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  • We frequently hear medical students and residents say that the medical education system is broken

  • and needs to be changed, but what about it is broken?

  • How exactly is medical education failing students?

  • Let’s talk about it.

  • Dr. Jubbal, Medschoolinsiders.com.

  • In an ideal world, the goal of medical education would be to mold students into the best, most

  • competent, and most caring physicians they can be.

  • Curriculums and clinical experiences would be optimized for learning and systems would

  • exist to support students who are struggling.

  • Unfortunately, this is not often the case with medical education in the United States.

  • It is estimated that nearly half of all medical students suffer from anxiety and nearly a

  • third from depression.

  • Moreover, according to the American Foundation for Suicide Prevention, 28% of residents experience

  • a major depressive episode during training compared to only 7-8% of similar-aged individuals

  • in the U.S. population.

  • Given these unsettling trends, it is clear that there are deeply-rooted problems within

  • medical education that need to be addressed.

  • Here are 5 ways that medical education is failing students.

  • Let’s start with the elephant in the room: the culture of medical education.

  • Becoming a doctor requires countless hours of studying and hard work.

  • Although many argue that medical education should be difficult given the responsibilities

  • that come with being a physician, others believe that the current system places too heavy of

  • a mental and physical burden on students and residents.

  • Aspiring physicians must regularly endure sleep deprivation, long nights, and work after

  • hours and on days off.

  • According to a recent Medscape survey, two-thirds of residents work greater than 50 hours per

  • week with a large percentage of residents exceeding 70-80 hours per week.

  • Although duty hour restrictions exist that limit residents to 80 hours and require at

  • least one day off per week, this is averaged over 4 weeks.

  • And even then, many programs violate these restrictions.

  • As such, there are many residents working in excess of 80 hours per week, which translates

  • to 13 to 14 hours per day, 6 days per week.

  • In addition, the environment during medical school is often extremely competitive.

  • Everyone is trying to achieve the highest grades, the best test scores, and the most

  • research to match into their desired specialty.

  • Not only does this immense pressure to perform often lead to feelings of inadequacy and impostor

  • syndrome, but it can also lead to fierce competition between students as wellwhich some students

  • take too far.

  • Some overly-competitive students will throw their peers under the bus in order to elevate

  • themselves in class or in rotations.

  • Instead of fostering a collaborative environment where students work together to maximize their

  • learning, the competitive nature of medical school can sometimes pit students against

  • one another.

  • This has many consequences.

  • To start, it causes many students to feel inadequatelike their peers are always

  • doing more than themwhich ultimately leads to feelings of inferiority and impostor

  • syndrome.

  • Over time, these feelings can develop into more serious mental health issues such as

  • anxiety, depression, and even suicide.

  • Next, this competition between students perpetuates the culture of overwork.

  • It’s not uncommon for students to brag about how much they study, how little they sleep,

  • and how much theyve sacrificed to excel in medical school and residency.

  • As a result, many students are pushed further and further to excel academically, often sacrificing

  • things like self-care and hobbies in the pursuit of performance.

  • Lastly, it can strain the relationships that students build with their peers and instructors

  • and make medical school feel like anevery person for themselfexperience.

  • Although this isn’t the case at every medical school and the transition to pass-fail curriculums

  • during the first two preclinical years has helped to address some of these issues, it

  • is still an unfortunate reality for many students today.

  • The next reason that medical education is failing students is that it relies too heavily

  • on standardized tests.

  • Prior to January 2022, USMLE Step 1 was considered the most important exam that future physicians

  • took during their training.

  • The reason was that your score on Step 1 was a major determinant of your competitiveness

  • for residency applications.

  • As a result, a low score on Step 1 often prohibited students from pursuing highly competitive

  • specialties.

  • If you wanted to become a dermatologist or a plastic surgeon, for instance, but you didn’t

  • score high enough on Step 1, you could pretty much kiss your dream specialty goodbyeall

  • because of a single, 8-hour test.

  • Although Step 1 has officially transitioned to pass-fail as of January 2022, this still

  • doesn’t change the overreliance on standardized tests.

  • Step 2CK is still graded on a numerical scale and will likely become the new Step 1 in terms

  • of its weight on residency applications.

  • The pressure to perform is just being shifted from one standardized test to another.

  • The problem is that standardized tests aren’t necessarily reflective of a student’s ability

  • to be a good physician, but rather their ability to take standardized tests.

  • There are many other factors that play into being a great physician beyond test scores

  • such as integrity, compassion, empathy, and other soft skills that cannot be evaluated

  • effectively with a computer-based exam.

  • Speaking of components of a medical student’s residency application, the overemphasis on

  • research is another way that medical education is failing students.

  • Although it is important to have the skills to analyze and understand research as a physician,

  • playing theresearch gamein medical school often consumes time that students could

  • spend developing skills that will make them better physicians instead.

  • Research in medical school is a numbers game and quantity is prioritized over quality.

  • If youre trying to match into a competitive specialty, you are encouraged to get your

  • name on as many research projects as possible to pad your CV.

  • The result is that many students end up spending large amounts of time producing research,

  • most of which is of little impact and doesn’t meaningfully progress the body of scientific

  • literature or our understanding of medicine.

  • The reality is that most physicians will not continue to do research once they have completed

  • their training, so why then do medical students have to commit so much time to research during

  • medical school?

  • That time could be better spent studying, seeing patients, and developing the skills

  • and knowledge necessary to become a competent physician.

  • Next are subjective evaluations.

  • During the third year of medical school, students must complete a series of rotations in a variety

  • of specialties.

  • At the end of each rotation, they are given a grade that is determined by two things:

  • their shelf scores and their subjective evaluations by their supervising resident and attending

  • physicians.

  • The weight given to shelf scores and subjective evaluations varies depending on the program

  • and the rotation; however, there are some clerkships that are predominantly determined

  • by subjective evaluations.

  • This is problematic as it puts the focus on trying to impress your preceptors as opposed

  • to trying to learn.

  • You may just get lucky or unlucky that you click or don’t with your preceptor.

  • If you both bond over your shared love of Formula 1, youre likely to get a stronger

  • evaluation than if you have nothing in common.

  • Additionally, many students will avoid asking questions when they don’t know something

  • just to avoid looking bad in front of their preceptors.

  • As such, these subjective evaluations may disincentivize students from asking questions

  • and addressing their gaps in knowledge.

  • Clinical rotations sometimes feel like theyre no longer about learning but rather about

  • politics and the fear of getting a bad grade instead.

  • Lastly, mistreatment and discrimination are not uncommon, both in terms of getting into

  • medical school and throughout the medical training process.

  • When you look at medical school admissions data, it is evident that students from certain

  • racial backgrounds have a much more difficult time getting into medical school than others.

  • Although affirmative action in medical school admissions aims to help increase diversity

  • among medical students, one of the unintended consequences is that it has made it significantly

  • more difficult for some students to get into medical school.

  • Asian students in particular are hurt the most by affirmative action policies.

  • The average Asian matriculant during the 2021-2022 application cycle had an average GPA of 3.79

  • and MCAT score of 514.5.

  • If we compare this to the average Black matriculant during this same year, the average Asian matriculant

  • achieved a GPA that was nearly 0.25 points higher and an MCAT score that was nearly 8

  • points higher.

  • For perspective, a 506 on the MCAT is a 65th percentile score and a 515 is a 90th percentile

  • score.

  • Ask anyone who has taken the MCAT, and theyll tell you how big of a difference this is.

  • Asian matriculants, despite being minorities in the US and facing discrimination beyond

  • academics, averaged a GPA and MCAT that was higher than even Caucasian matriculants.

  • Each year these differences vary, but recently Asians have averaged a GPA close to 0.1 points

  • higher and an MCAT more than 2 points higher than their Caucasian colleagues.

  • We cover this topic in depth in our Affirmative Action in Medical School Admissions video

  • - link in the description.

  • Unfortunately, discrimination and mistreatment don’t end once one gets into medical school

  • either.

  • According to a 2022 study published in JAMA, students from underrepresented groups who

  • reported mistreatment or discriminatory behavior had the highest attrition rates of any group.

  • Students who reported recurrent experiences of mistreatment had attrition rates of 4.1%

  • compared to 1.2% of students who reported no mistreatment.

  • In addition, students reporting recurrent experiences of discrimination had attrition

  • rates of 1.9% compared to 1.3% for students reporting no discrimination.

  • From this research, it is evident that there are issues with mistreatment and discrimination

  • within medical education that are causing some students to leave their medical training

  • altogether.

  • This comes at a time when we are facing looming physician shortages across a wide variety

  • of specialties as well.

  • These reasons just scratch the surface of the bigger issues in medical education.

  • We could go all day talking about issues of the rising costs of medical education, the

  • stigma of mental health among physicians and trainees, and burnout; however, we have covered

  • these topics in depth in previous videos.

  • We also plan to cover the topic of the residency bottleneck and unmatched residents in a comprehensive

  • future video, so make sure youre subscribed so you don’t miss out.

  • Although medical education has its flaws, it’s not all doom and gloom.

  • There are many things that medical education does well to prepare students for careers

  • in medicine.

  • That being said, it is still important to be aware of its shortcomings to better prepare

  • yourself for what to expect.

  • At Med School Insiders, our goal is to empower a generation of happier, healthier, and more

  • effective future doctors, and part of that is managing expectations.

  • Whereas others are hesitant to talk about the issues in medicine and medical education,