Compassion Deficit: How U.S. Med Schools Fail in Grading its Students
Two months ago, The New York Times published a fascinating article about the difficulties of grading U.S. medical school students on clinical skills that cannot be easily quantified: intuition, professionalism, compassion, and bedside manner. If they were graded on these criteria, many of these students would have flunked out.
In the mid-1990s, directors of internal medicine clerkships were asked to examine the grading standards for their students. According to the article, ”over 40 percent admitted they had passed students who should have failed .” After the study was released, some medical schools created a system called RIME (Reporter-Interpreter-Manager-Educator), which attempted to evaluate the professional growth of medical students. Even after this was implemented, a recent study has shown there has been little change in creating more compassionate, professional physicians.
Why have grading standards not changed? There are numerous factors that have prevented medical schools from embracing a new way to accurately judge the success of its students. Some medical educators are afraid these unprofessional students might be litigious. Some have been pressured by their higher ups to get more of these students into selective training programs. Some of it can be attributed to complacency with a system that has been used for decades.
The damage the current U.S. medical school system has done to the medical profession can be seen in the comments section of the article. The top comment from a Duke medical student gets to the heart of the problem. The Duke student suggests that the students (mainly admitted because of their high MCAT scores) who thrive in this environment are typically “ hyper-competitive, grade obsessed, rat-race running student who can game the system well and memorize and regurgitate information.” A 4th-year medical student added to this astute assessment, stating that these schools taught more to the test instead of patient care. From a patients perspective, a commenter named Bev complained about how she and her husband were mistreated by specialists who ignored their medical histories.
To combat this growing dissatisfaction with this unprofessional behavior, U.S. medical schools are in the process of implementing national standards for all students. These standards include testing students on a defined set of competencies such as interpersonal communication, professional behavior, and specialty-specific procedures. This is already being implemented in some residency programs and will take a few years more for medical schools to adopt these standards.
American University of Antigua (AUA) College of Medicine is aware of this situation plaguing these institutions and applauds the attempts by these medical schools to create a national standards list. Despite this, it will be difficult to change a culture that is defined solely on grades, cutthroat competitiveness between students, and medical educators failing to assist students in meaningful ways. There is little room to build compassionate physicians when students’ interpersonal skills aren’t properly assessed and when rivalries are fostered instead of teamwork. AUA has been ahead of U.S. medical schools in this regard. AUA has early hands-on clinical education in our curriculum to allow students to understand the many intricacies of patient care, students are encouraged to work together to solve clinical dilemmas, and professors are readily available to help students succeed in medical school.
There have been many advances in medical care both technologically and philosophically in the past decade. Patient-centric care should be the paradigm in medicine. It’s already the ethos in hospital construction. Hospitals are being built that, by their architectural design, will focus on fostering patients mental and physical health, increasing comfort levels, and reduce stress. If U.S. medical schools do not follow suit and build its students the same way, then the legacy of these hospitals will be defined as merely a shift in aesthetics instead of a revolutionary shift in medicine.