Blog Archive

Thursday, February 23, 2017

A Tale of 3 Medical Students

A Tale of 3 Medical Students

Here’s how medical school works…The first 2 years of medical school cover the acquisition of medical knowledge.  This occurs through lectures, reading, study, and testing.  The acquisition of this knowledge occurs through individual interaction and involvement with the subject matter.  The last 2 years of medical school include monthly clinical rotations at hospitals and clinics in the subspecialty areas of Medicine.  The student treats patients under the supervision of residents, faculty, and attending physicians.  Supervised clinical practice uses the knowledge acquired from the first 2 years of school on real patients for the last 2 years.  Here are examples of how 3 real medical students approached their learning.

 “John” attended the University of Illinois Medical School in the early 1970s, earning the honorary designation of “James Scholar”.  This honor entitled him to the exclusive use of a study carrel at the medical school, and the privilege of designing his own course of study, as long as he passed all requirements and exams.  John’s method of study involved reading each medical text book cover to cover, not attending class, and graduating in 3 years.

 “Mary” attended a US medical school in the South.  Her method of study for the first 2 years was as follows.  She listened to her online class lectures at an accelerated rate of speed on her computer.  She varied her locations between her apartment, Starbucks, and Panera Bread Company.  Her clinical rotations were taken at a variety of hospitals and clinics in the greater metro area around her medical school.

 “Joe” attended An international medical school.  He attended class lectures, read, studied, and took exams.  His clinical rotations took place in the New York City metropolitan area for the last 2 years of medical school.

 These 3 students each had a different approach to the didactic portion of their medical knowledge.  The clinical rotations were a fairly uniform experience, all taken in the US.  They all graduated from accredited medical schools with an MD degree.  They all passed USMLE parts I and II.  They all applied for residency through NRMP.  Haven’t they all fulfilled their side of the “Social Contract”?  Don’t they all deserve the opportunity to complete the final step in their training?

Tuesday, February 21, 2017

Our "Social Contract" / NRMP

Our “Social Contract”/ NRMP
Image result for contract images free 

All US citizens who have satisfied the requirements for an MD degree, and passed all required exams (USMLE I AND II), have earned the right to train and practice Medicine in the US.  This is our “Social Contract”.  Think of medical school as one big “lesson plan”.  As teachers know, each lesson plan begins with the “Behavioral Objective” and ends with the “Criterion Task”.  If the goals and benchmarks outlined in the Criterion Task have been met, the Behavioral Objective has been met.  US medical schools and government legislatures have determined the criteria required to practice Medicine in the US.  All medical school graduates who apply for residency through the NRMP (National Resident Matching Program) have met these criteria, both US medical school grads, as well as international medical school grads.  They have all passed the CRITERION TASK!

 Why aren’t we “upset” if 25% of unmatched grads are from international medical schools, especially since 42% of them in 2016 were US citizens?  Currently, 25% of physicians practicing in the US are international medical school graduates.(1) Considering the expected 90,000+ doctor shortage over the next decade, that is quite a waste of fully educated doctors!

 The ECFMG (Educational Council for Foreign Medical Graduates) has been promoting excellence in international medical education for 60 years! (1) This organization has been evaluating the readiness of IMGs (International Medical Graduates) to enter GME (Graduate Medical Education) programs in the US.  It has partnered with NBME (National Board of Medical Examiners) to develop the clinical skills assessment for the USMLE (US Medical Licensing Examination).  To become an accredited medical school with the SAME STANDARDS as a US medical school, a foreign med school has passed rigorous standards and criteria.

 “The ECFMG makes its world-class experience with the primary-source verification of medical education credentials available to the international medical regulatory community.”(1)  It is recognized world wide.  This is the organization monitoring graduates of international medical schools  The IMGs applying through the NRMP have met the “Criterion Task” for entry into US residencies!

Monday, February 20, 2017

What is the American Medical Association Doing? AMA

What is the American Medical Association doing?

            According to CME Report 3-A-16, from the Council on Medical Education, the AMA recognizes the funding and distribution of residency positions for GME (Graduate Medical Education) are “in crisis in the US and that meaningful and comprehensive reforms are urgently needed”.  This report focused only on US medical school seniors, and does not include International Medical Graduates (IMG).  Currently, 25% of practicing physicians in the US are graduates of international medical schools.(1)  Many of these are US citizens who attended international medical schools.(2)  Here are some of the points made in this report and Resolution 308 (A-16):

  • “There is a predicted physician shortage of between 46,100 and 90,400 physicians by 2025” (AAMC, March 2015)
  • The overall match rate for US and IMG medical students was 75.2%
  • The majority of the 25% not matching are International Medical Graduates(IMG)
  • There has been continuous growth of US medical schools and increased enrollment
  • There has been limited growth in Graduate Medical Education (residency positions) due to caps in federal funding (The Affordable Care Act)
  • The AMA “will strenuously advocate for legislation” along with the AAMC (Association of American Medical Colleges) to increase federal funding of GME
  • Medical school seniors’ “fear of being a loser” have caused residency applicants to apply to an average of 47 programs to avoid not matching into a residency (up 20% in the last 5 years)
  • This has forced program directors to use USMLE scores and quantitative criteria as a numeric “cutpoint” rather than perform an in-depth review of every application
  • USMLE  scores alone are NOT predictors of success in residencies
  • The AMA is opposed to state legislation for licensing “untrained” doctors on the basis of patient safety and quality concerns
If the AMA says the number of GME positions is in “crisis”, yet does not support state legislation for licensing unmatched doctors, how can this catastrophic deficit in residency slots be rectified before these fully educated and qualified doctors are forced to leave Medicine?  More than 40,000 doctors have not matched already in the last 5 years.

 Why isn’t the plight of unmatched international medical graduates as crucial as that of graduates of US medical schools, since 42% of IMG in 2016 were also US citizens?

 Are US medical schools better than IMGs?  Are US graduates smarter than IMG graduates?

 (2)   Report of the Council on Medical Education, CME Report 3-A-16