As both of my regular readers know, after many years of practice in a community hospital, we have within the last year become semi-academic with the arrival of residents and clinical clerks on our service. There was a near twenty year period without the presence of these keen clean slates and I must admit, I wasn't sure what to expect. The medical students have been by far the biggest surprise.
I was a little put off by the new dress code. In the old days jeans were generally relegated to the ER where they went well with surgical greens and ER personalities. I was taken aback when I discovered that they couldn't handle a microscope only to find that they had done virtually no histology and little anatomy. I was flabbergasted when I saw them demonstrating the physical exam from the wrong side of the patient's bed. (more on this another time). But what is most obvious and which has truly shocked me the most, is how damn good they are.
I don't know if it's the newer problem-oriented approach or simply getting the students into the hospital earlier, but the students I've had so far have been amazingly at ease with patients and the whole hospital routine. The first student we had functioned at what I would consider to be an intern's level. Within a week I was sending him off to see his own consults and when we rounded I would find a thorough history and physical and even a proposed diagnostic or treatment approach. Between rounding the student would see patients and write follow-up notes in the charts with confidence. At first I thought it was simply an outstanding student, and in fact he was, but his classmates have all exceeded my expectations. They all seem to be at ease with both patient and physician interaction, or at least a lot more comfortable than I was at this stage.
I imagine it's hard for medical school administrators to see the gradual impact of their longterm decisions on curriculum and clinical skills training, but from my vantage point as a Rip van Winkle of academic medicine, things have changed dramatically, and for the better.