Contributing Writer
Yale School of Medicine
A sleep-deprived, sanity-deficient MD/PhD student torn between the exciting promise of what lies ahead and the grueling reality of what it takes to get there.
With more applicants than ever, and a relatively static number of medical school and residency spots, there has been an increase in the use of metrics such as standardized test scores, GPAs and research publications to differentiate between applicants. Unfortunately, an emphasis on the unquantifiable attributes of physicians — the qualities that actually differentiate great clinicians from good ones — seems to have fallen by the wayside.
In light of this recent occasion, I would like to draw attention to the sexual harassment of a particularly vulnerable population that is a result of a unique power dynamic: they have no income, they have amassed significant debt and they depend on the subjective opinion of their abusers for validation of their work. Most frustrating, is that many of the corrective actions taken over the last 25 years have had a limited effect on changing this specific culture of abuse. This specific population is medical students.
Medical students are subjected to a barrage of advertising that inevitably leads to a physician-industry connection that can be harmful to our health care system. Medical students’ exposure to pharmaceutical marketing begins early, growing in frequency throughout their training.
In March 2016, six medical students at Harvard Medical School launched #endstep2cs, an initiative aimed to garner support for the termination of the United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills (CS) that is currently administered to medical students prior to graduation. This past week, we talked with Christopher Henderson, one of the organization founders, and Dr. Peter Katsufrakis, the senior vice president for assessment programs at the National Board of Medical Examiners (NBME), to discuss the faults and merits of both the CS exam and the student-led initiative to end it.
As future physicians, understanding the consequences of absolute resource levels impact health is critical. A physician who advises a better diet to somebody without the ability to act on that advice is of little more use than the physician who prescribes an imaginary medication. However, institutes of medical education do a disservice to their students by keeping the conversation so narrow. Medical schools must begin to more fully teach how relative inequality impacts health.
Everyone told me medical school would be hard. I thought I was prepared, but nothing actually prepares you for medical school like being in medical school. I was accustomed to working long hours, the constant stress of exams and little sleep. What I wasn’t accustomed to was the absolute dearth of creativity in the coursework.
As an “underrepresented minority” in medicine, my personal experiences of mistreatment while navigating the challenges of pursuing this career are mostly invisible to the rest of society, but I know that they are far from mythical or unique. In fact, my experiences harmonize perfectly with the tales of so many African-American physicians before me and even in the accounts of the students I currently mentor. Everyone asks, “Aren’t things different now for African-Americans?” Yes. But, are they better? Sadly, not exactly.
The cultural competency framework that has become the mainstay of medical education is often times employed in incredibly reductionist ways. It seems to propose that exposing physicians to homogenized, static and packaged ideas of culture will aid them in estimating patient behavior, preference or response in the clinic, thereby diminishing health care inequality. Training like this paves the way for even well-intentioned student-doctors to be explicitly ignorant under the auspices of clinical benefit. It spoils the good intent to create better patient outcomes by legitimizing the validity of stereotypes and the development of physician bias.
It is 1 p.m. on a Wednesday, and 250 medical students are filing into the lecture hall to listen to a lecture on health care and society. The chatter is not one of excitement, but of disconcertment. Many students complain that their time would be better spent studying hematology. These are not uncaring students who disavow the needs of the disabled, but a generation that demonstrates a palpable reaction to the way that medicine is taught. We may be quick to fault them for their alarming aversion to a discussion on ethics, but we must also consider: is ethics meant to be force-fed?
Four years. I had gone four years without crying in a faculty member’s or an advisor’s office. And there I was, sobbing all over myself, as I tried to explain the situation. A couple of days prior, I received a terse email from the training director, saying I needed to come in to meet with her. She was not happy with my most recent feat as a doctoral student.
December 10, 2015 marks the one-year anniversary of the inception of White Coats for Black Lives, a national organization of medical students that aims to eliminate racial bias and racism in the practice of medicine — as they are threats to the health and well-being of people of color.
One year ago, on December 10, 2014, over 3,000 medical students participated in the National White Coat Die-In. We knelt to the ground, rested our backs on concrete and tile, looked up at the ceiling and contemplated what it meant to be a citizen. We embraced a deafening silence pregnant with the implications of erasure. Our bodies, cloaked in the privilege of a white coat, painted a complicated image of advocacy and appropriation.
Writer-in-Training and in-Training Staff Member
Warren Alpert Medical School of Brown University
The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.
I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!
