Medical Schools follow the money.
Most of it comes from government and big Pharma. The research grants support the faculty and
staff and have been required to attract the best research teams and the
“prestige” that brings. Medical Schools are also attached to teaching hospitals
to give students exposure to actual healthcare.
The third component is the medical school curriculum.
Medical Schools need to recognize that the current model is
unsustainable. In the 1960s Medical Schools supported adding federal tax
dollars to subsidize treatment. The Medical Industrial Complex formed by Big
Pharma, Medical Equipment companies and Hospitals. They supported the emergence
of “medical specialties”.
We’ve invested $trillions into healthcare since the 1960s and we have
failed to find out what cancer is, but treatment costs are through the roof on
everything. Healthcare is overpriced and under-performing. Patients are
complaining about the cost and believe providers have a conflict of interest
and will not implement cost-saving measures. The article below describes how converting grades to “pass-fail” caused
panic with internships.
A disturbing truth about medical school — and America’s future doctor,
You may be surprised to learn that
medical students at many of the best schools in the country aren’t given grades
during the first two years of their medical education. They either pass their
coursework or they fail. And then, they take one high-stakes test that affects
their medical future.
While the effort to allow medical
students to take two years of course work on a pass-fail basis was driven by an
effort to make the notoriously difficult life of medical students easier, the
high-stakes testing consequence creates problems of its own.
In this post, Brenda
Sirovich, a physician and professor at
Dartmouth College’s medical school, writes about how this approach threatens to
compromise both the community of medicine and the quality of patients’ care.
She is a 2017 Public Voices Fellow with the OpEd Project, a social venture with
both a nonprofit and for-profit arm that is aimed at increasing the range of
voices and quality of ideas contributing to national and international debate.
[The list of test-optional colleges and universities
keeps growing despite College Board’s latest jab]
By Brenda Sirovich
News that a federal
educational experiment failed to
supply evidence in favor of Education Secretary Betsy DeVos’s school
choice agenda has undoubtedly elicited schadenfreude in some Democratic
circles. Somewhat lost in the story, however, is scrutiny of how students’
educational success or failure is measured.
The trend toward near-exclusive
reliance on standardized testing to measure educational achievement now extends
all the way to medical school. Many may not realize that the readiness of
aspiring doctors to enter the world of clinical medicine is now based
overwhelmingly on a single, standardized, closed-book, multiple choice test.
Scores on the test, the U.S. Medical
Licensing Step 1 Exam (a.k.a. the Boards), taken after two intense years of
classroom education, will overwhelmingly
determine where students do their
residency training. And their professional futures.
Such reliance on Board scores wasn’t
always this way. About 30 years ago, I took the Boards. I passed, and have
absolutely no idea how I scored (even though I am the kind of person who still
remembers the exact score I got on my SATs).
But a decade or so ago, residency
programs suddenly started caring, a lot, about Board scores — an unintended
consequence of a well-intentioned move by medical schools to grade the first two years pass-fail, to foster
student wellness.
Residency programs abruptly found
themselves in desperate need of a yardstick by which to measure and compare
student applicants. Board
scores were suddenly paramount.
Behold the mismatch: We aim to
prepare students for a career characterized by collaboration, complexity,
nuance and uncertainty; yet, we evaluate them on their ability to select autonomously
and without research among radio buttons representing a discrete range of
right-or-wrong responses.
After 20-odd years in practice, I
have yet to see a patient come in with a list of four or five possible
diagnoses, and ask that I select the most appropriate response. Nor have I, while searching online
for current evidence or recommendations, heard a patient cry out, “Stop!
This is a closed book appointment!”
Here’s the thing: Students understand
how they’re assessed; they’re all quite brilliant in this way, whether they’re
in medical school or high school or third grade. They figure out with lightning
speed what they need to do to maximize their performance on the assessment that
matters.
As a result, here is my students’ To
Do list:
1.
Do not attend class, unless
attendance is specifically required.
2.
Complain about the (modest) number
of class hours requiring attendance.
3.
Resist discretionary learning
opportunities, no matter how interesting.
Their logic is impeccable. Each
student’s sweet spot for MCQ mastery involves some combination of lecture
videos at double speed, late nights, ear buds, coffee and little human
interaction.
It works beautifully in achieving
the desired outcome of a good Board score.But what is the desired outcome? My students and others like them are
the doctors of tomorrow. They’ll care for me and you as we age. For our parents
facing life threatening illness and difficult decisions at the end of life. For
the children we haven’t yet contemplated.
The desired outcome should not be about test scores. We should hope students will have
learned how to find, evaluate and apply knowledge; how to work collaboratively;
how to tolerate and manage uncertainty; how to reason; how to walk in someone
else’s shoes; how to relentlessly pursue what’s best for each patient; how to
debate, be wrong, fail — and embrace and learn from it, each time; how
to become who they want to be.
It’s tough to do alone. It’s really
tough with ear buds in. To be sure, the medical students I
teach believe all
these capabilities are genuinely important. But they are keenly aware that
these are not what
will bring them educational success. The contrast exemplifies the pernicious
and corrosive power
of standardized metrics of success
in any educational setting — to transform what we value and how we learn.
“Every system is perfectly designed
to get the results it gets”: It’s taken me years to fully appreciate this
deceptively simple observation by one
of the fathers of health-care improvement science. Change the last two words to “by which we choose to
measure it,” and the paradigm clearly applies as well to education as to the
health-care systems Paul Batalden describes.
Clearly, we need objective and reproducible
measures of achievement. But when we permit the easy availability and seeming
objectivity of one measure to exalt itself as sovereign, we become singularly
capable of removing the joy from teaching, fragmenting a community of learning,
and undermining our commitment to foster curiosity, nourish problem solving and
inspire a love of lifelong learning.
http://news.doximity.com/entries/7539355?authenticated=false
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