There have been major changes in how medical schools are run compared to 15 or 20 years ago. You can get a good feel for this when you talk to some of the “old school” doctors. It was a completely different system back then. Even compared to five or ten years ago, so much has changed. I remember the first time I shadowed a Doctor who had graduated medical school in the late 1980s and because I did not have anyone in my family who was in the healthcare field this Doctor was the baseline for information regarding Medicine. He talked about his life in medical school and then about Residency and his life working as an Internal Medicine doctor. But a lot of what he told me is not the way Medicine is anymore. So much has changed and I would like to think that it has changed for the better. Here are some of the many things that have changed:
80 Hour Work Week During Residency
Prior to a couple of years ago, if you were a Resident that pretty much meant that you would be in the hospital 24/7. There were no restrictions on how many hours you worked per week or how many hours you worked straight through without getting time to sleep. If you were told to work you worked and did not really ask many questions. It sounds terrible but this is just the way it was. So when you talk to the older doctors, they will tell you how much of a nightmare Residency was because all they remember is working. This however has changed dramatically. A couple of years ago, ACGME (the people the decide important things about medical education), decided that it was not a good idea for Residents to work excessive hours without those hours being monitored and restricted to a certain point. Thus, it was decided that Residents including interns, would be capped at 80 hours of work each week. Someone who is an outsider to the field of Medicine may still think that 80 hours is way too much but compared to previously when Residents were working closer to 100 plus hours, 80 hours is a big relief. And the fact of the matter is that with this duty hour restriction, each Resident’s number of hours worked is not only documented but also made sure that they do not get too close to the 80 hour mark. Why would a Residency program care about making sure their Resident’s do not work more than 80 hours each week? Simple… because they will get in trouble from the ACGME if they did do that and that is a whole another struggle that no program wants to experience.
From the very first semester that I started medical school we had random Ethics classes we had to take. For my school specifically, Ethics was very well integrated into the curriculum. Each week we had a lecture given by a couple of professors who are passionate about ethical medicine and after this lecture we would have small group based discussions on topics that were presented in lecture. These small group discussions were actually very informative contrary to what I had originally thought about them. We would review different ethical cases and go around and talk about how we would have handled a certain situation or if we agreed or disagreed with the way a certain case was handled. Many times hearing another student’s thought process was the most fascinating part of the experience rather than someone’s response to the question.
This occurrence of specific classes to teach students Ethics is a very new concept. Many doctors today did not have the chance to take an Ethics course and actually there are still medical schools that do not have an Ethics course integrated into the curriculum.
Focus on “Humanities in Medicine”
20 years ago, no one even considered the “humanistic” side of medicine because it was 100 percent geared towards the “scientific” side of medicine. You considered your doctor to be a good doctor if they were technically good rather than using a couple of different factors including personality and beside manner. BEDSIDE MANNER… that term did not even really exist 20 years ago. No one cared if you had good bedside manner as long as you could get the job done. This has changed 180 degrees as time has progressed. A large amount of focus is being placed on the importance of teaching medical students about bedside manner and other things not related to the scientific aspect of taking care of patients. You might be thinking well how in the world do you teach a medical student bedside manner? It is hard to change people especially when they are 20+ years old. It is easier to teach little kids. But the thing is, bedside manner has become such a large part of how we practice medicine that if our medical schools did not teach medical students about this, it would be doing the medical students a disservice.
At my school like most other medical schools, we have standardized patients who come in and we practice different scenarios with these patients. These standardized patients give you feedback after your encounter with them and they focus on giving you tips on your bedside manner. After enough of these encounters, you realize how to change yourself to better accommodate what patients like. You may not be able to change overnight and you may feel like you are not even changing, but enough practice and exposure allows for you to change in a manner that is amenable to what patients want in their doctors.
When I have told some doctors that I have to leave early on a specific day for a Humanities session many have given me a blank stare saying “we never had that while we were in medical school.” This is completely true. The emphasis on Humanities is a very new thing but at the same time it is a great thing. Patient’s place a lot of importance on the way a doctor interacts with the patient and if it is something we can all work on then why not have a class during medical school?
Most of us who went to medical school did not do so because we are awesome in math and for most of us this is not one of our strong suits. Surprisingly, you do need to know and understand a little bit about math in order to understand some of the basics of something called evidence based medicine. Evidence based medicine is practicing medicine based on evidence found through scientific studies and papers. If you have ever perused through a scientific paper you will see all of the different numbers reported such as something as simple as probability to other more difficult calculations such as number needed to treat. In order to practice evidenced based medicine you need to understand where the numbers come from. Back in the day, no one took the time to teach medical students Biostatistics but assumed they would learn on the job either as medical students or residents. Although learning on the job is the most traditional way to learn, it is really nice to have a course dedicated to teaching you this as a medical student. Also, USMLE Step 1 expects you to be able to understand and apply Biostatistics and it is nice that medical schools are trying to do a better job of teaching these concepts to medical students.
The overarching theme of all of this is that much has changed in the way of medical education and as you can see from just a few of the listed changes that these changes were made in mind to ease the lives of medical students. Do not get too afraid when or if you shadow older physicians who talk about how rough medical school and residency were for them. Although this is true, medical school and residency are very difficult, when I think back to my time in medical school I remember some really great times. I did have time to spend with my family and friends as long as I managed my time well. Medicine is practiced quite differently than the way it was a long time ago for example the advent of electronic medical records has revolutionized the practice of Medicine. (Many doctors have found it difficult to keep up with all the advances in technology which are revolutionizing Medicine.) Going into the field of medicine is a lifelong journey of change and challenges and although you cannot pick and choose which challenges to face, you can rest assured that things will continue to change.