Mining script

Off Script: Is the next generation “weak” or do we need higher standards for ourselves?

Physicians who earned their MD decades ago bemoan the work ethic of doctors-in-training. Maybe it’s time we learned to teach again.

When Professor Maitland Jones Jr, PhD, lost his job at New York University after students signed a petition complaining that his chemistry class – a prerequisite for medical school – was too difficult, j I was as fascinated by the reaction of my colleagues as I was by the specifics of the story. Who knew so many doctors could be so excited about undergraduate education, bemoaning the firing of an organic chemistry professor as a microcosm of many a world’s ills?

For me, it was even more personal because Dr. Jones taught me when I was in college. When I took his course three decades ago (in the last century, actually), I clearly remember the heightened level of stress that was induced in many of my premed classmates when he berated the no -purists who took the course. At the time, I laughed at his jokes and I remember thinking at the time that their stress was unnecessary (important note: I was not premeditated at the time). Yes, the course was difficult, but for me it was much less stressful. In retrospect, I think I should have tried to understand my classmates’ point of view a little better.

By analogy, there is a famous and beautiful hike called Angels Landing in Zion National Park, Utah. Not for those afraid of heights, in some places the hiking trail is only 3-4 feet wide with steep drops of over 2,000 feet on each side. Walking on this path can cause panic because a capricious step could lead to a fall with serious consequences. But ask any of us to walk the same path on level ground, without deviating more than a few feet, and we’ll confidently cross without hesitation. Doing something difficult, but with no perceived consequences, is totally different from doing the same thing while feeling that your life’s dream could vanish with one misstep.

I have a lot more empathy for undergraduate and especially premed students now than when I took Dr. Jones’ course. Medical school is harder than ever to get into. Of course, my generation struggled and we walked back and forth (in a snowstorm) to realize what we did. But realistically, it’s much harder to get into all levels now than it was when we applied. Add to that the constant reminders about the burnout of healthcare workers and it’s hard not to admire the dedication of these students to enter what is at best a highly uncertain career path with a huge opportunity cost to the entrance.

Maybe it’s because I also see the world through the lens of having both a junior and a freshman in college, but what premed students of this generation have gone through during their short time as young adults has no parallel with mine. And it’s not just the pandemic. These students grew up in an era of post-9/11 uncertainty, participating in active shooting exercises in schools and witnessing the erosion and violation of basic human rights that many of us thought were unassailable, through ugly and unstable political times, while seeing firsthand the impending catastrophe of unmitigated climate change all around them. To say that their hopes for the future are dimmer than mine 30 years ago would be a gross understatement. In medicine, we compartmentalize, lock up extraneous thoughts and fears deep within ourselves so that we can do our job effectively. It’s something that’s been learned, out of necessity, over years of practice, but not something it’s fair to expect a 20-year-old to do innately.

So why have so many doctors reacted so viscerally to NYU’s student petition regarding class difficulty, especially without knowing all the details – something we are trained in. not to do in medicine? I suspect much of this stems from our own struggle to make sense of these unprecedented times and our own anxiety about what the future holds. Reflexively lashing out at the erosion of the high standards that made us “stronger” doctors and served to “weed out” students who failed to pass the orgo grade is understandable when we have struggling to connect with the changing world around us. But complaining “O tempora! O manners! won’t necessarily make things better and is probably more than a little unfair. We should at least admit the possibility that these students had legitimate concerns about the way Dr. Jones taught his course three decades after I first took him.

For me, this episode should remind us that the fundamental objective of teaching is to transmit knowledge to the learner: if the pupils do not “understand”, is not the teacher partly responsible? Yes, we should have high and ambitious standards, but if I created a test that my students got – like the New York Times reported – “single-digit scores, and even zeros,” I introspectively looked at myself as harshly as I would at the students who got those scores. One of the characteristics of a good doctor (and far more essential than an understanding of organic chemistry) is to educate and pass on our knowledge to others, especially to our patients and their families, but also to our trainees. If we fail to do this effectively, we cannot simply abandon those we are trying to teach and accuse them of not trying.

Especially as teachers and communicators, we ourselves need to grow and learn.

It means remembering that, especially as teachers and communicators, we ourselves still need to grow and learn. Recently, while attending CCU, I realized that my group of trainees were not reading the daily manuscripts that our fellow students emailed to them. Rather than assuming that this generation of students was “weaker” than mine or jumping to the conclusion that they didn’t even want to read, I spent time trying to understand how they learn the more effectively and I found that interactive learning and podcasts, for example, had more impact. Going forward, I decided that a more effective way to teach the material would be to discuss the strengths/weaknesses of primary literature rather than just emailing a reference and waiting for my team to burn by EPIC puts itself on a computer to read them. time.

Being a parent of undergraduate students myself has taught me that while maintaining high educational standards is important, I also need to put myself in my children’s shoes to communicate more effectively with them. . Without being too paternalistic, I think that we doctors must do the same with our trainees and students who will eventually be our colleagues. This is not pampering; it is an attempt to understand those remarkable individuals who want to enter our profession despite all the risks and inconveniences of doing so.

Some will decide it’s a bridge too far, or say people like me have gotten too “soft”. Nonetheless, based on my experience, I believe that we are doing these interns – our heritage – a huge disservice by assuming that they do not want rigor in their lives. Careful polling will show that they are some of the most resilient, inspiring and caring people we will meet, and it is up to us to find the best ways to reach them. Just as we did long ago, they have, against all odds, devoted their lives to the pursuit of a noble profession, with even lesser rewards expected for their sacrifice.


Off scenario is a first-person blog written by leading figures in the field of cardiology. It does not reflect the editorial position of TCTMD.