Competition at Medical School: A Good Thing?

According to medical student, “John,” medical school is all about competition. The students compete with each other to get the best grades, impress the professors, and be assigned to the rotations of choice. The schools compete with each other in offering the most diverse curriculum, having the best students, hiring the top professors, and more. Some of the schools compete by charging the least, meaning that they hire professors who may not be top quality. Others compete by saying they are worth the most and charging the Earth. All this competition should be good, right?

Actually, John believes that it is not. He has noticed that the most prestigious professors are not necessarily those who are the best teachers. Others just do not know the subject to which they have been assigned. They are PhD’s in another field or clinicians who left the basic sciences behind a long time ago and are being stretched beyond their capabilities due to the financial constraints of the institution.

Then, there is boasting about offering a large and diverse curriculum. But, an overload of information gives students little time to actually understand the material. The students then resort to rote memorization of often irrelevant details to pass tests, leaving no time for actual mastery of vital concepts.  Even the competition between students is not always helpful–especially when they do not share study materials or cheat in order to gain the upper hand.

Take a recent experience. John was in a class where the professor asked the students when a clinician should give a pregnant mother antibodies to the Rh factor. The answer given in the PowerPoint slides, that which most students memorized, was when the mother is Rh negative (meaning she would have anti-Rh antibodies). This view was popularized by the makers of Rho Gam and is what 99% of the student body answered. John pointed out that the mother only needs antibodies if the fetus is Rh+. Nonetheless, the professor counted the “book” answer as correct. The students then gave John a hard time for “making them look bad” by studying beyond the curriculum.

But, what did John actually do? He spent time understanding the body systems and, as a result, could come up with the answer by logic, not memorization. In a clinical situation, he would have spared the Rh- mother of an Rh- baby the possible exposure to viral agents found in human plasma and the possible allergic reactions, not to mention saving the cost of the unnecessary RhoGam.

Perhaps medical schools should major on giving the students less memorization-based and more understanding-based curricula. This will mean hiring professors who are both experts in the fields they teach and who also have the patience to help students grapple with and understand the systems. After all, passing tests is not enough when it comes to life and death issues.