Great Health Care Requires Great Medical Educators

Education is not an industrial process; it is a human one.

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The quality of United States medical education is a matter of concern to every person in the country. In our nation of 315 million people, we log 1.3 billion doctor visits annually -- or an average of about 4 visits per person per year. If doctors are poorly educated, we stand to lose money, time, health, peace of mind, and in some cases, even our lives. If we do a good job of educating physicians, we reap substantial benefits, avoiding unnecessary care and harmful mistakes and enjoying longer, healthier lives. 

About 60% of students who apply each year are not admitted, and many more students give up hopes of attending medical school before they ever apply. The more than 20,000 students who begin studies toward an M.D. degree each year in the U.S. have even greater investments ahead of them. Newly admitted medical students can expect to pay a small fortune over four years. The average cost of attending medical school at a public institution is about $50,000 per year, and this swells to $70,000 per year at private institutions. The typical public-school student graduates $150,000 in debt, while the figure is $180,000 for private school students.

SHARK300200.jpg"If I have seen further, it is by standing on the shoulders of giants." -Isaac Newton

(Library of Congress)

And medical school graduation is far from the end of training. To become fully qualified physicians and sit for a board exam, newly minted M.D.s must then complete residency training, which typically ranges from as few as three years (in fields such as family medicine and pediatrics) to as many as seven years (in fields such as neurosurgery). Many will then pursue additional fellowship training, for one to three years. Students who graduate from college at the age of 22 years with a goal of entering my field of pediatric radiology would typically complete medical school at 26 years, radiology residency at 31 years, and fellowship training at age 32.

An economist might add that there are substantial opportunity costs in pursuing this path. Instead of entering medical school, many of these students might pursue careers in business, in which, instead of paying out $50,000 per year, they might earn such an amount, if not more. As a result, many physicians-in-training postpone marriage and parenthood. By the time physicians complete their training, many of their college classmates already have homes, families, and established careers.

The major investments of time, talent, and treasure and the many personal and family sacrifices involved in becoming a doctor make it even more important to ensure that future physicians receive the best education possible. Traditionally, the 141 M.D. granting U.S. medical schools and their faculties have focused their attention on three key educational ingredients: curriculum, instructional methods, and assessment techniques. Curriculum concerns what knowledge and skills medical students are expected to learn, instructional methods address how they are taught, and assessment is used to determine how well they have learned it.

Medical schools are financed largely by revenues from patient care, and schools are often ranked according to research funding. ... Some may begin to see education as a loss.

But there is much more to educating medical students than these three elements. A school can provide the perfect curriculum, state-of-the-art instructional methods, and unimpeachable testing, yet do a poor job of educating future physicians. 

One ingredient missing from this account is the creativity, commitment, and inspiration of medical educators. Education is not an industrial process, akin to pressing mounds of clay into a uniform shape. Instead it is a human process. Students are not identical to one another. Each brings distinctive interests, abilities, and experiences. Like the practice of medicine itself, great education means establishing a relationship between human beings.

To promote excellence in medical education means paying attention to two different sorts of factors in the equation of educational excellence: those that tend to undermine the performance of medical educators, and those that tend to enhance it. One factor that detracts from educational performance is a lack of respect. Medical schools are financed largely by revenues from patient care, and schools are often ranked according to research funding. Despite the fact that the institutions themselves are known as schools, some may begin to see education as a loss.

Presented by

Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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