Medicine in Old Days vs Now

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Medicine as a profession and even the medical training process have evolved drastically over the past several decades. Technological advancements, cultural shifts, and regulation changes have resulted in an entirely different animal. Is it better, or is it worse? Let’s compare medicine today to how it was back then

 

How Medical School Has Changed

In the early 1900’s, medical school was nothing like it is today. Schools were concerned more about making money than they were about science or training competent physicians. Basic science was more of a “nice-to-have” than a “need-to-have.” In 1910, Abraham Flexner published the Flexner Report, urging medical schools to adopt several standards to improve medical education and training. It’s no surprise that some schools, many of which were completely off base in what medical education should look like, were closed shortly after.

It was this report that prompted the medical school pre-requisites for pre-med students, including biology, chemistry, and physics, which have since evolved and expanded. If organic chemistry is the bane of your existence, you have Mr. Flexner to thank. Clinical rotations became a standard part of medical school, and the 2 + 2 format was standardized, meaning the first two years emphasized pre-clinical didactics in the classroom, and the latter two years comprised of clinical rotations.

In 1942, the Liaison Commission for Medical Education, or LCME, was founded. As an accrediting body performing on-site reviews, its purpose was to uphold medical schools to the new and evolving standards.

In the last couple decades, medical school has evolved at a rapid pace. While some medical schools rely exclusively on lectures, more and more have begun transitioning to more interactive and effective forms of teaching, including problem-based learning, team-based learning, and flipped classrooms. Problem-based learning, or PBL, consists of small groups of students, usually around 6-10, and a physician facilitator, who together go through a hypothetical patient scenario. Team-based learning, or TBL, is similar, but it’s one teacher who is facilitating several smaller groups at the same time, often in a lecture hall setting. A flipped classroom is one where students study the textbook at home, and class time is reserved for questions and hands-on work.

Most schools also now have students seeing patients far before their third year. At my school, for example, we were interacting with patients during the second week of first year. As medical research has evolved and improved, the medical knowledge covered in medical schools has also grown exponentially. Students now have more to memorize than ever before, and it’s for this reason so many pre-med and med students turn to Anki as their new lord and savior. There’s also a new kid on the block, Memm, which is a new and improved study tool that is 2 years in the making. If you want to check it out and test drive the beta, subscribe to the Med School Insiders newsletter where we will be announcing its release and how to get involved.

 

How the Application Process Has Changed

The medical school application process has also radically transformed over the preceding decades. Not so lucky for you, getting into medical school has been trending towards being more and more competitive each and every year. In 1957, there were 12 applicants per spot. In 2010, that number rose to 40 applicants per spot.

The MCAT is also a completely different beast than the first version released in the 1940’s. Back in the 1920’s, students were flunking out of medical school left and right, at some schools even close to 50%. The Moss test, the precursor to the MCAT, was developed to test one’s readiness for medical school. That, combined with stricter medical school admission procedures and higher educational standards, dropped the attrition rate to a more reasonable 7% in the 1940’s.

The MCAT has been redesigned several times since, most recently in 2015, and now has a greater emphasis on the humanities than its predecessors. And that makes sense — after all, we’re beginning to appreciate that being a good doctor is about much more than being good at science. Teamwork and communication skills have been emphasized not only in medical school, but even in the admissions process. Multiple mini interviews, or MMI for short, uses a series of short scenarios to assess a candidate’s soft skills more effectively than a traditional interview.

 

How Being a Doctor Has Changed

Ask any doctor, and they’ll tell you that the golden years of medicine are behind us. What’s less agreed upon is when the golden years exactly were. Most contemporary physicians would consider the 1980’s as the good ol’ days of medicine. But in 1982, you had physicians lamenting about unwarranted criticism and how doctors needed more R-E-S-P-E-C-T. Clearly, the changing opinions and decreasing job satisfaction of physicians has been a slow and steady process

There are many benefits to being a doctor today compared to being a doctor a few decades ago. As Robert Wachter writes in The Digital Doctor , radiology before the computer revolution was an inefficient and slow process. You had to walk to the radiology department, schmooze with the radiologists, have them find the film, and on and on. It was tedious. Nowadays, we can quickly access images from our computer, mobile devices, and reference the radiologists’ formal readings written in the note.

But it hasn’t been all sunshine and rainbows. I’ve used EPIC for a few years, the most dominant electronic medical record, and it’s far from pleasant to use. In The Digital Doctor, Dr. Wachter doesn’t hold back in pointing out EPIC’s shortcomings, inefficiencies, and the potential for improvement in the marriage between computing and medicine. Don’t get me wrong, while it’s far from perfect, I definitely prefer EPIC over other EMR’s or, even worse, the dreaded paper charts.

The added regulations and billing requirements have made being a doctor less about being a doctor, and more about doing administrative work. Charting requirements and documenting are at an all time high. Atul Gawande elegantly explained Why Doctors Hate Their Computers in The New Yorker, pointing out that specialists who spend more time charting, meaning documenting on their computers rather than interfacing with patients, are more likely to be burned out. He explains that this is why emergency medicine doctors have higher burnout rates than neurosurgeons, even though neurosurgeons work way harder.

The numbers don’t lie. Burnout, depression, and suicide rates are at an all time high, and there doesn’t seem to be an easy solution. Doctors of yesteryear are quick to say that the issue is simply that millennials are too entitled and constantly complaining. But these doctors are also the same people that say they used to walk to school 15 miles in the snow, uphill both ways. Whether or not us millennials are whiny and entitled is beside the point. Being a medical student or doctor today is simply a completely different animal than it was back in their day.

First off, the amount of information medical students need to learn today is an order of magnitude greater than it was half a century ago. It’s not even a comparison. The pressure is higher due to ever increasingly intense levels of competition. As residents, they didn’t have to worry as about writing crazy detailed notes to avoid issues with insurance coverage. Doctors were paid well without the crushing levels of student loans. Mistakes were made, but because of the lack of well-intentioned yet poorly-implemented protocols of today, they weren’t subject to frequent penalties.

We like to think that patient care is vastly improved today compared to decades ago, but even that isn’t as clear cut as you might think.

What are your thoughts on medical school and the application process today versus in the past? Let me know with a comment below.

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