Medical education: In an ideal world, the aim of medical education would be to shape students into compassionate, competent, and exceptional physicians. The curriculum and clinical experiences would be optimized for effective learning, and support systems would be in place to assist struggling students. However, the reality of medical education in the United States often falls short of this ideal.
Research indicates that nearly half of all medical students experience anxiety, and around one-third suffer from depression. Moreover, data from the American Foundation for Suicide Prevention reveals that 28% of residents undergo a major depressive episode during their training, compared to only 7-8% of individuals of similar age in the general population. These troubling trends clearly indicate the existence of deep-rooted problems within medical education that require attention.
Here are five ways in which medical education fails students:
1 | Culture of Medical Education
The culture within medical education is a significant concern that needs to be addressed. While becoming a doctor necessitates rigorous studying and hard work, some argue that the current system places an excessive mental and physical burden on students and residents.
Medical trainees often endure sleep deprivation, long nights, and work outside regular hours. A Medscape survey revealed that two-thirds of residents work over 50 hours per week, with a substantial portion exceeding 70-80 hours per week. Although duty hour restrictions exist, limiting residents to 80 hours per week and requiring at least one day off, many programs violate these regulations. Consequently, numerous residents end up working more than 80 hours per week, equivalent to 13 to 14 hours per day for six days.
Furthermore, the competitive nature of medical school can foster an environment that is detrimental to students’ well-being. The pressure to achieve high grades, top test scores, and extensive research credentials often leads to feelings of inadequacy and impostor syndrome. It can also result in unhealthy competition among students, where some resort to undermining their peers to gain an advantage.
Instead of cultivating a collaborative atmosphere where students work together to maximize their learning, medical school competition can create divisions. This has several negative consequences. Firstly, it fosters feelings of inferiority and impostor syndrome among students. Over time, these feelings can contribute to more severe mental health issues such as anxiety, depression, and even suicide.
Secondly, the emphasis on competition perpetuates a culture of overwork. Students may boast about their study hours, lack of sleep, and sacrifices made in pursuit of academic success. Consequently, many students are driven to excel academically at the expense of self-care and personal interests.
Lastly, intense competition can strain relationships between students and instructors, creating an environment where medical school feels like a cutthroat experience. While this may not be the case at every institution, the unfortunate reality is that many students experience these challenges.
2 | Overreliance on Standardized Tests
Another area where medical education falls short is the excessive reliance on standardized tests. Historically, the USMLE Step 1 exam held immense importance in determining a student’s competitiveness for residency applications. A low score on Step 1 could severely limit one’s chances of pursuing highly competitive specialties.
Although Step 1 has transitioned to pass-fail as of January 2022, the overemphasis on standardized testing persists. Step 2 Clinical Knowledge (CK) is still graded numerically and is likely to become the new influential factor in residency applications. The pressure to perform well on standardized tests continues to be a burden for medical students.
The problem lies in the fact that standardized tests primarily measure a student’s ability to excel on such exams rather than their aptitude for being a competent physician. Skills like integrity, compassion, empathy, and other essential qualities are difficult to evaluate solely through computer-based exams.
3 | Research
The excessive emphasis on research is another area where medical education fails students. While it is important for physicians to understand and analyze research, playing the “research game” in medical school often consumes time that could be better spent developing practical skills for clinical practice.
In medical school, research is often pursued to boost one’s curriculum vitae (CV) and increase competitiveness for competitive specialties. As a result, students invest significant time in generating research output, much of which has minimal impact and does not substantially contribute to scientific knowledge or medical understanding.
Considering that most physicians do not continue their research endeavors beyond their training, it begs the question of why medical students are required to dedicate significant time to research during their schooling. That time could be better utilized for studying, patient care, and developing the necessary skills and knowledge to become competent physicians.
4 | Subjective Evaluations
Subjective evaluations pose another problem within medical education. During the third year of medical school, students complete rotations in various specialties, receiving grades determined by their shelf exam scores and subjective evaluations from resident and attending physicians.
The weight given to shelf scores and subjective evaluations varies across programs and rotations. However, some clerkships heavily rely on subjective evaluations, which can be problematic. This approach shifts the focus from genuine learning to trying to impress preceptors, potentially compromising the educational experience.
Subjective evaluations can be influenced by personal connections or shared interests between students and preceptors. Students who connect well with their preceptors may receive more favorable evaluaztions, while those who struggle to establish rapport may face challenges. Furthermore, students may hesitate to ask questions when they lack knowledge to avoid appearing incompetent, which hinders their learning and growth.
Clinical rotations should prioritize learning over politics and the fear of receiving a poor grade. However, subjective evaluations often create an environment where students feel compelled to prioritize impressing their preceptors rather than focusing on their own education.
5 | Mistreatment & Discrimination
Mistreatment and discrimination are unfortunately not uncommon in medical educatio1n, both in the process of gaining admission to medical school and throughout the training journey.
Data on medical school admissions indicate that students from certain racial backgrounds face greater challenges in gaining acceptance. While affirmative action aims to enhance diversity among medical students, unintended consequences have made it significantly more difficult for some students to gain admission. Asian students, in particular, are disproportionately affected by affirmative action policies, even though they consistently achieve higher average GPAs and MCAT scores compared to their peers.
Discrimination and mistreatment persist even after entering medical school. A 2022 study published in JAMA found that students from underrepresented groups who experienced mistreatment or discriminatory behavior had the
highest attrition rates. Recurrent mistreatment was associated with a 4.1% attrition rate, compared to 1.2% for students who reported no mistreatment. Similarly, students who faced recurrent discrimination had a 1.9% attrition rate, compared to 1.3% for those reporting no discrimination.
These research findings highlight the presence of mistreatment and discrimination within medical education, leading some students to abandon their medical training. Such attrition rates are concerning, particularly in the context of projected physician shortages across various specialties.
problems in medical educations
While medical education has its merits in preparing students for medical careers, it is crucial to acknowledge and address its shortcomings. At Med School Insiders, our mission is to empower a generation of future doctors who are happier, healthier, and more effective. Recognizing the issues within medicine and medical education is essential for effective preparation.
Despite the flaws in medical education in the U.S., overcoming this hurdle is necessary for those aspiring to become doctors. We are committed to supporting students at every stage of their journey, offering resources such as MCAT tutoring, medical school admissions guidance, USMLE tutoring, and assistance with residency applications.
