Your entire through line to me is medical education. It seems you feel medical education needs to change. And my perspective is that the make-up of medical trainees needs to change. Now, we can’t change a coddled generation en masse. But we can certainly help them unlearn some bad and unhelpful habits they picked up from general society.
Your entire through line to me is medical education. It seems you feel medical education needs to change. And my perspective is that the make-up of medical trainees needs to change. Now, we can’t change a coddled generation en masse. But we can certainly help them unlearn some bad and unhelpful habits they picked up from general society.
And if you want to debate whether we have a coddled generation or a generation and a half, get back to me after you read Coddling of the American Mind.
I’m a huge fan of Jonathan Haidt’s work (can’t wait to read his new book coming out). Just don’t think your sweeping generalization is an accurate characterization of what I see in current residents or fellows.
The bottleneck selection process for med school is intense. These people work just as hard and have significantly more debt, life delays, and demands on learning than even I experienced 10 years ago. Pharmacology has exploded. Sub-specialization of knowledge has reached new depths. The debate is not about ‘generational trends’ - that conflation not only misses the mark but also shifts the focus away from ‘at risk’ infrastructure which (yes) will require leadership from medical education to repair.
I’m curious - do you work with trainees? Have you seen evidence of lackluster work ethic in patient care from younger generations?
Leading edge Gen Z turn 29 this year. I predominantly work with cardiology fellows, so the next incoming class will be the first of that era. I also work with some IM residents, but usually the ones who want to be cardiology fellows one day, so work ethic has not been an issue….to date.
The perspective I describe is only what I’ve read and heard about the current era of med students, which seems congruent to what was described in the NEJM piece. Thankfully, I haven’t had to witness or experience any of that nonsense first hand. What I will say is that if students have such attitudes, I have no reason to expect that they would self -correct as medical graduates. So I guess we will see in the next few years if the quality of medical care suffers from the generational ills of newer physicians.
As you note, competition for medical school admission is intense….it’s a buyers market. If we are picking med students who expect coddling, maybe it’s our selection process, and not the education, that needs overhaul. Maybe we are rejecting the wrong people, when there are many other willing and eager people to choose from.
You also mentioned burn-out. No doubt an issue of our time. How is a variation in medical education going to mitigate that?
The best way to navigate the moral chasms / moral injury of a broken system is with moral courage and competence. I’ve framed longitudinal clinical mentorship as not just a cognitive apprenticeship but also a moral apprenticeship. It’s only a matter of time until our identities as physicians are fragmented (further distributed) across AI networks and talking about the ‘core’ of the physician identity is important in preserving the best of medicine.
I’m sure even your cards fellows have periods of diastole in between intense periods of systole. My experience with the vast majority of med students I work with is an earnestness, caring, and pride in their work to be good doctors. Standards and expectations remain quite high. I think most generational rhetoric is short-sighted (at least to what I can speak to in medicine).
I guess this speaks to some of the core tenets of your piece which I did not understand.
How is the system broken? I did fellowship training in the US but practice in Canada, so I don’t have first hand contemporary experience with the training paradigm there now. Perhaps things have changed but they seemed functional when I was there.
What moral chasms are you referring to? What moral injury is there a risk of? (What even is a “moral injury”?)
I agree with the importance of mentorship. And I acknowledge that mentorship goes beyond “how would you treat this” and “how would you approach the DDx of that”, to one where a philosophical approach to medicine may be imparted. But the need for incorporating mentorship into medical training needn’t require a top to bottom rethink of how medical training is conducted.
I should be more specific. Medical education isn’t broken - the US system of care is broken. Prior auth, insurance coverage, hospital wait for long term placement, clerical burdens, and a failing primary care system that’s attracting only 9% of IM grads (used to be 25%). I can’t speak to Canadian context but moral injury is when standard of care is lowered bc of systematic constraints. Like waiting 3-6 months for a stress test or 6-9 months for subspecialty consultation. Going into primary care takes moral courage and I’m grateful for the strong mentors who trained me for managing uncertainty / novelty / risk (all of which are increased when systems don’t function well). I wouldn’t have done primary care without them (and just gone into hospital medicine instead but that’s not where the need is). There are lots of places medical education could ‘put their eggs’ - I just so happen to believe it should be invested in developing / rewarding master educators who do this day in and day out. And the flexnerian to competency-based model is another conversation for another day. I just wanted to invite people to be open to reimagining a system where trainees want to go into primary care and want to serve their patients - the backbone of a multi-morbid health system. That cannot happen without organizational advocacy, collective influence, and a focus on intentional longitudinal clinical mentorship starting with medical students.
Ah, understood. I’ve never worked in the US system as an attending, so can only offer armchair commentary. I don’t envy the myriad bureaucratic barriers that you have to tackle every day. But we also have access issues, albeit perhaps distributed in a different fashion here north of the border. However, “ hospital waits for long term placement” certainly sounds very familiar, esp since I spent a week on service quite recently.
Your entire through line to me is medical education. It seems you feel medical education needs to change. And my perspective is that the make-up of medical trainees needs to change. Now, we can’t change a coddled generation en masse. But we can certainly help them unlearn some bad and unhelpful habits they picked up from general society.
And if you want to debate whether we have a coddled generation or a generation and a half, get back to me after you read Coddling of the American Mind.
I’m a huge fan of Jonathan Haidt’s work (can’t wait to read his new book coming out). Just don’t think your sweeping generalization is an accurate characterization of what I see in current residents or fellows.
The bottleneck selection process for med school is intense. These people work just as hard and have significantly more debt, life delays, and demands on learning than even I experienced 10 years ago. Pharmacology has exploded. Sub-specialization of knowledge has reached new depths. The debate is not about ‘generational trends’ - that conflation not only misses the mark but also shifts the focus away from ‘at risk’ infrastructure which (yes) will require leadership from medical education to repair.
I’m curious - do you work with trainees? Have you seen evidence of lackluster work ethic in patient care from younger generations?
Hey well we definitely share 1 thing in common.
Leading edge Gen Z turn 29 this year. I predominantly work with cardiology fellows, so the next incoming class will be the first of that era. I also work with some IM residents, but usually the ones who want to be cardiology fellows one day, so work ethic has not been an issue….to date.
The perspective I describe is only what I’ve read and heard about the current era of med students, which seems congruent to what was described in the NEJM piece. Thankfully, I haven’t had to witness or experience any of that nonsense first hand. What I will say is that if students have such attitudes, I have no reason to expect that they would self -correct as medical graduates. So I guess we will see in the next few years if the quality of medical care suffers from the generational ills of newer physicians.
As you note, competition for medical school admission is intense….it’s a buyers market. If we are picking med students who expect coddling, maybe it’s our selection process, and not the education, that needs overhaul. Maybe we are rejecting the wrong people, when there are many other willing and eager people to choose from.
You also mentioned burn-out. No doubt an issue of our time. How is a variation in medical education going to mitigate that?
The best way to navigate the moral chasms / moral injury of a broken system is with moral courage and competence. I’ve framed longitudinal clinical mentorship as not just a cognitive apprenticeship but also a moral apprenticeship. It’s only a matter of time until our identities as physicians are fragmented (further distributed) across AI networks and talking about the ‘core’ of the physician identity is important in preserving the best of medicine.
I’m sure even your cards fellows have periods of diastole in between intense periods of systole. My experience with the vast majority of med students I work with is an earnestness, caring, and pride in their work to be good doctors. Standards and expectations remain quite high. I think most generational rhetoric is short-sighted (at least to what I can speak to in medicine).
I guess this speaks to some of the core tenets of your piece which I did not understand.
How is the system broken? I did fellowship training in the US but practice in Canada, so I don’t have first hand contemporary experience with the training paradigm there now. Perhaps things have changed but they seemed functional when I was there.
What moral chasms are you referring to? What moral injury is there a risk of? (What even is a “moral injury”?)
I agree with the importance of mentorship. And I acknowledge that mentorship goes beyond “how would you treat this” and “how would you approach the DDx of that”, to one where a philosophical approach to medicine may be imparted. But the need for incorporating mentorship into medical training needn’t require a top to bottom rethink of how medical training is conducted.
This could be considered an example of moral injury: https://torontostarreplica.pressreader.com/article/282441353823829
I should be more specific. Medical education isn’t broken - the US system of care is broken. Prior auth, insurance coverage, hospital wait for long term placement, clerical burdens, and a failing primary care system that’s attracting only 9% of IM grads (used to be 25%). I can’t speak to Canadian context but moral injury is when standard of care is lowered bc of systematic constraints. Like waiting 3-6 months for a stress test or 6-9 months for subspecialty consultation. Going into primary care takes moral courage and I’m grateful for the strong mentors who trained me for managing uncertainty / novelty / risk (all of which are increased when systems don’t function well). I wouldn’t have done primary care without them (and just gone into hospital medicine instead but that’s not where the need is). There are lots of places medical education could ‘put their eggs’ - I just so happen to believe it should be invested in developing / rewarding master educators who do this day in and day out. And the flexnerian to competency-based model is another conversation for another day. I just wanted to invite people to be open to reimagining a system where trainees want to go into primary care and want to serve their patients - the backbone of a multi-morbid health system. That cannot happen without organizational advocacy, collective influence, and a focus on intentional longitudinal clinical mentorship starting with medical students.
Ah, understood. I’ve never worked in the US system as an attending, so can only offer armchair commentary. I don’t envy the myriad bureaucratic barriers that you have to tackle every day. But we also have access issues, albeit perhaps distributed in a different fashion here north of the border. However, “ hospital waits for long term placement” certainly sounds very familiar, esp since I spent a week on service quite recently.