{"id":1785,"date":"2016-03-14T12:33:55","date_gmt":"2016-03-14T16:33:55","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=1785"},"modified":"2016-03-14T12:38:32","modified_gmt":"2016-03-14T16:38:32","slug":"the-era-of-the-ill-prepared-medical-student","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/03\/the-era-of-the-ill-prepared-medical-student\/","title":{"rendered":"The Era of the Ill-Prepared Medical Student"},"content":{"rendered":"
\"Ahmad<\/a>

Ahmad Yousaf, MD, is the 2015-16 Ambulatory Chief Resident in Internal Medicine at Rutgers New Jersey Medical School.<\/p><\/div>\n

What is wrong with medical students nowadays?\u00a0This question has been circulating in the academic medical world for years. As an intern and\u00a0resident, I would hear complaints about how \u2018unready\u2019 they seemed. The grievances often\u00a0include adjectives like ill-prepared,\u00a0lazy,\u00a0 or uninterested.\u00a0 The complaints have burgeoned over time, and the examples are numerous in my institution: Students show up late to rounds with coffee in their hands;\u00a0one med student had the gall to go directly to the attending and request early dismissal because he \u2018had nothing to do.\u2019 The problem seems to permeate all schools.\u00a0 Beyond the effects of this behavior on student culture, it results in underprepared interns and residents.\"alg-school-test-jpg\"<\/a><\/p>\n

As a chief resident, I have set aside weekly teaching conferences with the students, and I think I have begun to better understand the issues. Just 5 to 10 years ago, medical school expectations were high. You were expected to show up early to rounds, leave late,\u00a0be at the beck and\u00a0call of your resident, and have\u00a0absolute respect for an attending physician.\u00a0 Respect for the process of education was standard.\u00a0 You dressed appropriately. You studied to impress, and you came to rounds prepared to try your best. So why have these standards changed recently? Because none of these qualities are rewarded appropriately in a student\u2019s medical school \u2018report card.\u2019<\/p>\n

\"reportcard\"<\/a><\/p>\n

Medical student grades, and therefore class ranks, theoretically are based upon two major components: clinical evaluations and test scores (i.e., shelf exams). But the truth is, in medical education today, evaluations completed by residents and attendings of students on their medical teams are essentially useless. Most evals result in clinical grades that are essentially the same, no matter how hard-working or lazy a student was on the floors.\u00a0 Many reasons are put forward to explain why this occurs, but I think the most important is \u2018evaluation burnout.\u2019\u00a0 Academic medicine is riddled with so many unneeded and redundant evaluations that most physicians do not put the time or mindshare into making them useful.\u00a0 This results in clinical scores that do not help discern who put forth the work to excel and who just showed up because they needed proof of attendance. It is for this reason that the test scores are weighted so much more heavily than clinical evaluations in the eyes of the average medical student.<\/p>\n

“Why get to work early and learn about my patient when my test score and a review of \u2018high yield\u2019 facts from a review book will further my career more effectively than learning how to do a good physical exam?” “What is the point of having a well-prepared presentation for rounds when I will get the same score as my colleague who spent the morning going through review questions?” “What is the point of impressing my attendings when all that really matters is my grade and class rank?”<\/p>\n

\"studying\"<\/a><\/p>\n

These questions\u00a0guide the behavior of students, and I cannot blame them. Medical school is competitive.\u00a0Long-term career plans depend on more than whether a resident team\u00a0thinks\u00a0a student is\u00a0not putting\u00a0quality time in on the wards.\u00a0 The finger must be pointed at\u00a0our medical education system,\u00a0which values test taking over clinical knowledge and skill. How can we expect to produce a generation of quality practitioners without ensuring that we instill the value of actually practicing that theoretical medicine they learn in textbooks and are quizzed on in exams?\u00a0 We somehow have to shift the tide of education toward, or perhaps back toward, an environment in which becoming a physician means more than a number or letter grade or a class rank.<\/p>\n

Do\u00a0you agree that students are ill-prepared?\u00a0Do you see a solution to the problem of students being less interested in the work on the wards?<\/p>\n

~Yousaf<\/p>\n","protected":false},"excerpt":{"rendered":"

What is wrong with medical students nowadays?\u00a0This question has been circulating in the academic medical world for years. As an intern and\u00a0resident, I would hear complaints about how \u2018unready\u2019 they seemed. The grievances often\u00a0include adjectives like ill-prepared,\u00a0lazy,\u00a0 or uninterested.\u00a0 The complaints have burgeoned over time, and the examples are numerous in my institution: Students show […]<\/p>\n","protected":false},"author":1255,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[72,47,33,40],"class_list":["post-1785","post","type-post","status-publish","format-standard","hentry","category-about-residency","tag-medical-education","tag-mentors","tag-reflections","tag-student-experience"],"yoast_head":"\nEra of the Ill-Prepared Medical Student<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/03\/the-era-of-the-ill-prepared-medical-student\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Era of the Ill-Prepared Medical Student\" \/>\n<meta property=\"og:description\" content=\"What is wrong with medical students nowadays?\u00a0This question has been circulating in the academic medical world for years. As an intern and\u00a0resident, I would hear complaints about how \u2018unready\u2019 they seemed. 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He studied Biomedical Engineering at the New Jersey Institute of Technology and then graduated from Rutgers New Jersey Medical School. He stayed at Rutgers to complete a residency in Internal Medicine and Pediatrics and has elected to stay 1 more year to be the Ambulatory Chief of Internal Medicine. His major life accomplishments include marrying a beautiful orthodontist who provides him with free dental care and having a rambunctious 1-year-old daughter who occupies most of their free time. He plans on staying within academic primary care or hospitalist medicine. 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