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Is medical school admission squashing creativity?

The views expressed are those of the author and are not necessarily those of Scientific American.


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What does it take to get into medical school today?

High MCAT scores. Pre-requisites galore, coupled with a stellar GPA. Research experience. Clinical experience. Volunteering.

It has become a series of checkboxes, many going through the process gripe. Worse, it’s an exercise in conformity.

Yesterday at TEDMED, Dr. Jacob Scott shone the spotlight on this system as a root cause of the lack of creativity among people going into medicine.

“You can’t take any risks, or you won’t get in [to medical school] – you won’t get into the club,” he told the audience. But, he continued, that means weeding out creativity. Future doctors are being trained to “memorize certainty,” rather than think imaginatively.

Having gone through the admissions process recently, I could relate to many of Dr. Scott’s sentiments. It’s true: preparing to get into medical school does little to encourage risk-taking. Admission criteria are rigid. And you know if you don’t do what they ask, there is no shortage of others who will.

Want to become a doctor? You can’t slip up, or you’ll fall behind. You can’t rock the boat, or you won’t get admitted.

This critique is not unique to medical education. Scott’s talk reminded me
of a speech by former Yale English professor William Deresiewicz to the 2009 plebe class of the United States Military Academy at West Point. Skeptical of modern benchmarks of success, Deresiewicz told the young cadets:

“It’s an endless series of hoops that you have to jump through [to get into college], starting from way back… What I saw around me were great kids who had been trained to be world-class hoop jumpers. Any goal you set them, they could achieve. Any test you gave them, they could pass with flying colors…. I had no doubt that they would continue to jump through hoops and ace tests and go on to Harvard Business School, or Michigan Law School, or Johns Hopkins Medical School, or Goldman Sachs, or McKinsey consulting, or whatever. And this approach would indeed take them far in life.”

Apply that to medical school, and you get a system that selects for people who have known they wanted to be doctors since the first day of college, or even earlier. Often, that translates into students who come from families of physicians. Those who come to discover the beauty of medicine through another path, later in their academic trajectories, find themselves significantly behind – with the gap so large that many are discouraged to try. It’s too late to become a doctor, they think.

And the mandates keep escalating. In 2015, for example, aspiring medical students will have to endure a new MCAT (Medical College Admission Test): about two hours longer, with new sections on psychology, sociology, and ethics in addition to the previous sections testing physics, chemistry, biology, verbal reasoning, and writing.

I do not contest the goal of cultivating well-rounded students. But I would disagree that multiple choice questions are the best way to assess these forms of thinking. I could imagine a situation where actually grappling with ethical situations in real life could keep someone from adequately preparing for the ethical section of the exam.

Not every desirable trait is exposed through filling in bubbles.

To me, the new test means more mandates. More hoops to jump through. More rigidity. More contrived benchmarks of success. More ways to fall behind.

***

Pointing out flaws in a system is a good first step. But it’s not enough.

The real question is: can we propose a better alternative?

There is no such thing as a perfect admissions system. Every method you can conceive will have benefits and drawbacks.

You select a system by identifying different options, evaluating them, comparing them, and determining not the one stands out as ideal, but the one that is least bad. The one that maximizes what you consider the most important pros, and minimizes your conception of the worst cons.

It’s like what Winston Churchill said about selecting the best form of government: “No one pretends that democracy is perfect or all-wise. Democracy is the worst form of Government except for all those other forms that have been tried from time
to time.”

No doubt, the medical school admissions system has flaws. But can we do any
better?

If not by grades, MCAT scores, and extracurricular activities, how do you identify good future doctors?

The status quo certainly has its advantages.

After his TEDMED talk, I had the pleasure of sitting down with Dr. Scott. “I’m just
blowing the whistle,” he admitted. “I don’t have the solution.”

Still, he had some suggestions. One was setting quotas on undergraduate majors. We could create a class of twenty biology majors, twenty physics majors, twenty English majors, and so on. “Your ways of thinking are strongly defined by your major,” he explained. Thus, to assemble a diverse array of thinkers, recruit a diverse array of majors.

And yet – isn’t a person more than his or her undergraduate major? Isn’t that ignoring all a person’s other traits that would predict a good doctor? Creating a new checkbox? Not rewarding holistic learning? I agreed that medical schools need diverse ways of thinking. But, I thought about the distinction between creating a well-rounded class – and a class comprised of well-rounded individuals. I wouldn’t want to neglect the latter.

I said this to Dr. Scott. He nodded and said: “right on.”

***

Maybe it’s that attitude, right there, that we need.

Discourse, not dogma. Not just criticizing the status quo, but proposing new ideas. Dialogue. An honest evaluation of pros and cons.

A person who says “right on” to opposing ideas. A person who can adjust his or her own ideas in response to new ones.

That’s a creative person. That’s a creative doctor.

Ilana Yurkiewicz About the Author: Ilana Yurkiewicz is a fourth-year student at Harvard Medical School who graduated from Yale University with a B.S. in biology. She was an AAAS Mass Media Fellow, and her work has appeared in the New England Journal of Medicine, Aeon Magazine, Science Progress, The News & Observer, and The Best Science Writing Online 2013. She has an academic interest in bioethics, currently conducting ethics research at Harvard after previously interning at the Presidential Commission for the Study of Bioethical Issues. She is also interested in general internal medicine and quality and systems improvement. Follow on Twitter @ilanayurkiewicz.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. ironjustice 9:53 am 04/13/2012

    A doctor rarely DOES anything but ask you questions. A computer can do THAT and can be easily adapted to diagnose when every patient completes a lengthy form which would give yes or no answers , much like a medical exam , which could diagnose a patient.
    Bigger and less expensive medical schools which will place ANY student who meets the LOWEST requirements.
    “Chinese builders erect 30-story building in 15 days”
    Saturate the market with moderately trained doctors , while graduating senior nurses to the ‘elevated’ position of doctor.

    Link to this
  2. 2. jgrosay 4:03 pm 04/13/2012

    I read many years ago that an average student takes nearly 5 years to overcome the mental chastration produced by the years spent in the University.

    Link to this
  3. 3. Medical school 6:45 am 05/2/2012

    This is my first time I visit here. I found so many interesting stuffs in your site especially its discussion. It was a beneficial workout for me anyway thanks a lot for sharing it.Medical school admission requirements

    Link to this
  4. 4. DonOs 2:30 pm 10/18/2012

    With nearly 45,000 yearly applicants, it’s understandable that medical schools use a more “systematic” approach to admissions.

    It must be very difficult to strike a balance between a holistic application process and a “hoop jumping” application process because each school has to look at so many applications!

    And I believe there is opportunity for creativity in the current process. Volunteering gives applicants a big opportunity to be creative in the way they serve the public, and you can write a creative medical school personal statement when the time comes.

    Link to this

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