Medical education is a complex business. How do you take young, energetic, hard working, bright people and transform them into caring physicians? Do you teach them five days a week, eight hours a day? Do you give them time for independent study? Do you have grades? What about class ranking? Do you teach compassion? Do you charge tuition or should the government fund it since society needs physicians? Do you tell them what specialty to pick or should they choose themselves?

I went to medical school from 1982-1986. I went to class forty hours a week. I had homework and examinations. We were graded and we were ranked. I was happy. I did not know any other model of education. The state medical school was inexpensive and the prospective income was sizeable but not enormous. Today, there are much fewer lectures. There is a lot of time for independent study. There are no grades. There is no class ranking. The most important assessment tool is part I of the medical boards. The typical medical student has enormous debt, and they could choose a specialty with enormous income potential. The variation in incomes among specialties has increased substantially. The pressures have changed. The impact of these changes are not clear-at least not to me.

Yesterday, I gave a lecture on eating disorders to five fourth year medical students who are part of the Primary Care College. The Primary Care College is for those who are interested in Family Medicine, Internal Medicine, Pediatrics or Psychiatry. I do not know why Psychiatry is part of the Primary Care College and neither did the students. In fact, the students told me that most people interested in primary care are not in the Primary Care College. We shared feeling confused. I spoke about how understanding eating disorders helps us to understand the mind/body connection. They seemed to listen. They asked good questions. At the end, we chatted about the changes in medical education and the changes in the practice of medicine. We spoke about health care reform and the need for more primary care doctors. They shared that most of their class will not be going into primary care. Most, want to specialize. No one says they want to specialize in order to make more money, but together we speculated that that was part of the motivation.

I left feeling puzzled. I left feeling old. I wondered how medical education could change so much in a relatively short period of time. I wondered how to think about these changes. I did not know. I do know that this next generation of doctors will take care of me and my loved ones as we age. I hope they will be there for us when we need them, but the uncertainty of it all is frightening. Watching young adults become physicians with life and death responsibilities is fascinating. At the same time, watching their development makes me realize that we not only depend on these people to take care of us and our loved ones, we also depend on the system of medical education to transform them into smart, intuitive and responsible doctors. I hope the system works.

About the Author

Shirah Vollmer, MD

Shirah Vollmer, MD, is an Associate Clinical Professor of Family Medicine and Psychiatry at the David Geffen School of Medicine at UCLA.

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