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Why Do 'Well-Rounded' Newly Minted Physicians Lack Life Skills?

— Now is the time to integrate "life skills" trainings into medical education

MedpageToday
A photo shot from behind the shoulder of a senior physician giving a lecture to medical students.

Ah, medical school. A destination dreamt of by pre-meds everywhere. Students spend years crafting a well-rounded repertoire for a chance to get in: master the basic sciences here; volunteer at a clinic there; perform at the Met if you can manage it. Once they finally reach medical school, 95% of that repertoire is suddenly, well, irrelevant. But, at least after getting to medical school, students will get to learn the ins and outs of the human body, attempting to create yet another all-encompassing medical persona: ace your coursework; lead an organization; don't forget to volunteer. Once they make it to residency, they will finally have a chance to apply all their hard-won expertise when they have to, um, select a billing code that properly reflects their 10-minute conversation with a patient. And, oh yeah, the patient doesn't have insurance. Huh? Didn't have a flashcard for that.

Okay, maybe I've exaggerated, and the foundational knowledge and accomplishments built up over those many, many years are certainly important for a physician's career. But what strikes me, a current medical student, as odd, is the lack of education around "life skills." Doesn't this fit perfectly into the "well-rounded" aesthetic?

Sure, medical school is about teaching doctors how to treat diseases and fix broken legs, and the schools are pretty good at that. Still, our graduates are walking into the wild world of modern medicine where our healthcare system -- so convoluted even M.C. Escher would get lost -- stands between these brand-new doctors and their patients. So, why not give them a leg up? Or a map at least.

Those "life skills," like "how insurance works," or "how to be a team leader," or even "how to treat a patient who is transgender/non-English speaking/a different color than me," are usually learned trial-by-fire. Unsuspecting residents fresh out of the pressure-cooker are just expected to figure it out, making mistakes and hopefully learning from them while they juggle the responsibilities they were trained to do. Suddenly, their smooth exterior is producing some sharp edges. It would be great if these skills could be incorporated into early medical education and training to give students a fighting chance.

But what would this look like? My suggestion is simple: add more coursework.

I certainly appreciate the temptation to boo that suggestion into submission, given the inordinate amount of coursework already standing between students and an MD -- but hear me out. With the somewhat recent transition of STEP 1 to the beloved pass/fail system, now is the perfect time to begin incorporating education on those life skills, as many medical schools are already restructuring their curricula. If you sensed a "but" coming from the medical school admin, here it is: why should medical schools, dedicated to creating physicians who excel at patient care, spend precious classroom hours devoted to anything other than medicine? Again, I offer a simple suggestion: patient care is about more than medicine.

The days are long gone when medical care was solely at the discretion of the physician; even great diagnosticians like (the fictional) Gregory House -- God love him -- wouldn't be able to hold a job. The importance of the patient's agency in medical decision-making, their right to healthcare, and respect for their human dignity are increasingly hot topics, and medical students shouldn't have to wait until they've stumbled into the wards to join the conversation. This could look like a longitudinal training, taught in parallel with the current curriculum. Or it could be a series of one-off lectures addressing any of the areas above.

All I'm asking is that medical schools begin teaching physicians-to-be how to be physicians with their patients; teach them how to leverage the healthcare machine for their patient's benefit. Eventually, this may smooth out those sharp edges and schools will start producing well-rounded physicians.

is an MD candidate at the Saint Louis University School of Medicine in the class of 2025.