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.
As a teenager in the mid-late 1990s, my father, an engineering educator, and I would talk about the ills of the healthcare system and how physicians lost control of healthcare: primarily because they concentrated on medicine rather than the forces changing healthcare delivery. I realized this was due to an outdated medical education system and reforming it might actually improve healthcare in this country. That was my Sputnik Moment.
Since graduating …
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Shorten medical training by 30% without sacrificing quality
The more I talk to new physicians who are transitioning into practice, the more I realize how many substantial life and career shifts occur post-residency.
I experienced these changes myself several years ago, but it’s taken me a while to fully process them and realize how they’ve affected my life.
In fact, it would be safe to say that I experienced a complete 180 after graduating from residency. I know other new …
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Tips for adjusting to life after residency
Shortness of breath. I felt it for the first time while running on June 21st, 2011. I had just been rejected from my first choice medical school a few days prior – post-interview, the worst. I took it as a personal affront. They didn’t like me, my personality. I wondered how I had come off – fake, phony, artificially enthusiastic maybe. Maybe they didn’t think I was up to their …
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Doctors need to understand what it means to be a patient
It’s hard to believe that nearly 1.5 years ago have elapsed since my first-year orientation to medical school. Much of it seemed protocol with session after session on rules and regulations, but I vividly remember the few hours spent outlining standardized patient encounters and how my assessments over the next four years would be based on my interactions with a complete stranger. As alien as that idea sounded to me, …
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Speak to a patient as though you were speaking to your grandparents
I was browsing the now famous mini-lecture website, TED.com, when a certain video caught my eye. The presenter began by naming the various pitfalls of anatomy dissection such as its high cost and noxious chemicals. He whirled through a short demonstration using his brand new Automage Table, a 3D touch screen rendering of the human form. In his virtual dissection, he quickly and effortlessly revealed various organs and vessels. He …
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Dissecting a cadaver cannot be replaced by technology
We finally broke down and bought floaties. The kids played for a few days in the shallows, but since neither of them are yet proficient swimmers, they dared not wander into deeper waters. Each day they watched as younger kids scooted around the pool wearing wing like contraptions colored with cartoon characters.
I never liked the idea of floaties. Much better, I thought, to let them struggle and build on the …
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Are the doctors of tomorrow going to sink or swim?
Every career has that one question that is notoriously hated by all. For nurses, that question is, “So, why didn’t you want to be a doctor?” For teachers, it’s questions about the age-old adage, “Those who can’t do, teach.” For medical students, that question is, “So, do you know what you want to do?”
It’s not that people who ask medical students about their career plans are ill-intentioned or nosy; in …
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The residency journey is just getting started
Some people critique Continuing Medical Education (CME) programs as spoon-feeding. As a young physician struggling to learn a lot of material, I actually appreciate a bit of ready-to-consume content that I can learn quickly and effectively. The American College of Cardiology (ACC) and other reputable institutions provide CME programs that, overall, help to keep physicians up on the literature and integrate new findings with existing knowledge. However, despite the basic …
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CME limitations and how we can improve Continuing Medical Education
I had a chance to “moonlight” in the internal medicine “drop-in” clinic at the Kaiser Medical Center in San Francisco while I was finishing my residency and endocrinology fellowship at UCSF. I was superbly trained in in-patient care and there was no IV or PA line that I couldn’t put in with my eyes closed. I was comfortable taking care of really sick people and thrived on complex, acute cases. I knew …
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Fixing health care includes reforming medical education
How many students enter college and immediately proclaim that they are “pre-med?” Often this declaration is accompanied with an already well thought-out choice for his or her future specialty. This incredible ability to see into the future must be hereditary, as I have had 3 or 4 different parents tell me about how their kids are going to have to choose between medical school A and B, and/or how Johnny …
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Use social media for MCAT help and to get into medical school
If you are a second-year medical student, there is one thing on your mind at this time of year: Step 1. Although scary, there are things that you can do to help calm your anxiety and get your best score.
Set a goal
In my opinion, before you start really preparing for Step 1, you should have two things clearly in mind: where you are with your score and where you want …
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How I scored a 257 on USMLE Step 1
In my first week of the 3rd year surgery clerkship, I was introduced to some of the “Rules of Surgery.” For example, “All bleeding stops eventually,” or, “Everyone doesn’t need to die with an incision,” and even “The enemy of good is better.”
Boarded for this particular afternoon was a pancreaticoduodenectomy (the Whipple procedure), which for students is known to be a must-see operation if given the opportunity. However, the night …
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Why do bad things happen to good people?
If Dr. Ezekiel Emanuel gets his wish, tomorrow’s physicians won’t deserve to be paid as well as physicians today because they won’t be as well trained.
Dr. Emanuel, a brother of Chicago Mayor Rahm Emanuel and a chief apologist for the Affordable Care Act, is the lead author of a startling opinion column in the March 21 Journal of the American Medical Association. He argues that there is “substantial waste” in …
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Reducing training will diminish the status of physicians
I eyed my chat screen with a good amount of suspicion. A friend of a friend who I had rarely spoken to had initiated a chat conversation with me with the opening line “How are medical school apps going?” The cursor blinked in anticipation.
I began to think about possible ulterior motives that she, another pre-medical student, could have had. Perhaps she just wanted to use me as a comparison for …
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The cutthroat pre-med culture needs to change
I have worked in continuing medical education for 12 years and the argument over industry support of CME has grown tired and wearisome. Truth be told, I’m sick of it. I have always been a staunch defender of industry support of CME – and still am, for the most part – but listening to the same old arguments on both sides of the issue has become akin to the Elmo …
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Reducing industry support of CME has unspoken consequences
So this is what it feels like to have a rush of adrenaline in crisis—a potent mix of excitement and panic.
I yelled out the patient’s name and shook him. No response. The only sounds were the shuffling of the sole nurse at the foot of the bed and the electronic hum of the myriad medical machines decorating the room. I slammed my fingers into the patient’s carotid arteries. No pulse.
As …
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A medical student reflects on the clinical year transition
Residency directors have a challenging job. They are entrusted with selecting young doctors and training them over the course of several years. Newly graduated medical students are thereby turned into internists, surgeons, radiologists, pathologists and the like. Fellowship directors build upon this foundation with extra training, setting the stage for these graduates to become clinical experts in their respective fields.
The Maintenance of Certification (MOC) process adds an additional and continued …
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Residency directors and board certification can work together
Doctor, do you know a lot about human nutrition? You said “yes?”
Congratulations, if that is true. But I suspect that South Carolina Congressman Joe Wilson’s infamous quote “you lie” is applicable.
American medical schools traditionally have done a horrible job with their curricular treatment of clinical nutrition. University curricula are controlled by the faculty and, when the faculty don’t know or care much about a topic, it often gets short shrift.
I …
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Should medical schools be mandated to teach nutrition?
Very few are as starkly aware of the transience of life as those working in the healthcare profession. We are expected to be, for want of a better word, immune to it; as if each death we face is somehow a vaccine that will eventually, with regular booster doses, provide us with enough immunity to be resistant to the Grim Reaper.
We spend years studying, arming ourselves with pages and pages …
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When medical students first deal with death
