Are Med Students Unprepared? Who's to Blame?
benzonit at GMAIL.COM
Tue Mar 27 02:34:40 UTC 2018
As a med school educator, seeing only mine and a few others, I wish we had
the luxury of committing these offences!
Few indeed are the physicians who are in active non-academic practice who
will teach at years 1 & 2, which are classroom-based.
The article doesn't break out Basic science (year 1), Clinical Science,
(year 2) and Clerkships (year 3.)
Year 4 is foregone; the audit rotations have to be done by October, with
the match this very month.
Needs more work to develop the idea.
I'd like to see a study of classroom hours by year and educational level of
the teachers, including clinical practice hours in real world (not med
On Mon, Mar 26, 2018 at 7:46 PM, David L Meyers <dm0015 at comcast.net> wrote:
> This article below raises serious issues. It may be blocked as
> proprietary. If so, the position paper from the Annals of Internal Medicine
> referenced in Dr Centor’s essay is available for free through the link
> “hidden curriculum” in the body..
> David L Meyers, MD FACEP
> Listserv Moderator/Board member
> Society to Improve Diagnosis in Medicine
> www.improvediagnosis.org |
> Save the Date: Diagnostic Error in Medicine, November 4-6, 2018; New
> Orleans, LA
> Are Med Students Unprepared? Who's to Blame?
> We learn how to act as physicians through observation and experience. This
> is particularly true during medical school, where attending physicians and
> residents shape interns and students through their actions. Unfortunately,
> we have many medical school leaders and clinician-educators who know how to
> talk the talk, but are deficient at walking the walk.
> Recently, the American College of Physicians published a position paper
> that contrasts the hidden curriculum <http:///viewarticle/893155> of
> lessons students learn from faculty who act at a lower standard than the
> standard described in the formal lectures they hear on ethics and
> professional behavior. Lectures rarely change behavior; witnessed behavior
> often does.
> But although we can state that we need more outstanding role models,
> making that happen proves more difficult than simply saying so.
> How can we break the cycle of unprofessional behavior? What should we
> expect from our clinician-educators? Why are they not always outstanding
> role models?
> In most medical schools, clinician-educators receive less financial and
> emotional support than they deserve. Many medical schools seemingly value
> funded researchers as their greatest asset, followed by highly specialized
> subspecialists who bring in high-revenue patients. Too often, teaching
> occupies the lowest rung in the prestige ladder of medical schools.
> Many clinician-educators carry heavy clinical loads. In medical schools,
> as in private practice, heavy clinical loads can create burnout. So, many
> clinician-educators suffer from burnout. We all know that burnout affects
> our personality and our professionalism. Some such physicians have the
> inner strength to maintain their professionalism, but unfortunately, not
> all do.
> We also do not evaluate clinician-educators as completely during the
> hiring process. A researcher's scholarly activity is heavily scrutinized,
> and the recruitment team tries to estimate whether he or she will receive
> funding and have a highly successful career. Highly subspecialized experts
> generally come from fellowships with a documented ability to provide
> tertiary or even quaternary care. But too often, we recruit
> clinician-educators to fill a hole in the schedule. Few starting
> clinician-educators have taken education courses or even read books or
> articles about clinical teaching. Rarely do the recruiters even review
> their educational track records.
> So some new clinician-educators, often fresh out of residency or
> fellowship, do not understand their roles and fail the role model test;
> some, of course, are great. Regrettably, schools often catch only the most
> egregious unprofessional behavior.
> We do not reward positive role models. At many institutions, only one of
> the many clinician-educators will receive an award for professionalism. Few
> schools have a mechanism (or perhaps even desire) for recognizing and
> rewarding those who work with medical students, interns, residents, and
> fellows and provide important successful role modeling.
> Too often, we recruit excellent clinician-educators and then overload them
> with clinical, education, and even committee activities. They often make
> much less money than their peers in private practice. Over the years, these
> great teachers and role models get frustrated with the medical school's
> apparent indifference to their contributions, and make the leap to private
> We relegate unsuccessful researchers to clinical teaching. These
> well-meaning physicians do not really want to teach clinical medicine. When
> this happens, it frustrates both these scientists and those clinicians who
> actively choose to be educators.
> We owe our students, interns, residents, and fellows a first-class
> education. That education should include great role modeling. The best role
> models are skilled bedside clinicians, excellent at interacting with other
> physicians and healthcare workers.
> But we should not expect great clinician-educators to reach that level
> Some organizations have invested resources in programs to help
> clinician-educators improve. The American College of Physicians has a
> wonderful book series titled Teaching Medicine
> The Society for General Internal Medicine (SGIM) has developed a very
> successful program, The SGIM TEACH Program: A Curriculum for Teachers of
> Clinical Medicine
> <https://link.springer.com/article/10.1007/s11606-017-4053-7>. Other
> medical organizations also have on-site training programs on teaching.
> Although these efforts are wonderful and include an emphasis on role
> modeling, compared with the number of clinician-educators spread across the
> country, we have insufficient resources. Right now, we inadequately prepare
> most educators before sending them out to teach our learners. Most students
> will tell you that some of them "luck into" outstanding teachers, whereas
> others have suboptimal experiences.
> The ACP position paper addresses an extremely important problem. We all
> must work to convince medical schools that they should prioritize education
> and role modeling. Too often, education is almost an afterthought. Many
> great educators feel undervalued. Our students deserve better.
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
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