operative check
A recent editorial in the New England Journal of Medicine lauded, albeit cautiously, point-of-care ultrasound that has risen to such an extent that it is now becoming an integral part of medical education.
Could the availability of ultrasound revolutionize clinical medicine in much the same way Laennec’s stethoscope broke the acoustic barrier?
Certainly this possibility can’t be ruled out. But I am not so sanguine. One thing I’m sure about: Indiscriminate …
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Forget ultrasound: Do a proper history and physical instead
With the rollout of Obamacare, we are living in a moment in which there is no dearth of heated debates among friends, family, and co-workers.
And often times, these debates degrade to become emotion vs. emotion, or even ad hominem, and so these initially well-meaning conversations morph into heated arguments that lead nowhere. (Even Immanuel Kant advised debaters to out-shout opponents when more civil methods of discourse had failed.)
It is far …
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A framework for evidence-based debate of contentious health issues
There are words in many languages that have no good English equivalent. During my work in Haiti, I’ve noticed my Haitian colleagues on occasion exhaling a phrase — “tet chaje” — which literally means “head charged.” More accurately, it describes a sense of being overwhelmed or conveying disbelief or frustration. Based on my limited experiences in the field, I can only begin to imagine the burnout that local providers face …
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There can be no global health without local staff
I had never seen my young cousin sit so still.
“What did you do?” my aunt wondered, amazed that her hyperactive 12-year-old had been transfixed for nearly an hour. “Were you two playing video games?”
“Actually we were just talking about some of the things I learned in medical school. He’s really interested,” I told her. Indeed, he hadn’t even touched one of the delicious samosas we were eating. Every time he …
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In medical school, sometimes you have to curb your enthusiasm
Translational research is a catchphrase in biomedical circles these days. But if you’re confused about what the term really means, you’re not alone.
It was 35 years ago when I first heard the term “translation” in a scientific context. It was about enabling basic research undertaken by the National Institutes of Health (NIH) to find its way into treatments for patients. Though that sounds pretty straightforward, I still have to explain …
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Why you should care about translational research
Picture this.
You walk into your doctor’s office for an urgent visit for new distressing symptoms. He (or she) takes your blood pressure, temperature, heart rate. All within normal limits. He asks you several questions pertaining to your symptoms, does a thorough exam and perhaps orders a quick in-office lab or two. You ask him what he thinks is going on.
The quandary
If it’s a slam dunk diagnosis, the branch point in …
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Do patients have a right to know their doctor’s uncertainty?
What do you do when your ideal residency program does not exist? This is a truth that all perspective applicants must come to terms with, but I was still hoping that I would be the exception. I had created my list of everything my top family medicine program must have, including strong research mentorship, dedicated faculty, and a welcoming resident environment, and I had an idea going into the interview season what …
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Choosing a perfect residency: What goes into a rank list
Should medical school be shortened to three years?
I say, “no.”
Here’s why.
There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase — residency training.
I do not see how medical students can choose a career path before they have …
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Don’t shorten medical school: Shorten undergraduate training instead
The field of nephrology is in a workforce crisis. We as a subspecialty have witnessed a steady decline in the number of applicants perusing nephrology fellowship over the last several years. In fact, fewer than 100 US medical school applicants participated in the 2014 nephrology fellowship match. This is a sobering statistic as 403 nephrology slots were available in this year’s …
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NephMadness 2014: Let’s reinvigorate nephrology
As a medical student, I am being taught not to judge patients. If a patient tells me that he has smoked cigarettes for forty years of his life despite the protests of his wife, I am supposed to nod my head understandingly without showing my inherent disapproval. If a patient tells me that she has given her husband genital herpes because she is cheating on him, I am not supposed …
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Everybody judges in the exam room
As a medical student looking to explore entrepreneurship, I quickly came across Shiv Gaglani’s October 2013 article in Entrepreneur, entitled “Why Medical Schools are Pumping Out Entrepreneurs,” in which he the highlights similarities and differences he sees between medical students and entrepreneurs. I was struck by his proposed differences — he does not share his take on their origins, so I have come to delineate my own view.
Medical students …
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Why medical schools discourage entrepreneurs
Match Day: It’s among the most memorable moments of medical school, a time when students, friends, family and faculty gather to open those coveted white envelopes. It’s the symbolic first step out of medical school and into residency, and a tradition that is beloved by many. Yet the matching process is viewed by those outside of the medical profession (and to some within it) as a very odd way to …
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Is Match Day outdated?
A hospital is not the homiest of establishments. The bright neon lights, strange smells and piercing high-pitched beeps that radiate from the rooms of dormant patients fill the halls in a symphony of annoying sensory stimulation. But to someone recovering from a relationship that just ended, hospitals are heavenly. When the lonely silence of your one bedroom apartment is overwhelmingly loud, beeping IV lines and incoherent mumbles are surprisingly therapeutic.
As …
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What spending time with critically ill patients taught me
