Maclean's Magazine: Building a Better Doctor

[Guest YongQ]

Hey everybody,

 

I don't know why but I seem to have to be defending my school a lot more these days... especially with the super-biased Maclean's article that just came out.

 

There are a lot of misconceptions and stereotypes about U of T that are just unqualified. For example, the author of that article (Robert Sheppard) for Macleans interviewed a Mac meds who basically said that her friend at U of T had cadaver dissections for 4 months... now just <!--EZCODE ITALIC START--> stop right there<!--EZCODE ITALIC END-->! She obviously wasn't listening to her friend because we only have 10 weeks of dissections, which end at the beginning of November! Frankly, I believe dissections are part of a complete medical education - IMO a med student who went through dissections has a much more complete 3D picture of human anatomy.

 

And this is the least of my qualms with the article. Perhaps the greatest complaint we at U of T have about the article is the general tone of, "All bow to Mac, to heck to U of T's antiquated ways" (of course this is up for interpretation, but this is the way I read it since I see 90% of the article as basically a Mac promo).

 

More comments to come... the 0T4 and 0T5 classes have lots to say about this matter.

 

YONGQ

[Guest YongQ]

Ooops, forgot, the article can be found at:

 

www.macleans.ca/xta-asp/s...6420.shtml

 

YONGQ

[Guest governorgeneral]

just love how they're all wearing official mac labcoats/scrubs. do all med schools do that?

[Guest questions]

I think better doctors are more efficient, make fewer mistakes, and diagnose problems early. However, I doubt there will be any statistics as to which schools produce a higher percentage of these types of people.

[Guest Carolyn]

Interestingly, I thought that it had a really good portrayal of UofT -- talking about the new initiatives etc. etc...

 

I think that one statement Menaka said about cadavers was likely taken out of proportion...

 

It definitely was a bit of a Mac promo - not sure how or why -- (Does Kelton (our dean) know someone??) I think it was an accurate portrayal of Mac, perhaps didn't do as good a job at UofT... I didn't read it as a which is better though...

[Guest Ian Wong]

I read this article once and decided to wait before posting anything. Now on reading it again, I'd first like to state that it's pretty cool to know that if I'm right, two of the med students quoted in that article have actually visited and posted on this board in the past.

 

I think that this article is pretty skewed towards McMaster, but I also don't see it as being negative towards U of T. Like you, YongQ, I think the article made sure to emphasize all the positives of PBL, early patient exposure, and use of rural communities in medical education.

 

However, it failed to mention that PBL (and I should add here that this is all completely in my opinion, and Carolyn and I probably disagree here ) is inferior when it comes to giving equal treatment to each disease within an organ system versus lectures or a PBL/lectures hybrid model. Lectures allow for the consistent coverage of material, while PBL can often bring you deep into one small area of a given disease process but miss out on the remainder. Your classmates in the neighbouring PBL room can be discussing entirely different material than what you are learning in your small group.

 

I also think that while PBL is great for teaching people to research material (and continuing education and evidence-based medicine are here to stay), that PBL can be very difficult to use if you are concerned about teaching basic sciences.

 

PBL also costs a lot more to administer, both in terms of increased man-power for hiring tutors/teachers, and in terms of space (you can't just cram everyone into a large lecture hall (present at any university), but rather have to find smaller rooms for each group). At UBC, there's both Med 1 and Med 2 classes, and a total of 40 PBL rooms that need to be set aside on Monday, Wednesday, and Friday mornings to accomodate these PBL sessions.

 

Also, as Carolyn has pointed out, PBL can take many different shapes and forms. However, I still believe that in whatever incarnation, there are still some big advantages to any system that also incorporates lectures: cost, consistent coverage of material, universality of material discussed throughout the class, easier to teach basic sciences.

 

Early patient exposure? Well, I agree totally here. Early patient exposure is the basis for developing good patient skills every on, and maintaining enthusiasm when slogging through the basic sciences. But, I think the article is a bit misleading when they state:<!--EZCODE QUOTE START--><blockquote>Quote:<hr> Most schools allow their students only limited contact with real patients until they've had a couple of years of classroom training and simulation.<hr></blockquote><!--EZCODE QUOTE END--> I think most schools start with patients very early on in the curriculum, and the only exception I can think of is McGill, where I believe they have 1.5 years of books, followed by 0.5 years of clinical skills, and then 2 years of clinical work like everyone else. If you want those extra experiences, you can always arrange them yourself. Any medical student in any medical school community can find preceptors to get some extra experiences.

 

Use of rural communities in medical education? I think the practical side of this is clear. If you can get a med student engrained into a smaller community early on, chances are better that they will stay. However, one criticism that I would bring up is that the rural communities are the most starved for doctors. How then is a community consisting of a small number of doctors supposed to then undertake the huge additional responsibility of training a medical student? I don't think the writer of the article appreciates just how much a medical student doing work in a family doctor's office will slow down the family doctor!

 

This is somewhat sustainable in the city due to the huge numbers of family doctors (so we only need impose on one family doctor for one afternoon a week), but if you were to try to educate a medical student for an entire week's time, let alone months or years, (particularly without the support of resident physicians who are often the prime source of education for medical students in an urban area with an attached residency program), it would get real tough real fast.

 

It's not just as simple as saying: "Oh well, let's just train them in the community."

 

The community is already hurting bad from lack of resources. Adding the additional burden of training a doctor from scratch will impose very large obstacles.

 

As a result, I think it's an interesting article. Surely it will get people's attention, which is always good. I agree however, that from my perspective it doesn't give the most balanced coverage.

 

Ian

UBC, Med 3

[Guest Carolyn]

Ahh the old PBL argument:

 

I'd agree with what Ian says about PBL in the context of UBC (as I understand it from asking students about it on elective)... I absolutely disagree about the statements about PBL in the context of Mac. However, in order for it to be effective, you must enjoy learning in this style and take on the responsibility to learn the appropriate depth and breadth (there are tons of resources available to guide you in determining that).

 

I also agree with Ian about the challenges of early exposure... I personally have found it essential to my learning but it is a wierd feeling sometimes working with a doctor who you know is stressed for time and behind an hour before you even show up. You want to learn, you want to help but somehow you feel like you may be slowing them down a little and in the majority of the time, these docs are not getting a cent. It is definitely a fine balance. It has been a nice realization in clerkship that I now have enough knowledge and skill to help as opposed to hinder (as much...)

[Guest UWOMED2005]

I've never worn my lab coat once. In fact, I got made fun of by a surgical resident for bringing it along on an elective!

 

Most of the profs here are moving away from wearing lab coats. Scrubs have their time and place (the OR) but the philosophy of many of the MDs at Western is that a lab coat is a barrier to effective patient relationships, being a vestige of Medicine's paternalistic past. Though I do have to admit lab coats can be useful when you spill your coffee. . .

 

And I kind of agree with YongQ. . . the article was kind of BS. A lot of the innovations in the so-called current "revolution" the author credits to Mac have been adopted/initiated by other schools! (Not to metnion it was kind of unclear what was part of this new revolution, and what was really part of Mac developing PBL) Clinical experience in first year? We have that. I think most schools now do. Decentralization? I'm not sure it's a good thing. . . but that's what the Windsor program being run through Western is all about. Seemed like the author knew zilch about medical education in Canada and was trying to connect dots that weren't there to make a good story.

 

It is kind of cool that the students featured post here.

[Guest UofT App]

The UofT 2nd-year-students who did the presentation for the interviewees today also made note of how skewed and biased this article is. Nice to see that the med students keep abreast of what's being said about their school.

[Guest ThugJaan]

Well it has been the topic of some discussion at UofT.

 

Personally, I didn't find it that bad; I mean the person that wrote it would choose Mac if he were to go to med school. It was basically pointing out the Mac curriculum and how different it was. It didn't comment on any studies acutally showing it to be better, so the article was alright IMHO.

 

The only problem was with that uneducated cadavear comment. Dissections are NOT the emphasis in first year and they are like at most 10 weeks or something, not 4 months. The emphasis in first year is anatomy and physiology...funny, I would hope those are emphasized at ALL medical schools or else you are missing the point of a soild foundation.

[Guest YongQ]

But ThugJaan, you have to admit that its representation of U of T wasn't as complete as its coverage of Mac - and since Maclean's is read by Canadians of every walk of life, these people are also inclined to believe that Mac is a superior school to U of T et al., because the general public knows very little about the med school curriculum. For example, if I were reading an article about the technology sector in Maclean's, I'd tend to believe a lot of what it says because (1) Maclean's is a reputable magazine and (2) I don't know jack about technology. This is the way in which the author of the article gives a distorted view - he didn't exactly misinform, but he gives the public a false impression of different formats of medical education used across the country.

 

YONGQ

[Guest Carolyn]

I'm sorry you guys at UofT felt that it gave an inaccurate view of UofT... The author must not have done a good job researching your school! It also sounds like the researcher read articles on Mac from the early 70s when it was innovative that Mac was sending it's students in early and inventing PBL!!

 

As far as I know the person who made the cadaver comment does not post here... I think I'm the only second year posting... Andrew does post from time to time but I haven't seen him around recently (must be busy saving lives in three ERs :b !!) (PLEASE sense the sarcasm!)

 

How is the guy interviewed from UofT taking the heat?

[Guest ThugJaan]

Hey,

 

The person interviewed from UofT happens to be on e of, if not the, most active person. He is class president, on governing council, and does a lot of other stuff as well. His comments about UofT, IMHO, were very refelctive of what most people here at UofT feel about the school. Also, he didn't make any false statements like other students in the article. I know that they student body is consdering a formal responce to the article, which will probably be discussed as early as on Tuesday.

 

YongQ:

 

I totally get what you are saying about other people taking the article to be the Gospel truth. However, I am sure if you were to ask a common person on the street 'Which is the best med school in Canada?" there answer, even after reading the article, woudl probably still be UofT just b.c it always wins the MacCleans ratings as the best med school. I think the article was very biased and really a sad example of some pivot-brain using his article to push his own views instead of reporting the facts.

 

But such is life I guess. I think why maybe I am not as boiled-over by it is that I just don't think the article will have that big an impact. Sure people read MacCleans. Sure after reading that article they will think 'Gee, Mac has a nice approach there'...but the article doesn't claim Mac is the best med school, and since the only objective rating that MacCleans puts out that acutally ranks the schools has UofT as the best med school, I still think most people will look at that and still believe UofT is the best med school in Canada.

[Guest JD]

U of T isn't ranked as the best med school by MacLean's (check the website again), but rather as the best school that offers doctorate (MD and PhD) degrees. They're actually ranking the undergrad part of the school, but grouped them into doctorate, comprehensive, etc. so schools of similar size are compared to each other.

[Guest JD]

However, U of T is still my first choice at this point.

[Guest medT3]

fairly accurate descriptiopn.

[Guest ThugJaan]

Yes JD you are technically correct, but to the common person reading that list, UofT is the best med school. I mean that was the very headline inthe Metro newspaper, so I am guessing that most people have that impression.

[Guest Ian Wong]

I would hope that the average magazine reader who sees that article and is contemplating medical school will take the extra step to determine: Which medical school is best for ME?

 

There's cool things about U of T, Mac, and every other med school out there on this planet.

 

Ian

UBC, Med 3