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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