Are there too many immature people entering medical school?

And should medical schools require work experience prior to entrance?

I’ve come to the realization that medical schools should require several years of postbaccalaureate experience before even considering applicants. My take on it is that the whole dynamic of the medical profession would change simply by requiring work experience as an entry to the field.

Comments

Anonymous
could not agree more. most medical students right out of college do not have the life experience to appreciate the challenges patients face
Anonymous
sorry, not an option. I for one am not interested in tacking on another 2-3 years to this process.
The real issue is the falling number (and presumably quality) of applicants applying to med schools. With increasing bureaucracy and plummeting incomes, what intelligent individual wouldn’t shy away from this field?
Thus, the real answer has more to do with fixing health care, infusing it with market forces, raising incomes and job satisfaction and this little problem will take care of itself.
On another note, I’m tired of this belief that med-students aren’t mature enough for the job. I for one am a 26 year straight from HS to college to MS, married, two kids (one with downs syndrome) and put a grand father through hospice. Don’t dare lump in with what ever group your talking about.
KipEsquire
Interesting question.
By way of comparison, no top-tier business school will consider any applicant who lacks meaningful work experience. On the otehr hand, no law school gives the slightest dang about it — all that matters are grades and LSAT scores (and affirmative action status).
So the question arguably becomes: Should doctors be recruited and trained like lawyers or like Wall Streeters?
Anonymous
Are you kidding? Get students that actually have a clue about business, and expect that people they are giving tens of thousands of dollars a year to actually provide decent service?
Where do you think you’d find administrators and professors who can deliver?
You think students with a clue would actually put up with most of the nonsense that goes on in lectures? Clinical students paying for the privilege of doing absolute scut work like getting a residents dry cleaning?
April fools is still a way off.
Anonymous
By the time I will be able to work unsupervised on my own I will be 31 years old. I went straight from high school to college, straight from college to medical school, straight from medical school to residency.
scalpel
I’d rather the process be shortened, like in some other countries. 4 years of college is unnecessary. Cut it to two or combine college with med school somehow.
Anonymous
I see absolutely no merit in this idea at all. Asking students to apply even later, forgoing even more years of professional livelihood is just unreasonable. That means fewer years to save for a home, for children, for retirement. Sorry, but I don’t owe it to anyone’s overvalued sense of entitlement to have to wait longer to apply for medical school just so I can have a few more gray hairs to satisfy someone else I have enough “life experience.” With a decade of deferred income and accumulated debt, I think that is already too much experience. More is just ridiculous.
Dustball
Most of the people responding here have obviously never read the premed boards at SDN.
It’s a train wreck. And some of those people are going to be doctors. What a terrifying thought.
I think if you were to require some life experience, shortening the process would need to be in order: more integrated, six year programs instead of 4 years undergrad, 4 years med school. But that wouldn’t solve the high school -> integrated program where you’re still getting young kids, now would it.
Anonymous
Best case is a shorter course straight out of high school, which is the way it is in most of the rest of the world (along with lower educational debt burden, too). Expecting a longer course is just not going to happen in a cost-sensitive environment that already wants to pay doctors less. Shortening careers just doesn’t fit that model at all, no matter what people think of how mature posters on SDN appear (or don’t.)
Given the way things are going with reimbursement, people need to get satisfied with whatever they presently have, because if present trends continue, they will soon have less service than they do now.
The truth is, most patients would not pay a nickel more to have a doctor they thought appreciated the struggles they or other patients face. They will squeal and whine, but that is free.
Anonymous
anon11:25
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A new study published by the Association of American Medical Colleges, which looked at 126 medical schools, found that 42,315 students applied in 2007, up 8.2 percent from 2006. The schools admitted 17,759 students, up 2.3 percent from 2006.
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while you may be mature enough, that does not mean that medical students as a whole are mature enough to do a good job, imo. it certainly varies with the individual. and there is no way of knowing if the additional stress of presumably more marriages, more divorces, more kids, more work experience, etc would make going through the process more or less educational.
whatever your thoughts, it seems clear that the current process of educating and training a physician does a wonderful job of generating feelings of bitterness and resentment.
ymmv.
Michael Rack, MD
I was young and immature when I started residency. I wasn’t young anymore when I finished my 5 year medicine/psychiatry residency.
Gasman
The business school grad needing work experience to get hired is a different beast than the physician. Believe it or not, residency is work experience; 3 to 7 years of merely 80 hour weeks, but it’s something.
While it is nice for there to be some heterogeneity in medical school classes, making everyone alike by having a few years of make-work prior to entry is not the way.
In the end, before making a serious proposal to consume more years of life from medical professionals, perhaps some data would be in order. (note data, not serial anecdotes) Firstly, begin with a retrospective study of students with prior job experience and compare them to their less experienced peers who went straight through from highschool-college-medschool-residency. Then if this shows a difference, find a way to control for all of the self selection bias that indicates that people who come to medicine late are different people to begin with, not merely different because of the work experience itself.
My med school anecdote (class of 91) is that of the 8 students who came to medicine after non-medical careers, 2 are already retired, one dead (age 58), and all pursued residencies that were only 3 years long. Experience also means older, with less years to practice, less time to commit to training, and fewer years to provide better care if indeed there is anything better about their care.
Anecdote 2. As a resident I didn’t care for the older residents, because they didn’t have the stamina to pull their weight in the unlimited hours era, and they felt like the single guys should work extra to subsidize their family life.
Richard
Interesting thought.
The average age at admission into my medical school class was 24.5 years old (class size, 224 students). While the majority still came straight through from high school to an undergraduate degree to medical school, we have a significant (~25%) number who have graduate degrees or other professional experience (engineers, nurses, lawyers, etc).
Medical school admissions (at least in Canada) already place a very high emphasis on character, maturity, and life experience. Good grades and a high MCAT score are still a prerequisite, but by no means a guarantee of admission.
Would I want more mature doctors? Sure. Do I think there’s a few people in my class who might not belong? Yup. But on the whole, I’m very impressed with the maturity of my classmates, and I know the grueling admissions process was effective at weeding out the crazies at my medical school.
I can’t speak for other medical schools or American medical schools at all, but certainly, NO, there are not too many immature people in my medical school.
As for the last comment (Anon 5:05), perhaps the bitterness is a product of the way our society views and treats physicians, not because of the people in medical school.
If we truly wish to address the shortage of primary care physicians, then perhaps we should be rewarding those who choose to go into that field, and recruit from an earlier age.
Anonymous
Medical education needs to begin as early as possible and be abbreviated. It is a waste of taxpayer money to admit students over the age of 30. They will not practice long enough to be any benefit to anyone.
Anyone who spent two years gaining “life experience” would quickly enroll in an MBA program, possibly at employer expense, rather than rolling the dice on a long and expensive medical education.
And while we are at it, let me suggest that “life experience” would be well provided by two mandatory years for males and females alike in the armed services. Be careful what you ask for.
halfmd
I never would’ve thought my piece on generating a more mature medical school class would lead to such a buzz on this website. One poster mentioned older residents who are unable to carry a heavy workload. Well I know lots of third-year students in their mid-20s who cannot carry a heavy workload, and become more of a burden to the rest of the team. While I certainly don’t want to create older physicians for the sake of creating more mature healers, I am constantly dismayed by the lack of true ethical and professional behavior that so many medical students, residents, and attending physicians show. And despite what classes such as Physician Training attempt to correct, immature premeds go on to become immature doctors.
I’ve also advocated for shortening the training time to get an M.D. Currently, medical students are forced to spend two years and $60,000 languishing away in lecture, while a dinosaur professor reads off PowerPoint slides. I could just as easily see people teaching themselves the entire curriculum from the basic sciences and then taking Step I as the ENTRY to medical school.
Yes, medical training does create a lot of cynics. I look back upon the all the hours that I’ve spent rounding and discussing what ifs, all the time I spent in Physician Training writing about my feelings, and all the times I’ve been pimped by a resident or attending whose sole goal is to embarrass students, rather than teach them, and they realize that a lot of very valuable time it’s been wasted that will serve no good in making me a better physician.
janemariemd
HalfMD, you must not have substantial “problem-based learning” in your first 2 years–that was in vogue when I was a faculty member at Baylor in the 1990′s. I’d agree that if the first 2 years are just about acquiring basic science knowledge, than why not let students study the books to pass Part I of the boards? As I recall, those classes were taught by mostly PhDs, who mostly didn’t like us med students anyway!
dr_clairebear
i think that one way of solving the problem of “immature” people in medical practice is to revert to the the MBBS degree that the British Medical System adopts. That way, while medical didactics are taught when the students are college age, they are also forced to have more clinical experience before making a decision to specialize.
i don’t think it would help any if you don’t let students into medical school if they have no prior work experience. you’d just end up turning off even more students from going into medical school to begin with.
nursingaround.blogspot.com
couldn’t agree more. Many students go into medicine for the wrong reason, eg Parental pressure, or perhaps they just thought why not…
It’s no wonder that so many doctors finish their training and then do something other than practice medicine. Many don’t even make it through training.
How about a one year hospital internship for the uninitiated, eg like doing all the basic but essential jobs, eg lifting, cleaning and toileting. Let them be led/bullied by nurses, as happens in their first year or two after graduation.
If they can handle that, then s
Anonymous
It’s amazing see how blithely those not in medicine prescribe solutions to this so-called “problem,” which, as far as I can see, actually being in medicine, isn’t really a problem.
If you don’t like working around junior people and medical students, then you really aren’t suited to work or seek care in a teaching hospital or other teaching environment. That goes for doctors, nurses and patients. There are private hospital and clinic alternatives to academic environments for those who can’t abide having junior or “immature” people around or who can’t understand or accept the limitations and qualities of the teaching and learning environment.
Making someone interested in medicine a toilet scrubber in a hospital is pointless drudgery. The fact is that most medical students are taking too long as it is to finish their training, having to defer many significant life commitments for utter lack of time and income and incomplete qualifications to work. Adding to that length of time is not the answer.
There seems to be no shortage people who resent doctors but who somehow also think themselves qualified to prescribe what medical training should include. How they should know–beyond thinking that they are older and pay bills and have accumulated personal obligations–is something that begs explanation. And just because you may work in a hospital around doctors does not make you qualified to know what training or experience they should have.
Anonymous
I am not a doctor, but the idea seems stupid to me just based on common sense alone.
1. Our memory and ability to learn goes down as we age. It seems to me that when you need to memorize a bunch of stuff, you better do it when you are younger. It’ll be a lot more difficult for a medical student to learn when they are older. Business school doesn’t seem to require to memorize quite as much information, but I could be mistaken.
2. As it was pointed out older people don’t have quite the same stamina as younger people. Everyone can tell a few anecdotes about some older people who can spend more nights sleepless than younger people, but as it was pointed out zillion times here the plural of anecdotes isn’t data. I think everyone of us who is over 35 can look back and remember how much easier it was to spend nights without sleep. Same with how much better our memory was.
In terms of shortening education, it seems to me that first two years of US colleges are often spent on the material people in other countries learn in high school. All the English composition, humanities and social science requirements… Shouldn’t a high school graduate already know how to write in his own language? The main reason the education is shorter in other countries is that people learn so much in high school. So higher education is more specialized, it doesn’t have all the generic subjects, only the requirements of one’s chosen profession.
Anonymous
The comparison to other countries’ secondary educational systems is going to have only a limited amount of value in this discussion. I don’t see the USA going to a French baccalaureate or British A/O level system probably ever. But you are right, the typical academic high school graduate from Europe has a more advanced education than a typical U.S. High School graduate. That is besides the point.
Making the course of medical school less lengthy is the issue, and then only as a way of also making it less costly. In the past, medical schools admitted college juniors without degrees and granted them degrees in course as they completed their first two years of medical school. With the exception of the small handful of five and six-year combined degree programs, that era is past. Unless the numbers of quality applicants falls significantly for most medical schools, I don’t see that era returning in any significant way. Now if medical practice reimbursements are really slashed and applications plummet, then I could see some states desperately resurrecting these programs, but that would be not likely to be much of an attractor if medicine became a relatively lower-paid field or a field that became widely known as no longer a profession that offered some degree of independence.
The comparison of medical training to MBAs and JDs is not particularly useful, except that law is more similar to medicine than is business. One cannot practice medicine without a medical degree and a residency; one can work on Wall Street as a trader or analyst with a bachelor’s degree. The MBA is as much a finishing school as it is a pathway to senior management jobs (and a contacts network), but it is not a prerequisite to licensure or bar admission. One can have significant and gainful work experience in business before going for the MBA; it is difficult or impossible to manage the equivalent in medicine before earning the M.D.

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