First posted on his blog on 03/04/2013
In the satirical novel The House of God, author Samuel Shem writes about experiences as a medical student at Harvard. In the novel, many famous quotations are used that have been passed on from generation after generation of medical students and residents. Some slang terminology is also referenced and characters are created to illustrate the qualities of certain types of students. One particular student that is found in every medical school class is the“Gunner”. The Gunner is a term used to describe a hyper competitive medical student who is motivated by performance and grades and will stop at nothing to succeed. Almost every medical school class in the US has a couple of students with this character trait. All of us who have trained in the past can still remember who these students were in our own classes. Sadly, a Gunner feels no remorse about climbing over others to achieve success on the medical wards when being evaluated by attending physicians. A Gunner never learns how to work well with others and, although performs remarkably well on exams and evaluations, is often left without essential skills for success in medical practice.
Last week in the New York Times, Author Pauline Chen writes about the inability of the current medical education system to “fail” students with poor interpersonal skills and the inability to work with a team. Now, more than ever, teamwork in medicine is essential to success. In the article the story of a bright, young medical student is detailed. This young student is able to ace all of the written exams but isolates herself from classmates, treats nurses and colleagues with disrespect and is unable to accept constructive criticism. The attending physician supervising the student laments that he is unable to “fail” her due to the fact that there are no objective evaluations in the medical school grading system to deal with important attributes such as bedside manner, communication skills and interaction with nurses and colleagues.
In my opinion, this story illustrates a major flaw in our medical education system. We have a responsibility to students as well as future patients to help create doctors who are not only brilliant diagnosticians and clinicians but are also compassionate, caring and able to easily work with others. No longer is medicine practiced by the Physician in isolation. Today, medicine is centered around a team approach. Nurses, physician extenders, social workers and physicians all work in concert to produce excellent patient outcomes. Healthcare reform has now mandated certain (sometimes arbitrary) quality measures and it is only through a comprehensive team approach that these can be achieved and (more importantly for the government) documented. Nothing productive has ever emerged from a negative confrontation with nurses or colleagues in a hospital. We must reward students who display the ability to work well with others and effectively communicate with staff. More importantly, we must teach students how to readily accept and respond to constructive criticism and continually self evaluate.
Certainly, proficiency with test taking and knowledge acquisition is essential to creating a successful, effective physician. However, a physician who is able to work well with teams and communicate effectively with non physician support personnel is just as essential. We must develop a system put that actively strives to teach and evaluate these important interpersonal skills in medical school. Once students are advanced to internship and residency, these bad habits are much more difficult (if not impossible) to break. Competitiveness and striving for excellence are still important qualities in medical students. However, compassion and concern for others may be even more rewarding in the long run.