Medical Student Editor and in-Training Staff Member Emeritus
University of Florida Fixel Movement and Neurorestoration Institute
Nita Chen is a current movement disorders fellow at University of Florida Movement and Neurorestoration program. She is Class of 2017 medical student at Albany Medical College. To become cultural, she spent her early educational years in Taiwan and thoroughly enjoyed wonderful Taiwanese food and milk tea, thus ruining her appetite for the rest of her life in the United States. Aside from her neuroscience and cognitive science majors during her undergraduate career, she holed herself up in her room writing silly fictional stories, doodling, and playing the piano. Or she could be found spazzing out like a gigantic science nerd in various laboratories. Now she just holes up in her room to study most of the time.
You knock on the door. “Come in.” When you enter the room, a gowned patient sits calmly atop the examination table. For the next 15 to 20 minutes, you spend your time in the small, cramped and surveillanced room with this individual to tease out the mystery of their chief complaint.
Throughout medical school and especially during our clinical rotations, students are often told to keep an open mind about choosing a specialty. This is sound advice, especially since many people change their minds once they are exposed to other fields. However, that does not mean that all specialties are perceived as equal — even in a primary-care focused medical school, third-year medical students often run into prejudice against FM. Worse, they may run into stereotypes about family med which could be enough to sway them away from the specialty they would really love.
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.
Guest Writer
Albany Medical College
Erin Ayala, PhD is a clinical faculty fellow in the Department of Psychiatry at Albany Medical College. She conducts research on health and wellness, does clinical work with medical students, and facilitates wellness initiatives and workshops at the college. When she’s not working, she’s training for triathlons, playing with her 2 dogs, and thinking of new ideas for personal hobbies and projects she may or may not actually finish.
