I’m not sure how I missed the article, but one of my favorite New York Times bloggers wrote a piece in April titled “Are Med School Grads Prepared to Practice Medicine?” I applaud Dr Pauline Chen’s attempt to discuss the variability of medical education across the United States and the need for more uniform standards and testing, but the resounding answer to this question is obvious and is absolutely no. Reading the comments on this article (something I keep telling myself not to do but somehow cant avoid) would make you think that every young doctor out there is completely incompetent and therefore is not ready to practice medicine. My opinion might be unpopular, but I would argue that not being prepared to practice medicine out of medical school isn’t necessarily a bad thing.
I’ve often commented that medical school is the time for learning how to act like a doctor, while internship is for learning how to actually be a doctor. Part of the problem with preparing medical students to be physicians is that no amount of training can fully prepare you for internship. As one of the chief residents this year, it has become all to clear how “preparing students to be doctors” is almost an insurmountable challenge. Throughout their “clinical training”, third and fourth year students struggle with the tremendous amount of factual information they must learn in the chaotic environment of the hospital, while preparing for exams at the end of their rotations that are a test of knowledge rather than skill. Additionally, students are often observing residents and attendings interact with patients, and rather than being the lead are often at the bottom of the totem pole, a situation that makes acquiring clinical knowledge much more difficult. As it is, medical school still focuses on education for factual knowledge instead of clinical knowledge.
Interns are no different, and their learning curve is particularly steep. Surgical interns start out particularly handicapped – not only must they conquer the knowledge base of a medical doctor, but they must also acquire the skills necessary to be a young surgeon. But a solid knowledge base of medical facts does not ensure that a student will be prepared to be an intern; the critically important part of intern year is learning accurate clinical judgments. Learning that skill that takes variable amounts of time to acquire from resident to resident, and among attending physicians, some will always be better than others. Interns are also charged with taking care of far more patients than their student counterparts, and while the amount of responsibility students have varies across medical schools, interns are directly involved and responsible for patient care. Part of learning to be a physician is well… actually being a physician. If students came in fully prepared to practice, what would we need residency for?
I firmly believe that nothing can fully prepare you for the first time your pager goes off as an intern and an emergency in one of your patients awaits you on the other end of the line. But perhaps there is room to do better in training medical students.