5 Problems with U.S. Medical Schools & Doctor Training


In an ideal world, the goal of medical education would be to mold students into the best, most competent, and most caring physicians they can be. Curriculums and clinical experiences would be optimized for learning and systems would exist to support students who are struggling. Unfortunately, this isn’t often the case with medical education in the United States.

It is estimated that nearly half of all medical students suffer from anxiety and nearly a third from depression. Moreover, according to the American Foundation for Suicide Prevention, 28% of residents experience a major depressive episode during training compared to only 7-8% of similar-aged individuals in the U.S. population. Given these unsettling trends, it is clear that there are deeply-rooted problems within medical education that need to be addressed.

Here are 5 ways that medical education is failing students.

  1. Culture of Medical Education
  2. Overreliance on Standardized Tests
  3. Research
  4. Subjective Evaluations
  5. Mistreatment & Discrimination


1 | Culture of Medical Education

Let’s start with the elephant in the room: the culture of medical education.

Becoming a doctor requires countless hours of studying and hard work. Although many argue that medical education should be difficult given the responsibilities that come with being a physician, others believe that the current system places too heavy of a mental and physical burden on students and residents.

Aspiring physicians must regularly endure sleep deprivation, long nights, and work after hours and on days off. According to a recent Medscape survey, two-thirds of residents work greater than 50 hours per week with a large percentage of residents exceeding 70-80 hours per week.

Although duty hour restrictions exist that limit residents to 80 hours and require at least one day off per week, they are averaged over 4 weeks. And even then, many programs violate them. As such, there are many residents working in excess of 80 hours per week, which translates to 13 to 14 hours per day, 6 days per week.

In addition, the environment during medical school is often extremely competitive. Everyone is trying to achieve the highest grades, the best test scores, and the most research to match into their desired specialty. Not only does this immense pressure to perform often lead to feelings of inadequacy and impostor syndrome, but it can also lead to fierce competition between students as well – which some students take too far.

Some overly-competitive students will throw their peers under the bus in order to elevate themselves in class or in rotations.

Instead of fostering a collaborative environment where students work together to maximize their learning, the competitive nature of medical school can sometimes pit students against one another. This has many consequences.

To start, it causes many students to feel inadequate – like their peers are always doing more than them – which ultimately leads to feelings of inferiority and impostor syndrome. Over time, these feelings can develop into more serious mental health issues such as anxiety, depression, and even suicide.

Next, this competition between students perpetuates the culture of overwork. It’s not uncommon for students to brag about how much they study, how little they sleep, and how much they’ve sacrificed to excel in medical school and residency. As a result, many students are pushed further and further to excel academically, often sacrificing things like self-care and hobbies in the pursuit of performance.

Lastly, it can strain the relationships that students build with their peers and instructors and make medical school feel like an “everyone for themself” experience. Although this isn’t the case at every medical school and the transition to pass-fail curriculums during the first two preclinical years has helped to address some of these issues, it is still an unfortunate reality for many students today.


2 | Overreliance on Standardized Tests

The next reason that medical education is failing students is that it relies too heavily on standardized tests.

Prior to January 2022, USMLE Step 1 was considered the most important exam that future physicians took during their training. The reason was that your score on Step 1 was a major determinant of your competitiveness for residency applications. As a result, a low score on Step 1 often prohibited students from pursuing highly competitive specialties.

If you wanted to become a dermatologist or a plastic surgeon, for instance, but you didn’t score high enough on Step 1, you could pretty much kiss your dream specialty goodbye – all because of a single, 8-hour test.

Although Step 1 has officially transitioned to pass-fail as of January 2022, this still doesn’t change the overreliance on standardized tests. Step 2CK is still graded on a numerical scale and will likely become the new Step 1 in terms of its weight on residency applications. The pressure to perform is just being shifted from one standardized test to another.

The problem is that standardized tests aren’t necessarily reflective of a student’s ability to be a good physician, but rather their ability to take standardized tests. There are many other factors that play into being a great physician beyond test scores such as integrity, compassion, empathy, and other soft skills that cannot be evaluated effectively with a computer-based exam.


3 | Research

Speaking of components of a medical student’s residency application, the overemphasis on research is another way that medical education is failing students. Although it is important to have the skills to analyze and understand research as a physician, playing the “research game” in medical school often consumes time that students could spend developing skills that will make them better physicians instead.

Research in medical school is a numbers game and quantity is prioritized over quality. If you’re trying to match into a competitive specialty, you are encouraged to get your name on as many research projects as possible to pad your CV. The result is that many students end up spending large amounts of time producing research, most of which is of little impact and doesn’t meaningfully progress the body of scientific literature or our understanding of medicine.

The reality is that most physicians will not continue to do research once they have completed their training, so why then do medical students have to commit so much time to research during medical school? That time could be better spent studying, seeing patients, and developing the skills and knowledge necessary to become a competent physician.


4 | Subjective Evaluations

Next are subjective evaluations.

During the third year of medical school, students must complete a series of rotations in a variety of specialties. At the end of each rotation, they are given a grade that is determined by two things: their shelf scores and their subjective evaluations by their supervising resident and attending physicians.

The weight given to shelf scores and subjective evaluations varies depending on the program and the rotation; however, there are some clerkships that are predominantly determined by subjective evaluations.

This is problematic as it puts the focus on trying to impress your preceptors as opposed to trying to learn. You may just get lucky or unlucky that you click or don’t with your preceptor. If you both bond over your shared love of Formula 1, you’re likely to get a stronger evaluation than if you have nothing in common.

Additionally, many students will avoid asking questions when they don’t know something just to avoid looking bad in front of their preceptors. As such, these subjective evaluations may disincentivize students from asking questions and addressing their gaps in knowledge.

Clinical rotations sometimes feel like they’re no longer about learning but rather about politics and the fear of getting a bad grade instead.


5 | Mistreatment & Discrimination

Lastly, mistreatment and discrimination are not uncommon, both in terms of getting into medical school and throughout the medical training process.

When you look at medical school admissions data, it is evident that students from certain racial backgrounds have a much more difficult time getting into medical school than others. Although affirmative action in medical school admissions aims to help increase diversity among medical students, one of the unintended consequences is that it has made it significantly more difficult for some students to get into medical school.

Asian students in particular are hurt the most by affirmative action policies. The average Asian matriculant during the 2021-2022 application cycle had an average GPA of 3.79 and MCAT score of 514.5. If we compare this to the average Black matriculant during this same year, the average Asian matriculant achieved a GPA that was nearly 0.25 points higher and an MCAT score that was nearly 8 points higher. For perspective, a 506 on the MCAT is a 65th percentile score and a 515 is a 90th percentile score. Ask anyone who has taken the MCAT, and they’ll tell you how big of a difference this is.

Asian matriculants, despite being minorities in the US and facing discrimination beyond academics, averaged a GPA and MCAT that was higher than even Caucasian matriculants. Each year these differences vary, but recently Asians have averaged a GPA close to 0.1 points higher and an MCAT more than 2 points higher than their Caucasian colleagues.

Unfortunately, discrimination and mistreatment don’t end once one gets into medical school either. According to a 2022 study published in JAMA, students from underrepresented groups who reported mistreatment or discriminatory behavior had the highest attrition rates of any group.

Students who reported recurrent experiences of mistreatment had attrition rates of 4.1% compared to 1.2% of students who reported no mistreatment. In addition, students reporting recurrent experiences of discrimination had attrition rates of 1.9% compared to 1.3% for students reporting no discrimination.

From this research, it is evident that there are issues with mistreatment and discrimination within medical education that are causing some students to leave their medical training altogether. This comes at a time when we are facing looming physician shortages across a wide variety of specialties as well.

Although medical education has its flaws, it’s not all doom and gloom. There are many things that medical education does well to prepare students for careers in medicine. That being said, it is still important to be aware of its shortcomings to better prepare yourself for what to expect.

At Med School Insiders, our goal is to empower a generation of happier, healthier, and more effective future doctors, and part of that is managing expectations. Whereas others are hesitant to talk about the issues in medicine and medical education, we believe it is important to understand these issues so you can better prepare yourself to tackle them.

Although medical education in the U.S. has its issues, if your dream is to become a doctor, it is a necessary hurdle to overcome – and we’re here to help you at each step of the way. From MCAT tutoring and medical school admissions to USMLE tutoring and residency applications, we have a variety of resources to help you along your path to becoming a doctor.

If you enjoyed this article, be sure to check out Affirmative Action and Medical School Admissions or USMLE Step 1 Pass/Fail is Changing Medical School.


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