No one can deny that medical students today face an increasingly competitive environment with a strong focus on board scores and class grades as strong requirements for entrance into competitive specialties. Mirroring the trends in both primary and secondary school, a standardized test has become the yardstick by which all physicians-in-training are compared.
The most recent survey reported by the National Resident Matching Program, showed that scores on Step 1 of the board licensure exam were the most highly cited factor that program directors used to determine which applicants to interview for their residency programs. While medical schools have expanded to accept more students, the number of residency positions available to finish the training of these newly minted physicians has remained stagnant.
The pressure for graduating physicians with $100,000 to $200,000 of student loan debt to obtain the necessary residency training in their chosen specialties is increasingly fierce. Medical students, already a competitive group of people by nature, are sometimes driven to extremes by their perceived need to outperform their peers.
Medical school requires countless hours of study, many of it necessarily spent alone with textbooks, flashcards, and lecture notes. When old fashioned study sessions are insufficient to make it to the top of the class, some students are turning to prescription stimulants to give them a competitive edge. At one medical university, it is common knowledge among the student body that struggling individuals are encouraged to see a physician about their “possible ADD,” or attention deficit disorder. It should be remembered that all of these individuals possessed the ability to successfully complete a baccalaureate degree, take the medical college admission test, and interview successfully in a competitive admission process to medical school. If these highly functional individuals have a disorder of attention, than perhaps the entire human population requires a prescription for stimulants.
In addition to the personal side effects of stimulant use — including high blood pressure, insomnia, and anxiety — the use of these medications by individuals who have never exhibited genuine symptoms of attention deficit prior to adulthood, is comparable to the use of anabolic steroids among athletes and should be discouraged. Test scores and class ranks are meaningless when they are derived through intellectual “doping” at the expense of the mental and physical health of the individuals involved.
Additionally, one has to wonder if the short term gains in concentration and study abilities really translates into a meaningful improvement in the future physician’s ability to diagnose disease and treat patients. The current environment of competition between medical students drives individuals to unhealthy extremes and is counter-productive when their future role as physicians will require collaboration with one another and other members of the healthcare team.
Changes to medical school curricula that reduce competition and enhance team-building abilities should be implemented to improve training and deter stimulant abuse.
Aimee Merino is a medical student.
