We’re Training Med Students to Be Robots. That Does Not Compute

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As a medical student, I have always awed at how intelligent and composed physicians are during their daily duties of caring for patients. I constantly think to myself, “How am I ever going to become like that? There is no way I will be able to make the right decisions for my patients with such limited time and information.” A physician’s ability to take a few key points from their patients and turn that into a diagnosis and treatment plan still fully eludes me, but it is the most crucial aspect that students must learn.

It is fascinating then, the way medical school works to mold young minds into the purposeful caretakers we will be in the future. In the first two years we barely have any interaction with people, buried in books and cramming all we can fit into our heads. For some schools, class attendance is optional; one can choose to stay at home to study and watch recorded lectures without any human contact if desired. All of this just to be turned loose third year with no real direction or idea of how to best approach each individual patient situation. On my first day of clerkships, I was barely able to get my words out as I looked down at my hospitalized patient with only a name and age to go with. Yet, I was supposed to determine everything this man needed to get out of the hospital as quickly as possible. Thus, it seems a bit odd that we are not teaching students how to be humans having a conversation with another human. Instead, medical school has opted to become a place where those who can remember the most finite of facts when clearly presented to them in a multiple-choice question format will do the best. It seems this method completely forgets about any human component to medicine, rewarding those with a photographic memory while caring little if they are kind, inquisitive, and able to create meaningful relationships.

Four months into my third-year clerkships, a startling trend has begun to distinguish itself: all of those sleepless nights spent reading books has created students who are essentially robots in the field. Most times I listen to my fellow students take a history and physical from a new patient, the rehearsed SOAP note order with corresponding mnemonics that has been drilled into their heads is painstakingly obvious. There is no creativity, no deviation for each unique case, only the occasional, “I’m sorry for your loss,” or, “I’m sorry to hear that,” sprinkled in using the same monotone voice that has been there from the beginning. Students are more worried about not asking a certain question than trying to actually connect with their patient in an empathetic manner. “Did I get everything asked?” is the more important question over, “Is there anything I can do for you?” There is absolutely no relatability or compassion given to these people who may be in a most dire situation, but thankfully the student asked about recent caffeine use. We have removed humanism from the very essence of caring for humans. This cannot be the best that we expect from our medical students because if they never learn this trait now, when will it magically appear?

There is, however, a simple solution to this problem, albeit one that many medical schools, residency programs, and governing bodies would be hesitant to undertake. First, schools need to emphasize the importance of humanism and start training students from the beginning with more standardized patients built into the curriculum. We need to be taught how to deal directly with more diverse types of people and be given immediate feedback from those people. Only they can truly explain their points of view and tell us how they would like their physicians to treat them. If schools weighted this aspect of the curriculum as heavily as they do an anatomy test, students would be forced to take it more seriously.

Next, we should make the USMLE CS and COMLEX PE an actual score instead of pass/fail. Give a humanism grade with these national board exams so we can evenly compare students for residency programs and take note of those who excel in the clinical realm. Right now, those who score near 100 and those right above 70 are considered equal, which is nowhere near the case when it comes down to actual physician skills. It goes without saying which physician every patient would pick given the choice. Continually, those with high scores should be given high consideration from residency programs, just as those who score 250 and above on Step 1 are. Unfortunately, most programs do not give much regard for the CS/PE, and this is an unfair rationale. If those who can pick the right answer out of a given group more often than others are considered more desirable candidates, why do we not hold those who come up with all the right answers on their own and act the part of a physician more favorably?

Let us value the skills that create good clinicians as much as we value clinical knowledge.

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