The Hypocrisy of Medical Education

[Applause]

my life as a medical student is pretty

much exactly what you would expect

most of my day is spent studying

complicated diseases and complicated

symptoms as well as even more

complicated terminology like

sphenopalatine ganglia neuralgia or

colitocholithiasis

i mean come on let’s face it if you’re

not frantically googling the

pronunciation of whatever the heck this

is before presenting a patient to an

attending

are you really in medical school

and admittedly like most 20-somethings i

spend a significant amount of my day

engaging with social media

now to be fair this really only serves

me one purpose

giving my brain a break from all the

studying by laughing at memes

in many ways memes have become a sort of

universal language among young people

they effectively portray and communicate

cultural expectations social norms and

current sentiments

so for the purposes of illustration i

thought i would pull just a couple of

medically related memes made by students

and physicians alike for you all today

so here’s one

now i think a lot of students would

probably laugh at this meme or at the

very least they’d probably relate to it

on some level

memes like this give both creators and

consumers a sense of solidarity a sense

of

hey yeah maybe this experience is hard

but at least we can all acknowledge it

and laugh about it

even so let’s not glaze over some of the

darker undertones being portrayed here

because every day i also see images

similar to this one that portray the

unhappiness of students and residents as

they brave a happy face

and work long sometimes 30 plus hour

shifts while also silently battling

their own demons of depression

burnout and anxiety

so yeah these memes might be funny and

we might laugh about them privately but

the reality they’re alluding to isn’t

funny at all

the internet hosts yet another symptom

of a deeper syndrome the so-called

medsperation pages now here ideas

probably otherwise thought of as toxic

have become normal expectations for many

students

expectations that studying should be the

only priority in your life that all

personal relationships must go on hold

until after your medical training

concludes

that you must literally suffer to

succeed you must deprive yourself of

sleep

food and exercise in order to achieve

your goals

now these aren’t funny in the slightest

and i really don’t think there’s any

covering up this very clear message

in order to be a successful physician

in order to take care of other people

you cannot take care of yourself

now this disturbing ideology certainly

extends beyond the internet into

everyday life and the effects of it

aren’t subtle either

i call the consequences of this ideology

the inflammation effect in medicine we

understand that negative health

consequences aren’t always caused by

acute injuries or diseases

rather

low levels of inflammation so low

they’re probably not actually even

noticeable to the patient over time can

grow larger to have devastating

consequences

this erosion of well-being is happening

within the medical community on a

cultural level

small daily behaviors like bragging

about how much you study how little you

sleep

or the classic oh my gosh that exam was

so hard i only got a 90 percent i’m

never going to get a good residency

well those are the inflammation and

we’re exposed to them

constantly

just recently i saw an instagram post

from a student on their surgical

rotation proudly proclaiming i haven’t

slept in 36 hours if you’re not grinding

you’re not running

i don’t know about that

okay so sometimes you have to work 36

hours i understand that but you’re

bragging about it

what is this something we brag about

i’m supposed to be impressed

once i started noticing this

inflammation i couldn’t stop seeing it

and it really started to bother me

this wasn’t something i had noticed in

undergrad so

what had changed

over the course of the past year i made

it my mission to get to the root of this

problematic culture

it’s a really interesting and also very

frustrating phenomenon i would ask a

group of classmates about how they

perceived their performance as a medical

student and as long as there were other

people around they would say things like

oh well you know if it were easy

everyone would do it or it is what it is

but one on one the truth would come out

they would tell me how unwell they felt

how burnt out they had become and how

little they felt they could trust their

peers because

they’re who i’m competing with

actually privately every single person i

talked to acknowledged that there was a

toxic culture brewing but no one dared

to admit it publicly

so the first thing i wanted to know was

whether this inflammation was localized

only to my own medical school to find

out i reached out to students at several

other medical schools all across the

united states i asked them about their

school cultures as well as their own

personal and professional motivations

and experiences within the medical

education system

here’s what i found out

ninety-one percent of students felt as

though medical school was academically

challenging

no

82 percent of students felt daily

pressure to study

65 percent of students cited peer

pressure as a major motivator for their

studies

and 73 percent

don’t discuss their grades study habits

or class ranking with others

now these numbers didn’t really surprise

me of course medical school involves

lots of studying and i think it’s really

reasonable to expect students to work

hard when they perceive their peers to

also be studying hard

i did wonder however if this amount they

were perceiving actually aligned with

reality

well no unsurprisingly it doesn’t and in

fact on average students are

overestimating how hard their peers are

working by about 30 percent further 39

reported feeling inferior to their peers

and 63 percent

reported feeling guilty if they didn’t

study for a certain amount of time each

day

but here’s the most disturbing statistic

22 percent of students i surveyed

reported that they engaged in what i

would call manipulative or malignant

behavior which included things like

withholding helpful resources from

classmates lying to them about

instruction times giving them

intentionally falsified notes

or speaking ill of them to residents and

attendings

now this isn’t the majority of students

but i do fear that it’s enough to have

serious consequences for everyone

manipulative behaviors like this result

in widespread distrust within student

communities which only further

exacerbates the already warped

perceptions and feelings of inferiority

felt by so many

even physicians have told me about the

passive aggressive or sometimes

blatantly aggressive behaviors that

often permeate hospital hallways

one resident told me about an old

medical school classmate who actually

went so far as to put mouthwash in the

contact lens solution of a colleague in

order to mess him up before an important

interview

bad i know

so why are we doing this

how have we gotten to the point where

stepping on each other to propel

ourselves to the top

is not only acceptable

but normal and maybe to some degree

expected

there are two ways to view the origins

of this toxic culture one is the result

of several systematic issues and one is

a more individualized issue

let’s start systematically

by 2032 there will be an estimated

shortage of 122

000 physicians in this country

to combat this medical school admissions

have risen 31 since 2002

and yet available residency positions

have not risen to meet this increased

demand

which means that finding necessary

postgraduate training has become much

much more competitive

on top of that it’s also worth

mentioning that in 2024 the average

graduating debt of a medical student

will exceed 300 000 dollars

so of course as far as we students are

concerned this all sets off a bit of a

panic we’re spending decades of our

lives and hundreds of thousands of

dollars on our education and yet it is

increasingly unlikely that we will be

able to find desired residency

placements upon graduation

all while millions of americans continue

to suffer from lack of access to health

care

of course students feel pressured to

compete and do well

but still let’s not all forget why

medical students are medical students

and that’s to learn medicine and to

learn it well

even here we’re starting to see some

issues of course there’s always pressure

to do well but the criteria of what it

means to do well

keeps rising higher and higher

to illustrate this check out usmle step

one the first standardized national

board exam that students all take as a

proxy so as you can see here every year

minimum passing scores as well as the

national average scores are rising

higher and higher

so are students working are students

smarter

probably not

are they working harder to meet higher

expectations

yes

is there a limit to how hard they can

push themselves

i think we might be approaching that

limit now these are very intelligent

driven individuals and yet over

one-fifth of them report regular

prescription stimulant use that’s three

times higher than college students 76

percent of them report that they use

these stimulants regularly in order to

keep up with academic demands they feel

they would not otherwise be able to meet

the good news

is that we’re starting to see some

changes in start of these systematic

issues

the usmle announced that starting next

year step one would be evaluated on a

pass fail basis which is a massive step

towards driving intense testing pressure

on students downwards

further many medical school curriculums

are also implementing past fail

standards so that students are no longer

pitted directly against each other for

class rankings these are actually really

good things for the mental health of our

students and we can all look forward to

seeing more positive changes in the

future

there is however the individual piece of

this puzzle and this is the component i

really want to focus on because a large

part of the problem lies within our

community itself

the field of medicine has had a long and

tumultuous relationship with the

perpetuation of burnout culture many

senior physicians still subscribes the

idea of i suffered when i was younger so

now you need to suffer too

that idea is dangerous

if this were a fraternity that was

hazing students by encouraging them to

stay awake for days by using illicit

substances to do so there would be

outrage wouldn’t there listen we’re

already in the middle of the medical

mental health crisis as many as 50

percent of current physicians meet

diagnostic criteria for mental illness

and yet only 26 of them are actually

seeking help

they very hypocritically are doing

exactly what they tell their patients

not to do

they don’t reach out

they don’t ask for help and they’re not

making their own health a priority

tragically this means that the suicide

rate among physicians is two to three

times higher than the general population

and yet these thousands of deaths tend

to be swept underneath the rug by this

culture

students mirror these figures closely

but what’s interesting is that when they

begin medical school the prevalence of

their mental health concerns is actually

about the same as their non-medical

counterparts which suggests that it’s

the demand and drive of their education

that contributes to their decline

and just like their attendings students

also aren’t seeking the help they need

the most commonly cited reason why is

fear of embarrassment around peers

pierce

there’s that word again

this really is a largely cultural

problem not only is pure fear

contributing to the decline of many the

health of many students as well as the

perpetuation of sabotage and mistrust

it’s the serious issue that we need to

address

now many of the issues i have presented

today are

rooted in systematic shortcomings very

much out of control for the majority of

us

but they are greatly magnified by

factors that are within our control and

please don’t mistake me the point of

this talk today wasn’t to complain about

the woes of being a medical student i

knew what i was getting myself into when

i enrolled in medical school

however i’m not ignorant to the

challenges that we face moving forward

as a community

every day i watch the people i learn and

work with suffer in silence because

their voices are squelched by a culture

that encourages self-destruction and

pursuit of what we deem as

success

we cannot in good conscience continue to

stand by and justify this destruction

because

your medical education needs to be

extremely difficult

now learning huge amounts of material

can be difficult making decisions of

life and death can be difficult working

those very long shifts to see many

patients in a strained health care

system

that can be difficult

not everyone is willing or able to do

this work and nor should they be

but at the very least what i’m saying is

that being able to trust your friends

should not be hard nor should be being

able to find security amongst your

co-workers

getting help in dealing with unique

career stressors

should not be hard

feeling valued as a learner and young

professional should not be hard

it’s important that we all ask ourselves

why am i doing this

am i mentioning to my classmate that i

haven’t slept in 36 hours because i want

affirmation

sympathy

do i want to be told wow you work so

hard when in reality i should be told

dude

that’s not healthy

i have two things to ask of all medical

professionals present and future

number one

be genuine consider the consequences of

your words and actions and do not

mislead others for personal gain

if you need help

ask for help if something goes wrong

don’t say that it went well we must each

consciously work to break these

illusions of perfection that have become

so dominating in this age of technology

because listen

everyone struggles everyone has bad days

and if they tell you that they don’t

they’re not being honest with you the

more open and honest we can be with each

other about our challenges

the more it encourages everyone to work

together instead of against each other

number two

have a voice

do not stand for mistreatment do not

excuse lies or manipulation just because

it feels normal

this is a massive issue that is eating

our community internally and it’s a

problem that can only be solved

internally

remember our wellness as health care

providers affects much more than just

ourselves

now i don’t expect these changes to

happen overnight but if today we can all

agree and accept that we do what we do

for the wellness of our millions of

patients

why do we not treat each other with the

same degree of care

thank you

[Applause]