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.
Poverty is a significant public health concern affecting 10-15% of individuals living in Canada and the United States. Recommendations to eliminate poverty have focused on areas of income, housing, food security, and early childhood development. Calls for government action and provision of resources to healthcare professionals have been issued. Notably, educating medical trainees to address poverty has been absent from the discussion.
Low socioeconomic status (SES) is a risk factor …
Read more…
Screening for poverty should be included in the medical curriculum
More than a century of American medical history was turned on its ear recently by the announcement that the groups that accredit medical residencies will unify their standards. Don’t be too hard on yourself if you failed to understand the significance (or notice at all). But this should be viewed as good news across the land. As someone who trains doctors from both traditions, I certainly welcome a more level playing field.
First, …
Read more…
The merging of MDs and DOs: A unification of training standards
Since becoming a full-time medical school faculty member again, I’ve volunteered to interview about two applicants each month from September through March. When I first started doing this, I was surprised that the admissions office did not provide me with a copy of the applicant’s resume and essay until the time of the interview, carried in a manila folder by the applicant.
But I quickly realized that it wasn’t necessary to …
Read more…
The impersonal nature of medical school personal statements
On Twitter a while ago, a medical student asked me how surgical program directors select new residents. Then a discussion arose among some academic surgeons on the same topic. Someone suggested that medical school grades were the best way to tell whether an applicant would be a successful resident.
The fact is that we aren’t really sure what the best way to choose residents is.
First, here’s what we really do.
A 2011 Read more…
What is the best way to choose residents?
As a philosophical coda to the 2013 cacophony over Obamacare, health care reform and the notion that doctors and their skills will be needed less in some indeterminate future, this last month saw a media frenzy about the fate of the doctor’s white coat.
It started with an article by Gonzalo Bearman and his colleagues in Infection Control and Epidemiology that asked the …
Read more…
Whither the white coat and why
There was a very large lesion in his left frontal lobe, and no one knew what it was.
He had been admitted earlier that day, after a neighbor found him in the hallway, confused and covered in urine. Now he sat in his bed quietly, while we stared at his brain and the bright spot that didn’t quite resemble something.
It can’t be tissue death from a stroke, insisted one resident. It …
Read more…
I saw my intellectual exercise as something I hadn’t before
The past few months I have joined thousands of individuals hoping to match into a residency program in 2014. I have had interviews all over the country and spent way too much time living out of a suitcase.
For many students, residency interview season is exciting. For others, it’s stressful and exhausting. But for me, more than anything else, the interview trail was inspiring.
I am currently applying to internal medicine-primary care …
Read more…
The bottleneck in ensuring sufficient primary care physicians
I’ll never forget the anxiety of the first day of medical school. I was excited. I was enthusiastic. I was overwhelmed. But all of these emotions were humbly interrupted by my profound, palpable sense of otherness. I was surrounded by one hundred and sixty-seven brilliant peers, many from high-ranking undergraduate schools and each of whom had countless accomplishments in their already rich pasts. They clearly, unquestionably deserved to be here. …
Read more…
The effect of imposter syndrome on medical students
“A new roadmap for improving residents’ professional skills was released Tuesday by the Accreditation Council for Graduate Medical Education (ACGME)” begins the press release.
As I dove into this announcement a bit further, I discovered the origins of this initiative outlined in this executive summary published by the ACGME on the “CLER Program:”
The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public’s need for a physician workforce capable of meeting the challenges of …
Read more…
Does the ACGME serve the needs of tomorrow’s physicians?
How do you ask a person to be the last person to go through an education system that is failing them? Yet we’re doing just that. Every day tens of thousands of medical student wake up to an education, and an education system, that is failing them. This is not to say that we are not producing good doctors. On the contrary, our doctors are likely the most well-educated, and …
Read more…
We are training physicians with an eye towards the past
Education debt nearly is a practical puzzle. For many students, this lending proves crucial and extends enormous utility. Stickiness usually surfaces only after a student graduates and his or her loans enter repayment. While debt dollars or repayment problems may differ across academic majors and college settings, students should be reasonably able to defer their education loans, regardless of lender, while enrolled in school.
When borrowing for education, students often draw …
Read more…
Why private education loans need reform
Recently, our residency program had the excellent fortune of hosting Dr. Bob Wachter as a visiting speaker. Dr. Wachter is considered a pioneer in the hospitalist movement and has built his career around inpatient quality and safety. During lunch with Dr. Wachter, some of our residents, and hospitalist faculty, we discussed the topic of resident autonomy in the hospital.
In the glory days of residency, I imagine that house officers experienced …
Read more…
Will resident autonomy disappear completely in the future?
In the past 84 days, I have traveled to eleven different cities, been left stranded in two unfamiliar airports by cancelled flights, met approximately 124 new people and briefly recited the more interesting parts of my life story far too many times to count — all for the purpose of matching to a residency program in March. Exhausting doesn’t come close to summing it up.
And yet, this process has also …
Read more…
Why I am grateful for Match Day
New journals are appearing almost every day. Does anyone read them? Journals keep popping up because of the need for faculty to publish. Another reason could be that publishers, particularly those who charge authors fees for publishing, are in the business of making money.
Authoring journal articles is not only enhancing to one’s CV (the old “publish or perish” cliché), it is required by residency review committees as evidence of “scholarly …
Read more…
As journals proliferate, so do authors
They say medicine is a hard science, based on heavily scrutinized theories and proven postulates. Medicine is supposedly made up of differentials, diagnostic workups, and medications aimed to alleviate or cure. Everything is based on evidence, everything. But, today, something happened that hasn’t been researched using IRBs; something intangible that restored my faith in humanity.
I was on my way home from a long day of being intensely questioned by residents …
Read more…
Medicine can be done with words, actions, or a smile
Remember your humanity, and forget the rest.
-The Russell-Einstein Manifesto
The American healthcare system is a paradox of triumph and failure. We lead the world in medical innovation, yet we lag behind in cost, quality, and equity. During my last month of medical school, I sat with a group of graduating students to discuss this challenge. As students, we had directly confronted the shortcomings of modern healthcare. As the next generation of …
Read more…
Approach patients as one human caring for another
During my internal medicine rotation, the medical students had the opportunity to attend intern morning report, an interactive teaching session where attending physicians walk the interns through a patient’s story, starting from the moment they hit the door of the emergency room to the final stages of diagnosis and treatment.
After discussing the patient’s symptoms, complaints and past medical history, the attendings always ask the group to think carefully about the …
Read more…
Shotgun medicine: An arrow is often better
A recent survey published in H&P, the Stanford medical school magazine, asked twenty graduating students to recommend books to read during the clinical rotation in internal medicine. Surprisingly, the top vote-getters weren’t books at all. The two most popular resources were both banks of practice questions, while the next two included a review book and a pocket handbook.
“Is this how our students learn the subtleties of sickness and health? What happened to textbooks? …
Read more…
The generational shift in the learning styles of medical students
Recently, I had the fortune of hearing the tale of Bob and his bum knee.
It all started when Bob picked me up at the end of a busy clinic day in his neon orange Subaru. Given that this particular shared car service promotes friendly conversation, Bob started up the gab by asking me what position I held in the medical center. After describing my work as a …
Read more…
Declining care from physicians in training
During my year as a chief resident, I have the privilege to attend on the general medicine service for 8 weeks. I recently completed 4 weeks and, as expected, found myself in an entirely new realm of patient care and accountability. I would be remiss without recalling a few of the pivotal lessons and poignant moments that stand out.
Transitioning from resident to attending inevitably results in greater scrutiny. Despite my best …
Read more…
The transition from chief resident to attending
