The Kids Are Okay

  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.

Comments

[WarmSocks]

Med students who don't know how to use a microscope? At all? My 14yo can use a microscope!

The rest of it's pretty cool, though. Can't wait for your follow-up on why side-of-the-bed is important for the physical exam :)

[Mandy]

It's good to hear things are changing. I'm working with ChiliTechnology and hoping that more hospitals will implement the ChiliPad to help bring greater comfort to their patients. It's a mattress pad that allows heating or cooling of any bed - the entire surface, not just the pillow.

[Helen]

Glad they're doing so well.

I've liked each and every med student I've met, both in the rheumatology and cardiology clinics I visit. (In fact, the first time I met my electrophysiologist, I felt much more at ease with the student than I did with him!)

[red rabbit]

Hm... med students who have done no anatomy or histology, who wear jeans on rotation, but who are excellent at the bedside: McMaster, right? There are a plethora of approaches running right now, and it's interesting to see the take of a person who has been around for the change.

I did histology and anatomy, never wore jeans on rotation, and was drilled on approaching a patient from the right. I went to one of the most traditional med schools in the country.

I like to think I got a better basic education, but I did struggle with clinical skills at the beginning. Given that I understand the difference between science and woo largely based on the fact that I know the anatomy, histology, and physiology, I don't know that I'd trade my education for theirs despite appearances.

The McMaster crop makes me wonder about the future of medicine. They have no concept of the mechanisms underlying the things they do. They (in my experience) have been susceptible to non-evidence based modalities and handwaving.

[3+speckled]

No, not McMaster but I believe our students were taught the same approach. My own training was about as traditional as they come so the difference is fairly dramatic. I haven't seen enough of them yet to see if this clinical comfort is at the cost of scientific soundness, as you suggest. Hope not.