Making Medical Education More Profitable (and Actually Applicable)

In a previous post, I talked about changing the US system to make medical school free or even pay to-be doctors from day one of medical school so that they don't have a soul-crushing debt smothering their empathy and directing their specialty selection. While it sounds far fetched, below are a few ideas that could make that dream closer to reality (so take note, Trump, Clinton, Johnson, or whoever else will lead this country).

First off, we could make the first two years entirely online (and even standardized). This realization hit me when we were scheduled to have a lecture from an obstetrician during my 2nd year of medical school. Unfortunately, both him and his back-up OB were both delivering babies at the time of the lecture, so my school administration simple played the previous year's video clip of the same lecture. The question occurred to me: why are we having these busy physicians and scientists re-invent the wheel by repeating their lectures every single year? This generation of students not only can handle online delivery of education, they have come to expect it.

Speaking of teaching to-be clinicians, I did an MD/PhD program, so I initially was excited to receive lectures from scientists during my first two years of medical school. However, the excitement faded quickly, especially when the pharmacologist (not pharmacist) told me I'd use the Henderson-Hasselbalch equation daily in the clinic, when the geneticist (a PhD in biochemistry, not a clinical geneticist) tested us on how many base-pairs the cystic fibrosis gene was, or when I got a week of lectures from a world-renowned PhD neurophysiologist on how spots located only micro- to millimeters apart within the brainstem control the depth, regularity, frequency, etc. of breathing.

Side note: he came to discover these foci and other painful clinically irrelevant minutiae that, if not memorized, meant poor grades.

My two brothers were at medical schools with even less research emphasis (per the US News and World Report rankings, but they still experienced this painful minutiae-memorization-expectation from scientists, who may be great scientists, but are not educators and certainly not clinicians. What killed my brothers was that they were paying hundreds of dollars per day for this. Soul-crushing indeed.

While in 1910, at the time of the Flexner report pushed scientific education on doctors, there may have been no distinction between "clinical" and "basic" branches of scientific disciplines; the fields have blossomed enough that there now is. You could not put a PhD pharmacologist in the pharmacy, or a PhD chemist in the clinical chemist laboratory without major problems arising. Why do we torture to-be doctors with deep basic science lectures (which are, frankly, largely irrelevant to practicing medicine) when there is so much more they could be learning that has direct clinical relevance? A national standardized curriculum would free up scientists from having the displeasure of lecturing medical students, as well as decrease clinician's distaste of basic science.

Additionally, with a standardized curriculum, medical student's would not have to be told over and over into their final year of medical school and even beyond "just in case they didn't emphasize this at your medical school" that the patient's right side is on the left of the screen when looking at MRIs or CT scans or other overly redundant "pearls." A standardized online curriculum could also be updated, so medical students are taught the best evidence-based material instead of having to learn about the many uses of calomel and other "oldies-but-goodies" drugs as taught by semi-retired PhD's that never got around to updating their slides they started collecting in the 1970's (no wait, they digitalized their slides to PowerPoint in the mid 2000’s once their slide projectors broke--my apologies).

Actually making the first two years of medical school medically relevant would cut down on the additional soul-crushing aspect of being tested on things that have no applicability or relation to your future profession.

The biggest problem I foresee with a clinically relevant curriculum is that the required USMLE Step 1 would have to be removed, since only a portion of the material tested is useful beyond crushing to-be doctors' souls and squashing the empathy out of them.