For years, medical schools only accepted those who scored highest on the MCATs or received top grades.
But, in an era where working with others is becoming more essential to patient care, whether future doctors can function as a member of a team is becoming increasingly important.
To that end, Maggie Mahar asks whether those who score the highest grades really are best suited to become doctors. In fact, students who score highly are more likely to be competitive, and as Dr. John Stobo, senior vice-president for health and health services at the University of California, says, “A student who must place first is more likely to let his ego get in the way when it comes to asking an experienced nurse for advice, or admitting that he made a mistake.”
Furthermore, Ms. Mahar suggests that filtering out self-described leaders may, in fact, better serve the medical profession: “Today, medicine needs more professionals who value the experience of working with a group. Students who are too quick to expound on why they are natural born leaders may have difficulty recognizing others as their peers””especially when a nurse speaks up to point out that a doctor is making a mistake.”
Although I agree that doctors need to work well within a team structure, stripping the profession of students destined for leadership roles, or those who are gifted academically may lead to a future of average, lemming-like doctors who simply do what they’re told.
And, indeed, that’s what some within the health policy world may want.
Related posts:
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- Medicine: The best and the brightest?
- Are academic physicians the next target on the inflated executive salary hit list?
- Mandating primary care
- Doctors suffer too when they make medical mistakes
- The best and the brightest
- Should doctors want their children to become physicians?
{ 21 comments }
Teams need leaders, and being smart is a good thing.
This gives me one more reason to doubt Ms. Mahar.
Docile like sheep, the dream of every evil tyrant.
Why the fear of independence? Why encourage groupthink? Why fear smart, competitive people? Why the banal, pasty justification that doctors shouldn’t be too smart or very competitive beacause they wouldn’t be easy to lead around like others that are easy to lead around. Like sheep.
Orwell would recognize this. Especially the banal paternalistic rationalization that it would be better for the “team” no to have too many bright or independent-minded people in medicine.
This makes me want to vomit.
Gosh, I’m sorry to say this, but I’m kind of shocked that this isn’t taken into account at most schools.
Here in a land, far far away (Canada), extracurricular involvement has been essential for medical school admission for, well, decades. Then again, Canadian schools have been pioneers in medical eduction
(eg. McMaster and PBL).
Being a “well-balanced” person is more predictive of surviving the lifestyle and being a compassionate caregiver. That’s why, at my school (UBC), 50% of the admissions score is based on academic stuff [the MCAT is only a hoop to jump thru, counting for 10%] and non-academics form the other half. Teamwork is a huge part of this.
Working in lab, playing on a sports team, working a summer camp, etc. were all ways that I (and others) have managed to learn to work with others. Sure, leadership can be important too, but healthcare seems more about recognizing what each person’s role is in the team, and if needed, enabling them to engage to their fullest capacity. Conflict resolution is another area where prior experience is of great benefit.
Again, I am kind of shocked to hear that this isn’t already acknowledged (and well in place) at all US schools. If you are worried about not having enough leaders and academic successes, don’t be! We still have to be the cream of the crop when it comes to book-lernin,’ and given the enormous size of the applicant pool, it’s not hard to find a full class of keen, well-rounded individuals who are capable of leadership, teamwork, and academic excellence.
As a current medical student and former athlete and coach in a competitive group sport, I can completely appreciate the sentiments of Ms. Mahar and Dr. Stobo. By no means do I undervalue intelligence and drive. But I will state that many students have a vision of an effective leader as a person who achieves the most individually, setting an example towards which to aspire. What many fail to see is that an effective leader in the group context should manipulate the proper balance of his or her group’s talents. When one’s group consists of individuals from clerical assistants to neurosurgeons, the truly effective leaders brings about the proper mix of responsibility and participation and maximize the skills and contributions of all. The doctor with the most lofty test scores is not automatically the best person to mold and foster talent and growth.
Absolutely we want the best & the brightest to become doctors.
What we don't want is "brightest" to the exclusion of "best." To me, "best" entails well-rounded which includes leadership, people skills, etc.
Guess what. Everybody has extracurriculars and research. Nobody can get into school with just a GPA and MCAT. They’re used as weed-out tools.
I’m pretty sure the students who value teamwork and harmony have gone into FP and primary care IM. Maybe these specialties could use some of the competition of fellowships and more competitive residencies.
When did excellence become a bad thing?
I have to say, after reading the first two comments, I thought there would be nothing more for me to write – but then following comments really seemed to miss the thrust of the piece. No one said teamwork isn't good, but the article stated: "To that end, Maggie Mahar asks whether those who score the highest grades really are best suited to become doctors. In fact, students who score highly are more likely to be competitive, and as Dr. John Stobo, senior vice-president for health and health services at the University of California, says, "A student who must place first is more likely to let his ego get in the way when it comes to asking an experienced nurse for advice, or admitting that he made a mistake."
Notice that the intelligent student is changed into the student who "must place first", changing your view of the high scorer as not merely someone who does well on exams but whose entire self-esteem relies upon doing so. And being competitive (in one context) is taken as clear evidence that you cannot be cooperative (in another context). Finally, nearly every medical student learns that many nurses have more practical knowledge than they do – perhaps the more intelligent students even learn that lesson faster!
Yes no one wants to work with an a&&hole; but medical schools should know that, within the bounds of reasonable cooperativeness and ability to communicate, knowledge and ability; not social skills and docility, should be of paramount importance.
As a medical student, I will say this: we need leadership, not ego; those with a sense of duty, not a desire for status.
The two are often confused (the competitive high-achieving individual, for instance) and in fact I dare say that few people really understand what good leadership really entails. It starts with integrity, ability to inspire, and ability to listen as well as speak.
Well said, Mr Molstrom.
If you talk to anyone trying to get drum up physician participation in organized medicine, hospital staff structure or the workings of medical groups, the reality is that there is too little leadership rather than too much. It can be very hard to convince physicians to get involved in issues outside the exam room, to the detriment of the profession.
In order to emphasize group work, perhaps more medical schools should adopt a group activity portion as part of their interview protocol. I know Northwestern University has such an activity. This allows them to see candidates as they interact in a group context.
As to the role of scores in the admission process, each candidate should be evaluated as an entire package, regardless of high or low scores.
Wow. All I can say is I see what must be fought more everyday. The will of the collective that shames those who excel. Who here knows Howard Rourke? I can tell some do and others do not.
A lot of hooey is flying about here. I am one of the grey beard who went to school in the “old days”. The admissions people said extracurriculars were necessary, so the motivated individualists provided them. In practice they went for grades and MCAT scores. In any case, we were “the best and brightest” with most GPA’s 3.8 or above and MCAT well above average of admitted student nationally. We were a lot of opinionated hard-headed individualist who upon being herded into our first year classes together, fought like cats and dogs. But we quickly began working together setting up systems to beat the system. Because we had too.
By third year clinicals, we were mostly adept at self-organizing to get the work done–we had to be. We conspired to herd the 10% who were too neurotic to do that into the same group together so the rest of us wouldn’t be pulled under by them.
Intelligient individualists will cooperate and work well in groups when it is conducive to fullfilling the goals that they have chosen as individuals. What they will not do is let others define their goals, values and standards. The latter I think, is what the policy wonks desire.
It is not possible in most clinical settings to be a dedicated doctor who puts the patients interest first and not sometimes but heads with the obstructionists, fools, incompetents, and crooks that one sometimes find in every organization. If everyone thinks you are an a-hole, you are. But if no one thinks you are an a-hole, then you aren’t doing your job.
When I was applying to medical school, an interviewer told me that he thought medical schools were taking too many smart people. His concern was that smart people got bored with medicine and ended up hating their jobs. I’m fairly sure it was a closed-file interview, so he didn’t know about my excellent MCAT score and grades. I was not accepted at that school.
Wow, I’m kind of surprised by the comments posted here. In my mind, the National Symposium on Medical and Health Care Education Reform (which Mahar was really just reporting on) hit the nail square on the head.
Doctors do not need to be any smarter than some threshold IQ and the best are rarely the brightest. Especially now, with the availability of information and diagnostic aids (which are ONLY going to become more important), you don’t need the traditional medical school skill set to be successful. Now, first year residents can out-diagnose and out-manage staff because of the knowledge in their extended brains (read: PDAs, rapidly searchable internet).
I think an interesting comparison is with engineering programs. Engineering students aren’t expected to do their thermodynamics exams without calculators or tables of constants and relevant formulas. When are medical schools going to start allowing students to write exams with PDAs and assistive software?
In my experience, doctors are disproportionately close-minded and short-sighted. Medicine as the old guard practiced it is dying.
LEFT OUT
The writer, PhD in English (1), has as usual missed large parts of the target. As noted in a JAMA op-ed, when the majority of medical students come from the top tiers of family SES — something is desparately wrong.
Like the middle-class being left out. Like rural whites being left out.
Not leadership, per se. Social class.
(1) MAHAR, M.A. (1975). THE SHAPE OF A HISTORY: ELIOT, HARDY, AND LAWRENCE. Ph.D. dissertation, Yale University, United States — Connecticut.
Given so many UMCs (upper-middle-class) kids with BMWs who don’t have to work so as to focus on the MCAT –
isn’t this game, really “teaching to the test?”
Of course. A silly game. That the public pays for.
I love these hypocrites and their recommendations about what they think is best for medical practice. It never fails that whenever one of these high-profile wonks gets sick, especially with something serious, they are on the plane to JFK or LGA to see someone at one of the medical Meccas. They aren’t looking for group-thinkers or passive easygoing personalities then. Same for presidents, congressmen and anyone else who gets things they want when things get scary–it’s off to see the Wizard.
This is a solution fit for the little people, at least for those who think of persons unlike themselves as the little people.
As a med student, I’ll admit sometimes I get concerned as to where some of my classmates will end up. The selection process does a good job getting driven students that score well on tests. But intellegence is only one aspect of the job. There are other characteristics that i find important -compassion, empathy, dedication, ethics, the ability to work in groups, etc.- those factors vary widely from student to student and from doctor to doctor.
I wish there was a higher standard in med school for these more humanitarian traits. But that will probably never happen because essentially current doctors choose future med students. People have the tendancy to select people similar to themselves. Since all doctors are smart- they will choose smart med students. But not all doctors are compassionate, ethical, dedicated, so in that reguard- the medical school selection process lags. It’s a shame.
Its not should always be like that , in my view. Rather , the sentence could be fliped ,as ,
“doctor must always be best and bright”. Because any negligence is not bearable on account of him.
I think she’s setting up a false dichotomy. Sure, the ability to work with others should be looked at (and is). However, there are many intelligent applicants who can both score well on the MCAT and work well with others.
Agree.. The Ego amongst Docs.
Well My Ego all gone,
after I failed my Final Med Exam.
The only exam I ever failed, making me a remedial.
This made me much more humble.
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