Perhaps even more than other students, many young people entering medical school are full of idealism and social-mindedness. After all, what greater career path is there than helping others who need medical treatment?
One noted physician, however, believes that medical school wrings the hope out of students. Michael Wilkes, a professor of medicine at the University of California at Davis, writes frequently about medical issues in the Sacramento (Calif.) Bee. Recently he set forth his concerns about something that happens to young medical students as they wend their way through medical school: They spend too much time with older doctors.
Wilkes calls this a hidden curriculum. Medical school faculty members are supposed to be close to their students so they can teach them the intricacies of medicine. What this all comes down to is the fact students generally become increasingly cynical as they watch the reality of treating patients. Wilkes describes it this way: Our lectures and discussions strongly emphasize ethics, professionalism and issues related to respecting and understanding the patient as an independent decisionmaker. But the influence of coursework pales compared with the power of the untaught curriculumthe influence of exposing students to what we actually do with patients and colleagues rather than what we say we should do.
Of course, you see the same phenomenon in other careers. So many young people start their careers with idealism and enthusiasm and then, as they progress, they get discouraged and disillusioned by the behavior of older colleagues. It doesnt take long to figure out that if you want to move ahead, you better not rock the boat. Sure, its nice to think there are people who wont conform, but most people want to succeed. Stepping on toes and being different doesnt necessarily earn brownie points with elders.
The stakes in medical school, however, are higher. It is one group of people who shouldnt be cynical too early in their careers. These young men and women will be dealing with the most intimate aspects of life and death.
Think of how young medical students must feel when they witness discriminatory behavior on the part of senior residents and teachers. Wilkes puts it this way: We can teach extensively about the appropriateness of respecting different cultures, different beliefs and different health practices, but when the student hears a resident dissing a patients mistaken notions of disease, or hears them making fun of a patients body, the lesson is clearto be a part of the club, this is the expected behavior.
Medical students are extremely observant, Wilkes says. They watch as their colleagues and instructors ignore patients who dont speak their language or wont enter the room of someone who has a terminal prognosis or wont help a nurse who is overwhelmed with helping three or more patients all at the same time. Think of the disillusionment these students must feel as they observe this behavior.
For medical students, Wilkes writes, there is a strong social driveand academic needto belong to the group, be it with surgeons, psychiatrists, pediatricians or the like, it is not surprising that students model the behaviors they see.
Wilkes refers to a publication of the Association of American Medical Colleges that found that medical students reach the pinnacle of cynicism in their final year and even become more cynical than their residents and faculty members.
So what do we take from all of this? Perhaps the lesson for us alldoctors, students and the publicis that our behavior is watched, and that those around us can learn important unintended lessons by what we do, rather than what we say, Wilkes writes.