If You Could, What Would You Change About Medical Schooling And Training?

If you could, what would you change about medical schooling and training- from undergraduate to residency in the US?

This question was originally posted on Quora.com and was answered by Michael Depietro, Pulmonary and Critical Care Medicine Physician



I would do the following

1. Much more exposure to biostatistics and data analysis in the first two years of medical school. Physicians will for the rest of their careers need to read medical journal articles critically and few are comfortable with understanding the presentation of the data unless they are actively engaged in clinical research themselves.
   
   
2. More universal and formal training in bedside ultrasound, this is the physical exam of the future.
   
   
3. Much more intense integration of reading radiographic images with anatomy training in the first year of medical school. There is way to much emphasis on memorizing details of anatomy that everyone forgets and not nearly enough emphasis on understanding radiographic anatomy which everyone will use.
   
   
4. Some of the basic sciences need to be better integrated into clinical medicine. This means at the end of the day having clinicians seriously involved in teaching it.
   
   
5. Someone needs to start paying for and thus rewarding teaching. In the current model there are only two activities that bring in dollars to both hospitals and medical schools. These are obtaining funded research and seeing patients. Both obviously are extremely important, and the heart of why medicine is done at all, but teaching the next generation of physicians is also critical. Doing it well does not get you much career advancement (it is a labor of love). In fact much of it is done for free. I spent about 20 years as voluntary clinical faculty at teaching hospitals affiliated with two medical schools while in private practice, I loved it, but expanding these teaching efforts was always a little controversial since teaching slows you down and negatively affects patient revenue generation. (If you see patients with a resident or medical student it is a slower process and you see fewer patients) Most clinical teaching in this country is trainees teaching other trainees. Medical students are not taught mostly by seasoned clinicians but by resident physicians still in training themselves. Residents teach other residents, and attending physicians may teach residents, if they happen to like doing do, but at other times residents teach themselves and function as cheap physician labor for the health care industry. We need to reward good teaching, which means we need to pay for it.

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