Over on Kevin M.D. Dr. Vineet Arora writes about what she learned while touring hospitals and a med school in China: http://www.kevinmd.com/blog/2010/05/china-medical-school-residency-training.html
“My husband and I recently traveled to Wuhan Medical School in the Hubei Province in central China,” she reports. “Our medical school [University of Chicago] has partnered with Wuhan to help inform their curricular reform efforts. We spent 4 days touring the hospitals and teaching facilities, meeting students and faculty, going on rounds, and giving talks. Although the language barrier was challenging, we had incredible translators who worked to translate every slide we spoke into Chinese. We also had the opportunity to observe and talk to students, residents, and faculty through translators to better understand their experiences.”
Unfortunately, Chinese medical students are getting a somewhat skewed view of medical education in the U.S. “The preclinical students told me they watch Grey’s Anatomy and House, MD and wonder if that is what medicine is like. I told them that U.S. medical students and premeds have wondered that too!”
While I don’t watch Grey’s Anatomy (too soapy for me), I have to admit that when I’m scanning channels, looking for a little down-time, and run into a re-run of “House,” I watch it. The show is quirky, and some of the acting is quite good. But I don’t think that “House” bears any more resemblance to the practice of medicine in real life than, say “ER”.
(Sidenote: If you’re looking for a glimpse into the heart and soul of medicine, rent DVDs of “St. Elsewhere” from Netflix. Brilliantly written, and extraordinarily well-acted (the series launched the careers of Denzel Washington, Ed Begley Jr., and Mark Harmon), “St. Elsewhere” stands head and shoulders above every other medical drama that I have ever seen—on television or on film. This is not because it is “realistic” in the conventional sense. “St. Elsewhere” offers a combination of black comedy and tragedy that captures the ambiguities, absurdities, and unknowns of life and death in a hospital where patients don’t always survive. “St. Elsewhere” was written by Tom Fontana, who would go on to write “Homicide: Life on the Street”, and “Oz,” and produced by Bruce Paltrow–husband of Blythe Danner and father of Gwyneth Paltrow.)
Fortunately, Chinese medical students are getting a more realistic idea of medical practice in their training. Arora reports that “Wuhan has a state of the art simulation to help students practice clinical medicine. As one attending physician said, ‘the book is book, but practice is practice.’”
Typically, Chinese medical students begin their education right after high school. (A standardized national exam in high school dictates whether students will get to go to medical school.) Once in med school, Arora explains, “the standard pathway is the 5 year option, with smaller 7 and 8 year options for the select few who desire more clinical training and research. China also has a foreign medical student population that include students from India, Canada, Africa and even the U.S. who spend 4 hours a day studying Chinese on top of their preclinical studies so they can eventually interact with Chinese patients.” Can you imagine learning Chinese while also going to medical school?
“Probably the most fascinating part of our trip was observing teaching rounds in 2 Chinese hospitals.” Arora writes. “The patients were three to a room and were wearing their own clothes instead of gowns. It is cold in the hospital since the buildings are not heated (I was wearing my winter coat the whole time). In both hospitals we were in, the clinical students did not ‘follow’ patients but worked as a group (4 to 5) with one attending physician to see all the patients.
“Through the long streams of Chinese, we could make out the terms ‘COPD’ in a lung ward or ‘Framingham’ when observing a cardiologist teaching medical students,” she adds. “Students who were thirsty for clinical teaching were furiously taking notes in little books. The familiar tradition of the attending ‘pimping’ the students was also observed. Students did not ask a lot of questions, which is consistent with more of the passive learning style documented in Chinese medical education — one thing that Wuhan very much wants to reform.
“Students were also carrying all the charts for the rounds and expected to do other clerical tasks. When I explained the term ‘scut work’ to our Chinese medical student translator, she told me that this work is actually part of their ‘cooperation score’ on the evaluation symbolizing teamwork.”
For Arora’s full post go to http://www.kevinmd.com/blog/2010/05/china-medical-school-residency-training.htmlon Kevin M.D.
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My real life experience is more like “Scrubs.”
Maggie,
Hmmm,
Another country that finds it is not necesary to complete four years of undergraduate school before attending medical school. The educational process in this country continues to be stodgy and outdated, and given the ever expanding costs of college and medical school, likely adds to only the wealthy being able to attend and the expectation of higher pay for doctors once they graduate. At my calculations, it costs somewhere around 400 grand to complete this educational process (40 grand a year for college and 60 grand for medical school are my assumptions). Don’t you think this might be a good area to cut some health care costs? But then again, why would secondary education give up all this money if they don’t have to? Better to maintain the same expensive and inefficient system!
By the way, were these medical students fresh out of high school imature and not ready for training?
Ed & Keith–
Ed– LOL
Keith– Given the size of its population, and the number of enormous problems that it faces (pollution, unemployment, poverty in the countryside), China cannot, at this point, give its doctors the rich educational background that many developed countries provide.
But someday, when China becomes a fully developed world power, it will. (The Chinese have great respect for education, art, history, literature etc–they have a rich cultural tradition.)
Chinese high school students are far more mature than American high school students becuase they are not nearly as spoiled. Most have had a much harder life, and had to grow up quickly. Also, their culture demands that children respect their elders, theat they be disciplined, that they work hard. .
I guess you never studied China or other parts of the developing world in college. . .
Developed countries like Canada, Germany, France, Sweden, and many others do offer their citizens an excellent education.
In Canada, students go to high school for 5 years. Then they go to the university for 4 years.
My daughter went to college in Canada, where she received an education that was better than many students receive at Ivy League universities here — in large part becuase our universities have very few requirements. (Our universitites are not stodgy–they are far too loose.)
My son, who teaches at a University in the U.S. has had many students from Canada (mainly when he was at Cornell) and was impressed by how well educated they were in Canada’s high schools.
When my daughter graduated from McGill in Montreal she had studied history, philosophy, political science, psychology literature, anthropology, science and she had passed a foreign language requirement.
She also became an exceptionally good writer. (She had to write about 12 papers each term)
I have met many doctors in the U.S. who got a good unviersity education and are imaginative, perceptive, extremely articulate, and able to hold up their end of the converation whether you’re talking about politics, the arts, or human behavior.
This is one of the reasons I like docotors. (Generally much more interesting than stock-brokers–or lawyers)
But unfortuantely I have met some U.S. docs who appear to have had little education. They’ve taken a lot of science courses that required rote memoriziation, but that’s about it.
They truly don’t know how to think–how to make a persuasive argument, how to analyze an argument, how to think in depth.
And in dealing with other human beings, they are obtuse. They have a hard time divining what others are feeling in part because they have read very little literature, psychology, anthropology. They haven’t studied music or art. . . . . They haven’t read Shakespeare. Their imaginations were never given a chance to develop.
Even when they sense what a patient might be feeling, they aren’t articulate enough to comfort the patient . (Limited vocabulary due ot lack of reading.)
And when it comes to politics–they know no history. Thus, it never occurred to them that the invasion of Iraq was going to turn out to be a lot like the war in Vietnam. (This they share with G.W. Bush. Actually, Bush serves as a good example of someone who went to an Ivy League school but never got an education. )
Those who know no history are doomed to repeat it.
This is a shame becaue most doctors are natively intelligent, but if they went through college taking only pre-med courses plus the easiest courses in other fields (focusing on their GPA rather than on getting an education) they emerge handicapped in ways that affect both their practice of medicine and their ability to truly live. .
A mind is a terrible thing to waste.
Education is the last place where we want to cut spending.
As a country, we spend far more on healthcare per-capita, than any other country.
But we spend less on public education, per capita, than many other countries. This goes a long way toward explaining why we are well on our way to becoming a 3rd-tier country–unless we do something soon.
Maggie,
I think you confuse public education with pre college education. We spend less on education up to the high school levels, but not at the post secondary levels and above.
The fact of the matter is that pre med requiresments leave little time for studying and obtaining a liberal arts education as you imagine. After you have taken physics, calculus, chemistry, organic chemistry, and biology, you don’t have many elctives left over for what you conceive as a well rounded liberal arts education. Most premeds still major in the sciences. Life is a learning experience and it may be those experiences we have before we even get to college are the ones that shape our personality and behavior. I think you give too much credit to a bloated and costly system that is pricing students out of the market, much as we are doing in medicine today. At the very least, students and their overburdened families should be given a choice rather than pay additional costs of 50 grand a year for more time to mature and develop.
Keith–
First, thank you very much for responding. I was afraid I was taking such a hard line that you would be put off.
But college education is somethign that I have spent much time thinking about, both becuase I spent seven teaching (English lit) at a university before I beacme a journalist, and because I have watched my two chidren go through college.
First you’re right,in term of how much the U.S. spend on education. I was talking about how little we spend on K-12 public education.
But that explains why so many American kids aren’t prepared to go to college. Even if they get in (have the money, get a loan) they’re not in a position to take advantage of a college education. I don’t blame them– I blame the lack of funding and real support (respect) for public education K-12.
And I agree that, today, med schools encourage college students who are pre-med to spend most of their time taking math & science courses (that, doctors tell me, often aren’t relevant to what they will need to know as doctors.)
I also think that the pressure to have a nearly perfect GPA is a problem which causes pre-meds to avoid tough but very good humanities courses where they might not get A’s.
Maybe Med schools should adjust their requirements so that pre-meds will feel safe if they get some B+’s in non pre-med courses.
Some admissions comittees at very good med schools reward students who venture outside the pre-med curriculum.
I agree that life is a learning experience, and many people who wind up being doctors learn form life experience outside (before and after) college.
But less wealthy students are less likely to enjoy those experiences,
Students coming from working class families– or families that are staistically middle class (roughly $58,000–$63,000 total family income)most need a college education because they didn’t enjoy the advantgages of growing up in a family that traveled, a family where everyone talked about books or what they had just read in the newspaper, etc,
An we want these kids to become doctors too
So we do agree on some points regarding medical school education!
I think there are many parallels between the issues we have in medicine and post graduate education. Both are resistent to significant change in their methods of delivery of their product, and both have expanded in cost over and above that of general inflation in the recent past. This has resulted in problems of access to both health care and post secondary education for more and more of the middle class, who cannot afford either and which in tandem are destroying access to upward mobiity. Just as you have proposed and supported changes in the health care system to streamline it and make it more efficient and cost effective, I think a similar approach will need to occur with post sencondary education. It may be a stronger junior college system with less of an emphasis on the 4 year college would be one way to lower costs. Possibly an entry point to medical school that does not require 4 years of college matriculation (I know you disagree on this point).
I would be concerned that we are limiting the pool of students that will be able to overcome these economic hurdles and disuading just the students you wish to atttract from differnet backgrounds if colleges continue to raise tuition 4-8% yearly. The same race to be the best cutting edge hospital that we have seen explode the costs of health care is also occuring at the college level where universtiies increasingly pay higher and higher salaries to superstar professors to attract them to teach at their school, much like what hospitals do in hiring a superstar surgeon to attract patients to their hospital. And hospitals and college campuses are the only two places you can find construction cranes these days!
Of course the increased cost of a 4 year college and medical school combined is what allows doctor to argue that they need to make an elevated income to compensate for the huge front load investment. this has contributed in a negative way by forcing more and more med students to elect high paying specialty training rather than what our health system desperatly needs; primary care and a focus on healthy lifestyles and prevention.
I agree that 4 years of college is a great thing and allows a student to mature, but I am afraid we may not have the luxury of taking on this added expense. Not unless post secondary costs are reigned in also or the goverment provides more subsidies; an unlikely senario given our current budget deficit.
Unless the same innovation that I do not see happening at the collegiant level occurs, we will have the same issues that are present with health care, and limiting the pool of individuals that can attend college will result in a less educated population which we all recognise is the only way for us to maintain our standard of living in this country.