This week’s post comes in the form of a commentary on a recent N.Y. Times article, The Real World is Not an Exam (http://well NULL.blogs NULL.nytimes NULL.com/2014/02/10/the-real-world-is-not-an-exam/). As someone who has generally performed better on tests than he has in real life myself, my bias has always been in favor of allowing medical students and residents to first learn the material before being asked to perform. I agree that doing well on the hundreds of multiple choice tests that one is required to pass before graduating from medical school only gets one so far. But, wouldn’t it be grand if we had some way of teaching the material to students ahead of time (you know, the way they do in school) rather than simply expect them to absorb it on their own in the clinical setting? As an undergrad, I was required to get A’s in a bunch of classes which were really not necessary in order to be prepared for medical school. As a medical student, I had to pass a bunch of classes during my first 2 years which only minimally relate to what I need to know for practice. Therefore, going into my clinical clerkships, I was only marginally more prepared than a really good high school graduate would have been. And, by the time you get to this point in your medical training, true teaching experiences are few and far between. They tend to happen on the go – i.e. a quick discussion of how to manage hyponatremia before seeing the next sick patient. And any “knowledge” transmitted in this way is inherently suspect. Prior to becoming a 3rd year medical student, I considered myself to be a rigorous skeptic with regard to medical or other scientific knowledge, obsessively combing through primary sources in order to sort out a contradiction between 2 equally reputable textbooks. I quickly realized that is impossible to function this way in medicine. The students who do well and get ahead are those who have strong opinions and present them with confidence, not those who fail to reach an opinion in the absence of a scientifically compelling reason. In many ways, the difference between doctor an patient is pretty minimal. Patients can google all the same information we can. The major difference is that people believe doctors because we wear the white coat and express our opinions more forcefully.
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