The bureaucracy that has engulfed medical education

While my career has included patient care, research and administration, I have always considered medical education my primary purpose. Having had the great opportunity to know many students and residents, having had the great opportunity to visit many medical schools, and having had wonderful colleagues, I have great concerns about the bureaucracy craze that has engulfed medical education.

This morning I spent a few minutes reading tweets, and came across a question about culture. As a sports fan, you see coaches and managers who consistently have success. You see great X and O minds have great failure. You start to understand that the culture that the leader creates allows everyone else to succeed.

I recently read a fascinating book: Strings Attached. This book pays homage to a tough teacher who expected perfection and constantly challenged his music students. He pushed them to do better. And he loved them, and they knew it.

Medical education succeeds when one creates a culture demanding excellence and the leaders help the learners become more excellent. Medical education does not succeed because someone wrote a great curriculum. Medical education does not succeed because of strict adherence to work hours. Medical education does not succeed through spoon feeding. Medical education succeeds with excellent role models. We need educators who challenge the learners to improve daily. We need accurate positive and negative feedback for our learners — and immediate feedback, not after weeks.

Bureaucracy consistently creates parameters for educators. Bureaucrats want reports. They judge programs using checklists. But do they capture passion? Yes, passion is critical to success in medical education. As I remember my role models, I remember their passion for internal medicine.

Passion has the great virtue of being contagious. When we exhibit openly our love of patient care, our learners catch that passion, a passion that stimulates the learners to grow every day.

I worry about all the jargon surrounding education these days. We worry about competencies and milestones, but do we worry about instilling our love for medicine? I submit that if we focused more on passion we would have more success.

But perhaps I am really an over the hill romantic.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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  • guest

    The other thing that bureaucracy fairly consistently creates (or at least, attracts) is sociopaths. In a system where there are so many rules that no person can possibly keep track of them, let alone consistently follow them, those who thrive will be those who successfully create the appearance of following the rules, while avoiding as many of them as possible in order to maintain efficiency and not get bogged down. Just something to think about.

  • buzzkillerjsmith

    The resident are just being properly prepared for their future careers.

    The computer revolution has made this all worse as people who do little meaningful work make demands on the time of those who do. This is of course in their best interest (or what else would they do all day?), but is suboptimal for those who provide important goods and services.

    It’s going to get worse, much worse, in medicine and in other fields. Big Data scares the heck out of me.

    The Economist had an interesting piece a while back called “In praise of laziness.” : Apparently the Dutch have a word, vergaderzieke, that means “meeting sickness”. McKinsey Global Institute reported that highly skilled office workers spend up to 25% of their time writing and responding to emails. Regrettably, some of these folks are monkeys on our backs.

    I saw all this 20 years ago when I worked at Kaiser, although I never imagined it would get this bad. We had meetings and memos, memos and meetings. If you do instead of your regular work it is wonderful, but for most of us this was in addition to seeing 140 pts per week, (4/hour x 7 hours/day x 5 days per week). Those who called the meetings and sent the memo worked 3 half-days per week and saw 42 per week (4/hour x 3 half-days / week). They seemed mighty pleased with themselves when they worked in an extra pt or two during that time.

    I should add that I never minded medical education meetings.

    Things are now so much worse because of the ease of interrupting and annoying other people, keeping them from their work. But the bright side is that you can just have the docs work later into the evening for no extra pay.

    • SarahJ89

      I hate meetings. No matter what job I’ve ever been on I have hated meetings. They are such time sucks.

      Actually… I hate working with people. I love people but if you want something done, just tell me what it is and leave me alone. If I need help I’ll get it. I’m glad I’m older now and not likely to end up in one of these ghastly “team” environments so popular nowadays.

  • Shirie Leng, MD

    I’m afraid Buzz might be right. Current education IS preparing med students for their future work. Passion might be there in the student, it might be there in the teacher, but regulations and rules soon cool the passion and stoke the fires of survival.

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