Building a Better Doctor

by Allan Joseph

As medicine changes faster and faster, the medical community keeps talking about reforming the way we train physicians. Medical schools across the nation are revamping their curricula, and now, driven in part by an upcoming change in the MCAT, the focus is shifting to the prospective physician’s undergraduate years: the premedical education.

Perhaps the highest-profile call for reform is this editorial in the New England Journal of Medicine from Dr. David Muller of the Mount Sinai School of Medicine. Dr. Muller lays out the case for “premed reform” quite nicely, and I won’t go over that again, though it’s certainly worth reading in full. Yet if we want to create the “21st century physician” (here’s a good, recent look at what that looks like), I think Dr. Muller and other premed-reform advocates aren’t going far enough. If we really want to create the physician of the future, we have to look beyond undergraduate classrooms and laboratories — we need to do more.

One thing that surprised me about my recent trip through the medical-school admissions process* was this: You don’t need a whole lot of prior knowledge to succeed in medical school. Sure, taking that extra advanced biochemistry class as a college senior might make for a slightly easier weekend of studying a year down the road. But the fact is that with a fairly basic level of scientific knowledge (the MCAT’s chemistry, physics and biology sections aren’t much beyond an Advanced Placement high school course), most premedical students could learn the sort of “book knowledge” physicians need in medical school. The things that will truly set good physicians of the future apart, however, take much longer than a couple years of classwork and rotations — they form over a lifetime. And those skills — “soft skills” like empathy, problem-solving, project management, and communication — don’t often develop in the undergraduate classroom.

Yet we still expect premedical students to get them in the classroom. If we keep expecting them to do that, we’ll still struggle to create the right kinds of physicians. So let’s broaden our focus and encourage premeds to put down a textbook every once in a while — and maybe even get them to think they don’t have to spend their free time doing research, either.

Two specific pieces of the premedical experience come to mind:

1. Extracurricular experience. Every premed knows a full resume is a good one when it comes to medical school applications. But rarely do schools take a hard look at what those experiences actually helped students developed, perhaps beyond time management. Medical schools should begin to evaluate students based on the skills they developed and demonstrated in their extracurricular activities. For example, students who don’t hold leadership titles in student clubs often have to learn how to communicate, work in a team, improvise, and balance multiple demands. Those students don’t always get the name recognition, but in a healthcare system moving towards team-based care, they’re incredibly valuable. It’s certainly difficult for medical schools to figure that out, but perhaps more targeted application questions about experiences that helped developed target skills could supplant questions that simply require lists of experiences and responsibilities.

2. Interview Day. They’re certainly some of the most stressful days a premedical student will face, but the surprising part is, the evidence says that traditional interviews don’t do a great job at selecting the best students — perhaps they filter out the very worst communicators at most. That’s why schools around the country are moving to new interview formats: group interviews, blinded “Multiple Mini Interviews,” and others. No interview method is perfect, but interviews based on group problem-solving like those at Northwestern or ethical scenarios like those at Duke are a good start. They allow medical schools to directly observe the qualities they want. More schools should move towards these innovative models, which allow students with the necessary soft skills to succeed.

These are only two suggestions of ways to improve the premedical experience, but they’re effective because they change the incentives premedical students face. If there’s a tangible reward to developing problem-solving skills as an undergraduate, premeds will do it. If there isn’t, they won’t. Certainly this alone isn’t going to solve our problems — we still need to change our curricula and, in the long run, push for a sea change in the premedical culture — but they’re a start. And medical schools can start looking for them now, because the longer they wait to really start looking for the physician of the 21st century, the more the 21st century goes by.

*If only to combat the perception that I might be whining about the system because it spat me out, it may be worth noting that I’m very happy with how the process went and am making a final decision in the next two weeks. In addition, I haven’t mentioned any schools I applied to in this post. 

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Allan Joseph is a senior at the University of Notre Dame studying economics and pre-medical studies. You can follow him on Twitter @allanmjoseph.

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