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.
“What is the one best test?”
A test-taker’s frustration boils over as they read this prompt and think, “in real life we would do all of the above.” And for the most part, they are correct. In the United States, medical trainees are taught for exam purposes to answer the one best test for diagnosis or the one best procedure for management.
However, in practice the same trainees watch our role-models take …
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Medical trainees have access to far too many resources
Let’s talk for a moment about medical education. I went to a work-related party recently and rode in the elevator with a dear friend who is my contemporary, and a more senior and highly regarded faculty member known for her work in medical education. Both were afraid for the future of medical education in different ways.
My contemporary was concerned that the emphasis on the use of advanced technologies like ultrasound …
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Teach caring people how to be caring doctors
Nothing puts more fear into the heart of an internist than a dermatologic chief complaint. And for good reason: we have very little exposure to the breadth of the field. To us, all rashes seem to be maculopapular, all bumps are pustules … or was that nodules?
It’s not that we internists don’t care about the skin or don’t appreciate its complexity. Rather, we simply haven’t seen enough bumps, rashes, and …
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Doctors should hone their abilities to recognize visual patterns
Despite recent buzz about shifting resident education to community health centers, hospital based education is here to stay. The model of education, though outmoded, is simple. Get residents exposed to as much disease as possible, in the shortest amount of time. The future of American health care is not in acute management of tertiary care; but in integrated, team-based care. To get there involves focusing not only on educational content, …
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Is deep learning in medical education possible?
Imagine you, like most traditional medical students, went to college for four years to earn an undergraduate degree. Like many, you might also have obtained a graduate degree or worked for a period of time. You then spend time and money fulfilling extracurricular activities, taking the Medical College Admission Test (MCAT), applying to schools and traveling for interviews. If you are part of the lucky minority — roughly 40 percent …
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It’s a fearful time for medical students
Recently, I attended the annual AAMC meeting where the question, “What will medical education look like in 2033?” was asked in a session called “Lightyears Beyond Flexner.”
After this thought-provoking session, I too pondered academic medicine’s fate. I would like to share my reflections in this forum.
Without question, technology stood out as a major theme in this conference. And for good reason: clearly it is already permeating every corner of our …
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How technology will revolutionize medical training
The use of standardized or simulated patients (SPs) in medical education for the teaching and assessment of clinical skills has enormously expanded the opportunities for medical students and residents to develop and practice their skills in challenging and high-risk clinical situations without any risk to patients.
While many use these two terms interchangeably, most medical educators define a simulated patient as an individual who is trained to act as a real patient in order to …
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Using simulated patients in medical education
Over the past 300 years, the peer review process has played an integral role in scientific publishing. If you don’t happen to spend your time injecting laboratory mice with toxic chemicals and submitting your results to the New England Journal of Medicine, here’s how it typically works: A manuscript is submitted to a journal using an online manager, after which editors screen the paper and decide whether it merits further consideration. At …
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The problem with peer review in scientific publishing
After years of pounding the post-baccalaureate pre-med pavement, I did it. I got accepted to medical school. And I did it as an out lesbian on my application.
Disclosing my sexual identity on my AMCAS personal statement felt like a big risk even though my mentors assured me that it would pay off in the end. My hesitation to be out on my primary application was due, in part, to a …
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Making the decision to be out on a medical school application
While interviewing for medical schools last fall, I observed a strange phenomenon: every institution I encountered would underscore its student-run free clinic as a major highlight of the medical education they could offer. First- and second-year students would speak rapturously about the experience they gained from clinic. Working there, they said, reminded them of why they wanted to become doctors in the first place.
Today, the majority of all U.S. medical …
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Can student run free clinics help the health care safety net?
“Ms. M,” the resident says, “I saw in your chart that the last time you had surgery you had a pulmonary embolism.” She nods with recognition: “I felt like I couldn’t breathe. It was really scary.” Then: “I sure don’t want that again.” The resident lifts up the covers and sees that the patient’s calves don compression boots. “Make sure you keep the boots on,” he says, pointing.
What do boots …
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When talking with patients, sometimes we skip steps
In my 3 years of residency, the nearly universal resident response to outpatient continuity clinic was a disturbing, guttural groan. I recognize that many aspects of primary care drag down even the most enduring physicians. But I have also found primary care — particularly with a panel of high-risk and complex patients — to be a welcome challenge. I recently spoke with one of my institution’s main advocates for academic primary …
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Primary care suffers from guideline overload
In medicine, we pledge: primum non nocere. First, do no harm. But before we can do no harm as doctors, we need to be doctors. And before we can be doctors, we need to be human beings. Being a doctor is a great privilege, but it is a subordinate privilege. Being human comes first.
I distinctly recall the time in my medical education when I realized I was becoming more medical …
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Doctors need to remember that they need to be human first
Since the beginning of it all, since that exact moment where I shot up from my friend’s dorm room cot with a revelation to pursue my ancestral calling in medicine, I have been continually questioned by family and friends on exactly where I sit in the totem pole of physicianhood. And I get it. With terms like sub-intern, intern, senior resident and attending, it must be confusing …
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What does it mean to be a medical intern?
When we die, we die alone. Regardless the number of those who surround our deathbed, we experience our last breath alone. Our last feeling of pain. Our last moment of hope. Our last words, our parting gift to the sentient world as we depart the duress of consciousness. The ethereal message leaves our lips to pierce the very tangible aroma of Clorox and human excrement. The hearts of the healthy, …
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How do I stay human in a system comprised of superhuman demands?
It’s common knowledge among third year medical students that statistically a lot of us are mentally damaged in some way. Knowing these stats makes us feel better about our ongoing feelings of low self esteem, high anxiety and sometimes outright panic. In the car on the way to rotations, regular starters of conversation are statements like, “Did you know 35% of med students are depressed at any given time?”, to …
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When do medical students lose their empathy?
I continue to study for my third ABIM recertifications in both cardiovascular disease and cardiac electrophysiology. In preparation for the examinations, I purchased the review materials offered by the American College of Cardiology called ACCSAP-8 and took a surprisingly expensive cardiac electrophysiology board review course held in Chicago recently. I find I have little time to study all of this material while delivering patient care, so I’ve been getting up at 4:30-5:00am each day when …
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Does board recertification do more harm than good?
As a resident, probably the most common piece of feedback one receives is, “Read more and expand your clinical knowledge base.” This critique is a standard and generic piece of feedback to encourage the younger generation to never quit in the endless pursuit of knowledge. As our erudite attendings know, medical knowledge always evolves and often reverses course. Thus, the trainee is reminded to establish the habit of keeping up …
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What’s the best way to keep up with medical literature?
I was 15-years-old the first time I went on a date. Like any rookie, I had no idea what to expect. As my date and I sat at the red-and-white-checkered table at TGI Fridays, I watched his expression slowly change from one of interest to trepidation; after drowning him with endless conversation, I was hardly surprised when he informed me that he would not be calling for a second date. …
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Are you dating the person or the patient?
Earlier this year, we launched the Teaching Value and Choosing Wisely Competition in conjunction with Costs of Care and the ABIM Foundation. Why a competition? Not surprisingly, traditional “literature review” yielded little by way of promising strategies for educators who wished to learn how to teach about value.
However, we had all learned of isolated stories of success, occasionally through attending professional meetings, sometimes via networking with colleagues, or more …
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Finding the most promising innovations to teach value
