Sunday, February 17, 2013

Patronizing Politics

I'm about a month into my board study. The most recent class we had was reproduction so I thought I'd take a practice test and see how I did. I only got a 55%. That's supposed to be what is most fresh in my mind so I did a few practice questions from renal, cardio, and reproduction which is the class we are currently in. Turns out there's not much variation in my score. I've ranged between 45% and 55%. There are some board prep materials that say that this is fairly typical right at the beginning of your intensive study and that intense study over the next 5 months can increase the percentage correct by about 20-25%. We'll see what happens.

The product/customer relationship is a little blurry in medical schools. First of all, we rack up more than a half a million dollars in opportunity cost to be taught how to be good doctors, competitive for our desired residencies, and to avoid as many life-threatening mistakes as possible. And the students expect the best educational experience possible. However, in order to generate enough demand for the school to justify charging future students that amount, administration tries to make our scores on the boards better than other schools'. Not only that, but the school has to ensure that the students are socially savvy enough that residency directors might want to be around them. We, as students, are both the product and direct consumer of medical education. Residency directors are also consumers of medical education and capitalize heavily on the inexpensive labor residents provide.

I can't think of any other good or service that is both a product and consumer to two parties and the situation creates some strained relationships. There is something of a conflict of students' and administrators' interests which is addressed most directly by the following from a syllabus for a class whose stated purpose is to prepare doctors to talk to nurses, pharmacists, medical techs, etc.

-"The course goals and your goals may not always align, but the value of the journey is often overlooked when striving to reach a goal. We are away of the intensity involved in your second year of professional training, perhaps more so that the student embarking on this journey."

How patronizing.

On paper, a curriculum that offers a course in interprofessional communication is a selling point to donors and other institutions that operate under segregated conditions where the doctor fights with a nurse who tells the pharmacist how to do his job, etc. After all, aren't medical misunderstandings responsible for the 100,000 deaths resulting from medical errors? The school is able to brag, "Look at us. We are doing something to correct a problem. We are a fantastic institution that deserves riches and the brightest students of next year's application cycle." And just think how it must look for the creators of such a course to have their brainchild copied into the curricula of medical schools across the country.

The truth is, forcing nurse, pharmacy, medical, veterinary, and occupational therapy students together to talk about medical marijuana, the role of proprietary information, or the prevalence of diabetes does nothing to improve communication between a surgical resident on his thirty-fifth hour since sleep and a nurse working graveyard. The goal of the institution is not the same as the goal of the student because the institution is driven by impressions which help grants, but the students just want to pass the next basic science test.

Students are stupid. They can smell politics, posturing, and cloaked idiocy before the end of the first class session and sometimes sooner.