Sunday, February 22, 2015

Medical Education Is Changing. But Is It For The Better?

American medical doctors have been considered the best physicians in the world for over a century now. People come from all over the world seeking a medical education in this country because it is universally accepted as the most highly developed. Yet the Wall Street Journal recently wrote about how medical schools are changing their academics to graduate doctors who are more in tuned with the current fiscal and political climate. My question though is if this will produce better doctors.

At Hofstra North Shore-LIJ School of Medicine, freshman med students spend their first eight weeks being trained to become EMT's. They will supposedly become more proficient at dealing with fast moving, life or death situations. There are so many things wrong with this. I know plenty of fast thinking physicians, including surgeons, emergency physicians, and internists who make critical decisions without having gone through EMT training. I think EMT's have an essential role in the healthcare system. I did one night of ride-along with an EMT during my ER rotation and it was kind of cool and fun. But with so much information med students have to cram in with only four years to do it, it seems such a waste of time and resources for these students to be taking eight weeks off their harried lives to do what requires mainly a high school education to complete. If I am paying $50,000 per year to attend medical school, I would feel really screwed having to spend one sixth of that for EMT school, which costs far less.

At NYU Medical School, students are required to look up every charge that a patient receives during his care at the hospital. This is supposed to help them understand why healthcare costs so much in this country. Says Marc Triola, NYU's associate dean for educational informatics, "This isn't a textbook exercise. This is real life and students love it." The problem is that doctors actually have almost zero responsibility for how much hospitals charge their patients. That is negotiated between the hospital and the insurance companies. How can med students learning about ridiculous $11,000 colonoscopies make them better doctors? It just takes more time away from actually seeing and taking care of patients.

Even the MCAT has changed to this more politically correct medical training. The new test starting in April last two hours longer than the old one--six and a half hours long. Holy crap. Who can take a test for nearly seven hours without their brains melting? And the test now includes subjects like behavioral and social sciences. Thus you get questions like which choice "is most consistent with the sociological paradigm of symbolic interactionism?" What the hell did I just type? What kind of weird ass question is that for future doctors? Will patients prefer to go see a physician who answered that question correctly?

Schools don't even want their future graduates to memorize as much data anymore. We used to cram for nights on end to make sure we didn't look stupid during morning rounds when we got picked on by the attending. Now, says NYU's Dr. Triola, "The fund of medical knowledge is now growing and changing too fast for humans to keep up with, and the facts you memorize today might not be relevant five years from now." Instead they are interested in making sure their student display "information seeking behavior." In other words, do the students know how to use Google. You know what? If doctors know how to use Google to look up medical problems, their patients surely do too. Who needs physicians if everybody is googling the same information? And what happens when the physician has to make split second life and death decisions? Between their EMT training and lack of internalized medical knowledge, the doctors will have to make a blind choice without the crutch of the internet. Is that a doctor you want to treat your family?

This is just one more way that American medicine is losing its way and becoming more irrelevant. No good can come out of this when medical schools are more worried about teaching their students the costs of medicine instead of how to treat their patients. If memorizing medical information that has accumulated over centuries of intense research is considered too burdensome and old school for students, then surely we are not graduating students who are worthy of being called medical doctors.

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