I would like to preface this article by emphatically stating that I love my medical school. The things I discuss here are universal ideas relevant to virtually any US medical school. How do I know this? From lingering about on social media, as well as talking with friends who are scattered all over the country.
Wellness. What exactly is that? I suppose you can define it however you want, but it is definitely a buzz word in the world of medical education. While it is great that this is at the forefront of educators minds, I think there are some competing forces that derail a productive outcome. The first has to do with the structuring of curriculums. Now, I would not wish this job upon my fiercest enemy. Medicine is incredibly vast and does not fall neatly into little boxes. So, how the hell do you go about organizing it in such a fashion, breaking it down into two years of digestible lectures? By and large, most schools do a great job of this. However, there can often be undertones of hostility toward external board prep resources. I think a lot of this stems from misunderstanding. First, these resources are (or at least can be) top notched. Let’s face it, not all lectures are created equal. This is only to be expected given the uphill battle I just touched on, as well as differing skills of presenters. Let’s be honest, public speaking and teaching are skills. Second, external resources (again, generally) are organized beautifully. This helps you categorize complicated things, contributing to understanding and retention. Again, it is difficult superbly organize blocks or courses. So, why not work with, rather than again the resources that students so often utilize. Use them to guide your organization and certainly to make sure you cover any and all relevant topics. This only needs to be a skeleton though. The uniqueness of your own curriculum can overlay this.
This brings be to a second point that I am not even quite sure how I feel about myself. Can the first year, assuming you are not in a curriculum that dives directly into basic sciences, be streamlined? This is two-fold. First, does all that information, things like biochemistry, anatomy (literally every god damn structure in the body), really add to our future clinical foundation? It is important to a degree, but I definitely feel that some of this material can be cut out. Two, it certainly doesn’t add much relevance to boards. Yes, you need it in there to build a strong foundation, but do we really need to dive to the depths we currently do? Perhaps I am just taking for granted what I got out of this, but perhaps things could be trimmed. This is definitely happening at some schools, as they instead choose to jump right into organ systems.
Now, let’s move onto something that I know drives all medical students crazy. Schools are not lying when they say they care about our wellness, but unfortunately their actions betray them sometimes. It feels as if scheduling is done is a backwards manner. By this I mean that, whatever is being taught, a basic science course or something auxiliary, they begin by saying we need to full x number of hours. Then they go about filling that time period. There is generally always value in there, but it is surrounded by a shit load of fluff. Why? Why not just start the other way around? If you begin with saying what is the value we want to instill and then go about instilling that in an efficient manner, you can cut 4 hours of torture into a productive, engaging 1-2 hours. For example, we had an ethics thread recently inserted into our curriculum. This is no doubt something of value to us as future physicians. However, they went about it in the aforementioned backwards manner. It chewed up so much more time than necessary. What is the end result? Students are disengaged, resentful, and retain nothing of value. If you were instead to begin with the idea of instilling value, rather than filling up time, the result would be much more fruitful. This is very frustrating to me because of the message it sends. Again, medical schools do not intend for this, but it is no doubt the consequence. As medical students, we have to be incredibly vigilant and disciplined to maintain sanity, not to mention try to have some sort of balance outline school. When the school does not reflect our commitment to this ideal, it feels like a slap in the face. Moreover, it actually potentiates burnout.
Time for another disclaimer. Although inflammatory, this idea applies to only a minority of my school’s curriculum, which I am sure is reflective of most schools in the country. Again, I am very pleased with the past two years, but feel that this mindset could make them that much better and have a positive impact on student mental health.
I will admit that there is so much I do not know about medical school accreditation and the scrutiny they must undergo. I am sure much of this “fluff” stems from this, so perhaps they are caught in the middle themselves.
In short, my recipe for student wellness is to implement what I have discussed. First, complement the curriculum with both content and the organization of respected external resources. Second, respect our time (just as we are forced to do) and approach everything with a value mentality.
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