Med School, Heal Thyself

By Claudia Wallis

New studies prescribe better ways of training doctors

On your mark! High school is the easy part. Just be sure of getting A's in science and good SAT scores, and maybe do some volunteer work in a hospital (it looks nice on your record). Get set! The pressure is on in college. Nothing less than an A will do for all pre-med courses. Choose a major in one of the sciences and fill out the rest of the schedule with "Mickey Mouse" subjects, lest your cumulative average slip below Aminus. Go! You are in. At med school you will spend 30 to 40 hours a week at lectures, and as many more studying. But do not plan on actually grasping the material; there is no time to do more than memorize for exams. And do not plan on getting much sleep--for at least the next seven years.

For those seeking an M.D. these days, the race begins early, the course is arduous, and the prize, once achieved, may hardly seem worth the effort. Medical students grumble about the unceasing pressures, the torrents of material, the lack of time to think, much less relax. And they are not the only ones complaining. Patients gripe that the products of this regimen, the current crop of doctors, have no compassion, run their practices like assembly lines and are more fascinated by tests and procedures than by the human beings they treat. Medical school deans and faculty members, meanwhile, worry about turning out narrow-minded, unenthusiastic graduates who have little perspective on the facts they have swallowed. After conducting a survey at Stanford, Medical Professor Saul Rosenberg concluded that medical students are widely perceived as "aggressive, competitive, narrow, dishonest, unfriendly individuals, in other words, nerds."

"Medical education is not in optimum health," declares Dr. Daniel Tosteson, dean of Harvard Medical School. What is worse, he adds, is that "there is little agreement on the diagnosis and treatment." Indeed, virtually every med school dean in the country has his own prescriptions for fixing what is wrong. Last week, for instance, prestigious Johns Hopkins School of Medicine announced a plan to guarantee admission to students still in their junior year of college. The purpose, said Hopkins Dean Richard Ross, is to encourage students to take a broader and more flexible approach to their senior year. Said he: "We would like to reverse the trend toward early specialization and overemphasis on science as preparation for medicine."

To bring some focus to the problems and encourage reform on a national scale, the Association of American Medical Colleges, which represents all 127 medical schools in the U.S. and all 16 in Canada, is conducting a threeyear, $1 million survey, the first sweeping examination of medical education in a half-century. The aim, says A.A.M.C. President John Cooper, is to determine "what is the education that all physicians need," and how to make the process less "brutal."

The panel has already discovered that students and faculty members around the U.S. agree on at least one point: there is simply too much for young doctors to learn. Medical school has always been demanding, but because of the tremendous explosion of knowledge since World War II, the curriculum is now bursting at the seams. "Memorization, that's what it's all about," says David Earle, 24, a medical student at the University of California, San Francisco. Students are now inundated with factual details, a process some panel members characterize as "dense-pack education."

In his new book, The Youngest Science: Notes of a Medicine-Watcher, Dr. Lewis Thomas, who is chancellor of Memorial Sloan-Kettering Cancer Center in New York City, comments on the changes that occurred as medicine went from "a profoundly ignorant profession" to "a technology based on science." Students today are so overwhelmed by information that "many get turned off by basic science, instead of being flabbergasted by how wonderful it is," said Thomas in an interview with TIME. He goes so far as to suggest that the curriculum for the first two years should be "cut in half."

Ironically, much of the information pushed on medical students will be of limited use when they become practitioners. "Eighty percent of what I learn won't be relevant in 30 years," says Lachlan Forrow, 27, a fourth-year medical student at Harvard. According to Dean Donald Tapley of Columbia's College of Physicians and Surgeons, "biochemistry and molecular genetics are moving so fast that students graduating this year are not up to date because they learned it three years ago."

The pace of scientific discovery is so rapid that there is no point in trying to teach every last fact, says A.A.M.C. Panel Chairman Steven Muller, who is president of both Johns Hopkins University and its hospital. Instead, Muller and many of his peers want to pare down the curriculum so that students can concentrate on the fundamentals of medical science and practice. At the same time, they argue, students must be taught how to stay abreast of their evolving profession. Says August Swanson, director of academic affairs at the A.A.M.C.: "We have to teach our students to be lifelong learners and give them the conceptual knowledge and study skills that will allow them to keep up."

The A.A.M.C. panel will not make its recommendations until November 1984. In the meantime, medical schools are already experimenting with a number of innovations. Ohio State and the University of Illinois have pioneered in the use of computers to train doctors. With the quantity of medical literature expanding a hundredfold in a decade, the computer is probably the only tool that can allow doctors to stay up to date. Tufts School of Medicine plans to break ground this year for a $23 million health-sciences education building. Funded largely by the Federal Government, it is designed to be a national prototype for "lifetime medical education," says Carl Edwards, chief consultant on the project.

Elsewhere, universities are taking steps to cut the work load and make classes more interesting. At Washington University School of Medicine in St. Louis, the amount of time that students spend in the classroom has been reduced by 15%, and more outside exercises and research projects have been introduced instead. At Northwestern, faculty members have been experimenting with more imaginative teaching techniques. Professor James Garvin, for instance, now spikes his biochemistry lectures with a "case of the week," such as scurvy or nerve-gas poisoning, to make the subject seem less dry and abstract.

Other universities are attempting to reduce the pressures on students by spreading medical education over more than four years. The University of Missouri accepts applicants right out of high school for enrollment in a special eight-year program that integrates medical courses with undergraduate work. Boston University has a similar program that begins in the junior year of college. Another way of unpacking the curriculum would be to extend some of the course work into the three to six years that most doctors spend in residency programs. "Now that postgraduate training has become practically obligatory, there is no longer the urgency to teach everything in the first four years," says Dr. Thomas Meikle, dean of Cornell Medical College. Meikle prefers this approach to admitting students before they have finished college. Says he: "Nothing can replace four solid years of the liberal arts."

Unfortunately, very few medical students are so broadly educated. Far too many who start out with wide interests become narrowly focused in their fight to get into med school. Students blame the problem on admissions committees, which emphasize grades and test scores over the personal attributes and interests that may make an individual a superior doctor. Notes Utah University Psychologist Calvin Taylor: "Based on test scores, you cannot predict who is going to be the most knowledgeable physician ten years later." Perhaps, says Thomas, "there should be an admissions quota for the solid citizens who rank in the middle of their class."

Whether med schools can actually foster sympathy and compassion in students is a matter of debate, but a number of educators feel that it is at least worth trying. At Brown, students "practice" medicine with professional actors who play patients. The scenes are videotaped, and students review them later to learn how to communicate better with those they treat. Columbia has taken a more academic approach by establishing the Center for the Study of Society and Medicine, which, says Dean Tapley, will offer instruction on "how to deal with the patient, the patient's family and his whole life, rather than 'the third bed on the left with a coronary.' "

Certainly the best way to humanize doctors is to humanize their training. The common aim of all efforts to reform medical education is to allow students more time to absorb and reflect upon what they learn and more freedom to pursue personal interests. Says Dean John Sandson of Boston University: "If we want our students to be compassionate, we as faculty and administrators have to be compassionate too."

--By Claudia Wai. Reported by Dick Thompson/San Francisco and Lisa Towle/Boston

With reporting by Dick Thompson, Lisa Towle This file is automatically generated by a robot program, so viewer discretion is required.