Monday, June 23, 2008

Are today's medical students wusses? Consider what's different now.

Lately I've heard more and more rants about how today's medical students need to "grow up" or that we are "wusses" for not wanting high-stress jobs or for asking what we need to know for the exam, or how today's senior physicians are "washed up and out of touch."

Don't get me wrong, I strongly agree with the fact that medical students should not be recording remains of body donors (as mentioned in here). This does NOT happen at my medical school; along with virtually all of my classmates, I am strongly in support of my faculty's oft-stated policy that bringing cameras into the lab is grounds for dismissal from the program. While you can be upset at the students for doing this, there's also a lot to be said for not giving the students the opportunity.

What I am referring to is the impression of some more senior doctors that today's medical students are wimps, and that medical students today recoil to comments like this by saying that old doctors have no idea what it's like now.

One retired MD in my faculty, extremely well-respected among nearly everyone who knows about him, made the entire first-year class an exception to this during a lecture by making comments to them that he thinks they never would have survived medical school back in his day.

This only generates division between the generations. "How can he say that?" they reply. "HE would never make it through OUR medical school class. There is SO much more known about medicine today... heck, DNA wasn't even INVENTED when he was a medical student!" Despite their exaggerated protests, they have a point. One example: a rheumatologist told us "The things you are learning in this week in your second year of medical school weren't taught to me until my fellowship."

And whereas most people respect him very highly for his accomplishments in the faculty, all the first-years I spoke to on this won't see him for that. In their words, they think he is a "tool."


In fact, that retired doctor is right in one regard - today's medical students wouldn't make it through medical school back in his day... but only because they wouldn't make it in to medical school back then. This goes both ways, though - he and many from his generation (as I've heard many M.D. interviewers from that generation say during interview weekend) would likely not make it past the admissions process to get into medical school if he submitted his application from 1950 to one of today's medical schools.

And that leads me to the point of this post. Admissions procedures, like so many things, are very, very different today from how they used to be. Comparing a medical school class of today to a medical school class of 20, 30 or 40 years ago is virtually impossible.

Some of the differences I can come up with:

1. How medical students are admitted.

---> Class of 1960: Chosen on the basis of GPA.
---> Class of 2000: Chosen for extracurriculars, personality, answer to the ... . These days, many people in medicine know someone with stellar MCAT marks and GPA who are not in medical school. Back in the day, they were the only ones in medical school.

As a result of the admissions, this leads to a difference in:

2. The type of medical students that are admitted.

---> Class of 1960: Students who put medicine first. Everything else second.
---> Class of 2010: Variety of extracurriculars and social supports (family, friends, etc.) Can't get in to medical school without demonstrating this.

The type of students that get in is related to:

3. How the students that get in approach a high volume of information.

---> Class of 1960: Medicine comes first, so I will learn it all.
---> Class of 2010: How much do I need to know to pass the tests, so I can still have time to enjoy time with my family, friends, and extracurriculars?

This impacts:

4. Types of specialties students choose

---> Class of 1960: Specialties that allow them to be doctors 24 hours per day, live at the hospital, and surround their lives around their career
--> Class of 2010: A documented increased interest in "Lifestyle specialties" (a term now recognized and used by the AAMC) such as the "R.O.A.D. to a good lifestyle" - Radiology, Ophthalmology, Anesthesiology, Dermatology. Or, working 4-day work weeks. As medschoolhell puts it, "Honestly, why work 60 hour weeks for $120,000 per year if you can work the same amount of time and pull in $300,000?" This way, they can spend time with their families and doing the things they love, with their career on the side. Apparently that is what makes us wusses.

Put both types of medical students in a high-stress situation, and that leads us to the fifth difference.

5. What happens when these medical students are subjected to extreme stress

---> Class of 1960: Learn the physiology, pathology, and stay awake until you know it all. This is not a problem because its what they did during undergrad, and medicine comes first so sleep is the only thing that needs to be sacrificed.

---> Class of 2010: Learn the physiology, pathology, and stay awake until you know it all. This is a major problem because during undergrad, these students relied on their many extracurriculars to help relieve stress... but now, the volume of information is much too great to have time for anything other than study. So, far too many students have outlets in other ways... drugs to help them get to sleep (both prescription ie. sleeping pills, and non-prescription ie. alcohol), full-on medically diagnosed anxiety attacks, many minor freak-out sessions.

Anatomy on the Beach has written on this as well, and mentions a number of other factors: dashed expectations, professors who could probably do a better job of explaining the relevance of some of the seemingly irrelevant, nitpicky details we're expected to memorize and regurgitate, and the reality and stress of medical school which can dampen the enthusiasm of learning.

Well, this is just my take on the situation - in my opinion, the Class of 1960 and Class of 2010 are too different to be compared to each other and call one group "wusses" in relation to the other. I would be very interested in hearing from people who have been around longer and therefore know about this situation a lot better than I do...or anyone who has thoughts or can think of other differences.


14 comments:

Beach Bum said...

Hey,

Thanks for the link. I've been thinking about this for a while, and this post promted some more thoughts.

BB

incidental findings said...

Not just long ago, but when I was a student. I got into med school on numbers.

Med school was all work for me. My MS3 was harder than my intern year.

And I do share the opinion that folks looking for <40 hr work weeks are looking in the wrong field. Most of the derms I know work 60+ hr weeks. Most opthos I know see 40+ patients a day. Gas has overnight calls. Rads has high malpractice, and far more stringent standards on read speed and accuracy than most people realize.

But most importantly, the thing that defines a profession is self-identification.

Physicians complain that the prestige of the profession has diminished, but what do you expect when even we don't take our profession seriously anymore...

Sorry to blather on. This is what happens when I stop posting my own blog entries.

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Anonymous said...

I think you'll find this kind of generational warfare in pretty much every profession. To some extent, I think it's just human nature to lament the good old days and to blame the younger generation for not measuring up.

Times change. Often it's for the better.

Most people - not just medical students or physicians - nowadays want some balance in their lives. I don't see this as a bad thing; people tend to be happier and more productive when they're not constantly exhausted and stressed out. I think this is something the older generation can learn from younger people.

Some changes are not for the better, of course. There is much more of an attitude of self-entitlement, among patients as well as medical students. In a wealthy society, people are accustomed to having what they want... and they want *a lot* without necessarily having to work hard for it.

I worry about my nephew, who recently graduated from college. He's a great kid with a good work ethic... but here's a kid who has *never,* except for one summer, had to work for a paycheck. Pretty much all his life, his parents have paid for whatever he wants - private music lessons, trips abroad, a new car, you name it. And I'm not sure how well-prepared he is for real life. I know a lot of other kids who are in the same boat, who may be on the highway to depression because their coping skills have never really been tested.

I dunno, there's probably a happy medium somewhere. It's something I search for personally. I believe in the meaning of work; it's a big part of one's identity and it's how you engage with the rest of the world and hopefully make it a better place, even in a small way. I mean, none of us is an island, right? But I think the rest of life needs to be meaningful too, so people have the opportunity to become well-rounded, interesting human beings.

My own physician is younger (late 30s) and he's really great - smart, caring, wide range of interests and he's not at all paternalistic like many of the older guys used to be. So there's hope.

Doctor Ayche said...

Don't overlook the significant change in med school class composition that has occurred as a result of women entering (and in some specialties dominating) the field. As for wussiness... It is true that many women are more likely to seek careers in which they can balance work with family. Yet a woman in my class delivered her first child, took less than a week off, and was back to take finals a week later. Nothing wussy about that.

Anonymous said...

There is a regrettable tendency among physicians (and medical students) to proclaim that Other Doctors Are Dumb (Or Weak). Orthopods say this about obstetricians. Internists say this about orthopods. Pediatricians say this about family docs. And so on.

The version of this you are guilty of, Vitum, is to say: Other Generations Are Dumb (Or Wussy). You are guilty of precisely the same error as was committed by the lecturer in first year. He evidently thinks you're all wusses. You clearly think the Class of 1960 was a bunch of textbook-memorizing robots without extracurricular interests or talents.

I don't think either generalization is fair--or true. In some respects, his generation had a much more difficult time that you have: no internet, no Dr Google, no downloading the lecture onto your laptop, no "self study time" or "Dean of Student Affairs". In other ways, your class has it harder: more to learn, higher expectations regarding clinical and communications skills, more stress regarding internships and residencies.

Not to be a wuss, but: a pox on both your houses! Respect is a two way street, Vitum.

- signed The Prof Who Reads Your Blog

mcd7m said...

Hello! I am a second year medical student at the University of Virginia. I am doing a research project this summer on blogs maintained by medical students and physicians and I have really enjoyed reading yours! I found your comparison of medical students now and then really compelling. I wanted to let you know about an online journal at UVA called Hospital Drive, which can be found at http://hospitaldrive.med.virginia.edu/. I think you and your readers would really enjoy reading and perhaps even submitting material to the journal. Happy Reading!

Enrico said...

24h hospital work? Are you kidding me? The physicians of yesteryear had FAR MORE time off once they started a practice than today's docs. It used to be a running joke not to get sick on Wednesdays because that was the usual doctor golfing day. And don't get me started on autonomy: your average family doc delivered babies, did minor surgeries, blah blah with no unreasonable threat of lawsuits. Things went wrong, but they THANKED the doctor for doing his best anyway.

I admit the training was more rigorous then by far, but mainly because 1) it adopted a military rather than a more socratic mentality, and 2) the paternalistic "this is the way I did it and so will you" approach could really only be broken with both women entering medical school classes in droves (since there was no precedent) and the rate of scientific discovery finally outpacing medical curricula. Managed care ended the "golden years" in the 80s and has gone from bringing physicians down from the clouds (probably needed) to burying them in the dirt. (pendulum swung too far)

I agree with Anonymous Professor--you are guilty in this piece of presenting an unbalanced view. Every numbered item has one sentence for 1960 and a far longer writeup for 2010, just as a simple example that doesn't even require reading what you wrote.

That said, I'd much rather be sick today than in 1960. :D

Vitum Medicinus said...

It's a fair accusation that I am not balanced in this. While I usually try to be, I knew from the start I didn't have a chance, since I wasn't around in the '60s and I know a lot more about what goes on in my class. I'm going on what I've been told, mostly.

Rather than try to say one group is worse than the other, I'm more or less trying to explain it's too tough to compare the two groups.

I appreciate the insight about the things that went on in those days - I always look forward to anonprof's comments since I know I stand to learn a lot from him...and he is NOT one of those irrelevant, nitpicky profs Anatomy on the Beach talked about.

I was eager to read the comments that I knew would come so that I could learn a bit more about that era. Please keep 'em coming.

Frank Drackman said...

Its a shitload harder to get in Med School now than in the old days. 1960? almost no women, and the few blacks who got in went mostly to Morehouse, Howard, or Meharry. Not alot of financial aid in 1960, so a much more upper middle class College population. only 179 million Americans in 1960, populations almost doubled, but most states still have the same number of medical school spots. And I graduated in 88' so I don't have a dog in the fight.

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