What Do They Call the Person Who Graduates Last in Medical School?

Are you ready for mediocre physicians to do your brain surgery?

Posted Oct 15, 2010

The answer is, "Doctor" but are you ready for a mediocre physician to do your brain surgery? 

It is not just the lower incentive for people to choose to go to medical school, graduate one or two hundred thousand dollars in debt, and with the lower reimbursements spend ten years paying off debts. The other problem is the quality of American college graduates is not what it used to be so medical schools don't have the pool of the best and brightest to train. Where have these great potential physicians, jurists, engineers, researchers, and innovative software designers gone?

College Dropout Rising...FOR GIFTED KIDS
More and more gifted kids are dropping or flunking out of college therefore gone from the graduate school applicant pool. It is not news that gifted children are failing to thrive in schools encumbered by the high stakes standardized tests. What is becoming evident now that the generation trained through the teach-to-the-test homogenized curriculum also lost out on opportunities to develop their gifts and talents. Without opportunities to develop higher cognition, judgment, and analysis, or experience the challenge of academic engagement suited to their abilities, they arrived at college unprepared for their first ever experience of having to develop organizational skills,  apply effort to achieve success, and needing to ask for help.

In the past we've heard excuses like, "All kids are gifted in their own way" but now the mantra is, "We can't afford the time to devote to gifted kids when the test results look at how many kids get satisfactory scores. There is no "credit" for scores high above average, but there are penalties for the numbers scoring below average."

When I left my neurology practice to "make a difference" in education twelve years ago, one low performing school administrator told the faculty, "The best use of your time is with students just below passing. Time spent helping them raises our test score rating. The kids in the bottom quarter take too much time to reach the standards and the best use of gifted kids is to have them work with that near passing group, because we don't get any higher test rating for superior test scores."
Sounds outrageous, but this is the mandate passed down from administrators who are charged with bringing up test passing numbers or face fund reduction and closure.

They Never Learn to Think
Gifted children are usually willing to help a classmate, but are turned off to school when that is their responsibility much of the day with no opportunities for enrichment and challenge to keep them motivated. "Twice-gifted" children lose out in the push to "get through" the overstuffed curriculum required for the test. The excessive quantity of material teachers must "cover" and students must memorize leaves insufficient teacher time to observe and discover children who are gifted, but need to their exceptional abilities to compensate for their learning challenges.

Even for the gifted children who are identified and not used as unpaid instructional aides for classmates, the funding for special programs has been siphoned into the underperforming students for greatest "bang for the buck" test score fixes.

Other gifted children with social or emotional disabilities are not identified as gifted because they are identified as having behavior problems. These behavior problems are the manifestations of the brain's involuntary response to the stress of anxiety, boredom, or frustration. When academics are one-size-fits-all, the unchallenged brain goes into the reactive state where the behavior outputs are limited to fight/flight/freeze. What teachers see in class are students acting out or zoning out because once they master the material, they are left to follow along with the whole class and listen to the same material taught and drilled over and over.

Spiral of Failure
But why shouldn't gifted students finally have their chance to shine once they are in college, especially the very best colleges and universities to which they were accepted? Unless they were fortunate enough to go to private schools or high performing schools where test pressure did not leach into all aspects of the school experience, they miss something important that sets them up for failure in college—they never learned to think.

Students in the U.S. are underprepared for higher learning and the jobs of the 21st century. Many gifted students who are now in college experienced a K-12 education that included an over-packed curriculum and teach-to-the test homogenized instruction. The pressure that many K-12 educators experience to "get through the curriculum" leaves little time for students to experience the problem-based learning needed to build their highest thinking and reasoning skills.

When these students reached college during the past four years they were faced with challenges requiring the executive functions they did not develop in the years before college. These are the higher brain processing networks that direct organizing, prioritizing, resistance of immediate gratification, goal-development, critical analysis, and independent thinking. After years of memorizing were all that was required for high test scores, and no opportunity to experience the challenges that promote the development of the neural networks that are needed for these executive functions, gifted students were unprepared cognitively and emotionally for their new challenges.

Success Without Challenge Doesn't Prepare Students for Reality
Gifted students, who previously were highly successful when assessments were limited to regurgitation of memorized information, were not prepared for judging the validity of sources of information or the use of induction, deduction, and critical analysis to write academic papers. The consequences resulting from inadequate development of their highest cognitive thinking led many highly gifted students into a spiral of failure.

The increase in amount of information overwhelmed even the most proficient memories because these students did not have experience prioritizing what was the most important information or recognizing core ideas would serve to relate isolated facts into connecting concepts. Their studying was inefficient and inadequate for the new assessments they faced.

Without previously having to independently plan their time, especially for long-term projects and papers, which were cut from a curriculum dedicated to force-feeding facts, these students were suddenly struggling for the first time in their lives. For many, this experience caused them to question their intelligence, feel like frauds, and fear asking for help and exposing themselves as not deserving of the "gifted" label they'd been given.

Especially in the top colleges, the change in the type of work was difficult for students who never previously had to organize their time effectively or use critical analysis and insightful, creative thinking to solve challenging problems. Memorizing came easy to them and thinking was not necessary to excel at the minimal demands on their brains during their precollege earlier years.

The college experience included more work and more freedom, balancing the greater work load with the need for sleep and exercise, and just as they needed the skills and guidance to make good planning and judgment choices, they did not have the easy access to familiar classroom teacher in a small class. Many of their classmates without the same intellectual gifts received guidance from teachers in high school to help them learn to plan their time for long-term projects by requiring sections of these reports or projects to be turned in at regular intervals. Suddenly in college work assigned at the beginning of a semester and due ten or more weeks later, was not something the gifted students could put off until the night before and still get the easy A their work got in high school. Tests and reading required more effort and thought than "last minute cramming" could provide.

My Grades Prove I'm a Fraud and Don't Belong Here
As these previously highly successful, praised, and honored students were unprepared for the work quantity and expectations of independent thinking, they were even more unprepared for the first low grades they ever received. Because they were no longer in the "safe" environments of their undergraduate schools, where they were acknowledged for their superiority, it was daunting to need help and not know where to find it—or to admit they needed it.

A generation of gifted students who went through the one-size-fits-all public education system that grew out of No Child Left Behind, entered college unprepared and dropped out or flunked out in greater numbers than ever before. Colleges even the most academically prestigious needed to provide remedial reading, writing, and mathematics for new students.

Gifted students who equated the need for help with personal inadequacy lost confidence in their abilities and potentials. Without support or guidance during their personal struggles and questioning of their own abilities, many of these students developed who had fixed mindsets (believing that their success as the result of the brains they were born with and what they can't do or understand easily is beyond their power to change). These students assumed they had reached the peak of their abilities and had no control of their future success. They were had no confidence that effort could influence their outcomes and lacked the resilience to persevere through setbacks.

The brain responds with the release of the pleasure promoting neurotransmitter dopamine when an individual experiences the satisfaction of recognizing progress and achievement, especially when there it was challenging. Without the frequent support weekly quizzes to acknowledge their achievement, or even personal relationships with professors to give them verbal feedback, the gifted students were cut off from recognition of their progress. Because it had always been there, many had not developed the growth mindset of recognizing their own effort to progress connection. Gone was the dopamine-pleasure response to academics that they had become used to.

High-risk behaviors

High-risk behaviors became the substitute stimulus for the dopamine-boost they previously enjoyed from academic success and the inadequate development of their executive functions of judgment, risk-assessment, and delay of immediate gratification did not prepare them to resist the short-term pleasure jolt of these unhealthy pursuits. For some students, drugs became an external source of that satisfaction. In fact, cocaine and speed work by increasing the brain's circulating levels of its own dopamine. The problem is that once the stores are rapidly depleted due to the effects of these drugs, the students were left with even lower feelings and spiraled into further drug use or profound depression.

The loss to these students themselves and to society is incalculable and must not happen to the current generation of students.

What Parents Can Do

Because memorization that was often easy for gifted children in precollege years is no longer adequate for high quality work in college, children need opportunities to build organizational and prioritization skills their classmates were working on, with teacher guidance, back in elementary school. Discussing this proactively with gifted children and preparing them for what to expect permits them to recognize they are not frauds, but that effort and planning is part of high-level success in any endeavor. I'm not sure that it takes the popular claim of 10,000 hours to become an expert at something, but the concept that effort and practice to is what builds the neural circuits of memory and executive function is something all children need to understand.

The 21st century best opportunities will be open only to students with proficiency in these executive function skills and conceptual knowledge. If there are inadequate opportunities for high-level information processing in school, parents can promote the opportunities for conceptual thinking and higher order executive functions their children will certainly need in college and in the best jobs of the future.

Prepare Gifted Children for the Challenges and Opportunities

A study of 12-year-olds found organizational skills for time-management to be a critical skill to develop if success is to be sustained beyond elementary school.
Study Findings
* Time management was not correlated with vocabulary scores, so time management doesn't seem to be a part of general intelligence.
* Time management scores (total score and the two subscales of meeting deadlines and planning) correlated with grades. Better time management was consistent with better grades overall.
* Time management correlated with conscientiousness, which was as a predictor of career success.
Reference: Liu, O.L., Rijmen, F., MacCann, C., & Roberts, R. (2009). Personality and Individual Differences The assessment of time management skills in middle-school students. Personality and Individual Differences. (That is the name of the Journal)

Time management, the completion of tasks within an expected timeframe while maintaining quality through planning, organizing, prioritizing, resisting immediate gratification, and analysis, can be incorporated into family activities. The goal is to help children develop foundations of emotional self-awareness, a sense of competence through recognizing effort-to-goal correlation, ability to recognize their own incremental goal progress, and willingness to participate in new endeavors even when there is risk of making mistakes

Early preparation, beginning in elementary school help children develop and maintain competence, resilience, flexibility, responsiveness to corrective feedback, sustain creativity, and retain confidence in their own abilities to control of the things around them. You can provide them with opportunities to plan and organize with constructive, supportive feedback - and to make mistakes and learn from them when their brains are in the low stress state that sustains higher cognitive function.

For young children, taking apart complex things, such as home appliances, and examining the parts gives children the experience of realizing that they can understand some of their parts. That knowledge builds their confidence that even difficult information can be learned and challenging problems solved by approaching the small parts of the whole that they can understand and eventually even the most complex concepts can be understood by "breaking them down" or taking them apart until there are some simple aspects they can understand and moving on from there.

Later preparation: Higher Order Thinking

Encourage your gifted adolescent to use higher order thinking by comparing and contrasting concepts, giving new examples of how information learned in class can be applied outside class, and applying learning to solve new types of problems. Promote practice using prioritizing, organizing, critical analysis with interesting home projects or personal interests (planning a vacation including costs, routes, places to visit, appropriate overnight stops; budgeting saving/working/weekly spending to have enough money for a desired electric guitar by a self-specified date; analyzing environmental impact, cost, and benefits of his/her choices for the next family car). These authentic experiences will build the skills that may not have been needed previously, give your child the experience of success and mistakes based on the consequences of their planning. These experiences you provide will be support for their gifts (and for some, their lives) as they move to each year's greater social, emotional, and academic independence and responsibility for their decisions, choices, and actions.

Preparing the Brightest Children for Solving the Problems and Embracing the Opportunities of the World They Will Inherit

Collaborate with your child. Children of today need new skills for the coming century to be ready to collaborate with others on a global level to find creative solutions to problems now and in the future. New information is being discovered and disseminated at a phenomenal rate. It is predicted that 50% of facts your children memorize today will no longer be fully accurate or complete in the near future. Your children need to know how to find accurate information and use critical analysis to assess the veracity/bias and current as well as potential uses of new information. These are the executive functions children need to develop and practice in the home and school today, or they will be unprepared to find, analyze, and use the new information of tomorrow.

In a global world of collaboration communication and tolerance (openness) to unfamiliar cultures and ideas will be a critical skill sought in job applicants in the future. Children need family discussions and experiences to learn about and feel comfortable communicating with people of other cultures.

Provide authentic opportunities for creative problem solving and insight. These experiences develop the executive functions that will grow and ultimately guide your children to make the wisest choices in work and social situations, and ultimately to use creative intelligence and resilience to perceive problems as opportunities and apply their strong neural circuits of judgment, analysis, induction, and deduction to creative solutions.

With your help your children won't deny or doubt their gifts when they enter college and they will develop the academic, social, and emotional attributes they will rely on to embrace the innovations and creative opportunities that await them in the 21st century as they lead society to an exciting future only their creative minds can envision and their brains can actualize.