Student and Resident Letters to the Editor: Admissions, Assessment, and Advocacy
Carrie L. Barlow
High school science teacher, Chapel Hill High School,
Chapel Hill, North Carolina.
Reference
1 Gikandi JW, Morrow D, Davis NE. Online
formative assessment in higher education:
A review of the literature. Comput Educ.
2011;57:2333–2351.
Do “Good” Medical Students
Really Make Good Doctors?
To the Editor: The quintessential
“good” medical student isn’t difficult
to picture. Her dedication borders on
obsession and pays dividends in the form
of excellent marks, supervisor praise, and
the knowledge that she is responsible
for raising the bar out of reach of the
rest. “Good” medical students usually
also count flashcards among their brief
list of hobbies, and are those for whom
sleep deprivation is a competitive sport.
Success in medical school is almost
wholly defined by exam results, and
there are no bonus marks for being well
rounded. However, whether extreme
dedication alone is ultimately enough to
make a good doctor remains to be seen.
Academic achievement is a key aspect
of most medical students’ identities.
Unfortunately, upon starting medical
school many students experience the
difficult realization that they have moved
to a different part of the bell curve than the
part to which they have been accustomed.
The desire to ascend back to the pointy
end is readily appreciable. Unfortunately,
the qualities that facilitate this, and those
that are valued throughout medical school
by the culture or curriculum, are also
those that predispose us to burnout and
a poor work–life balance. Mental illness
is becoming an occupational hazard of
medical training.1 Considering the narrow
definition of the “good” medical student
that we internalize from our first day, along
with the internal and external pressures
to achieve this status, it is not difficult to
imagine why this might be.
The “good” medical students may
become successful doctors as judged by
the formidably high standards of the
profession, though it may come at a cost
to their personal well-being. However, the
qualities that this process fosters are not
necessarily those that patients identify as
most valuable, such as communication
skills, patience, and empathy. It is
Academic Medicine, Vol. 92, No. 6 / June 2017
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
indisputable that aptitude is vitally
important. A medical student who can’t
tell aspirin from adenosine isn’t just failing
to meet the criteria of a “good” student, he
is a danger to patients. However, it is also
possible that the cost that we are willing to
accept to produce the best and brightest is
immense, and is not always in our future
patients’ best interests. Considering this, if
we thought about the pervasive attitudes
that inform our definition of a “good”
medical student as a disease, it’s hard to
believe that we would not try to treat it.
Disclosures: None reported.
Imogen Thomson
Third-year MD student and MPhil candidate,
University of Sydney, Sydney, Australia; itho4440@
uni.sydney.edu.au.
Reference
1 Dyrbye LN, Thomas MR, Shanafelt TD.
Systematic review of depression, anxiety, and
other indicators of psychological distress
among U.S. and Canadian medical students.
Acad Med. 2006;81:354–373.
Medical Students Call for
Single-Payer National Health
Insurance
To the Editor: I wish to thank the
authors of “Role Modeling and Regional
Health Care Intensity: U.S. Medical
Student Attitudes Toward and Experiences
With Cost-Conscious Care”1 for providing
students across the country an opportunity
to voice our collective thoughts on this
subject. I also wish to voice a collective
request for a 36th item for future surveys:
How much do you support or oppose
single-payer national health insurance?
Like all medical students and researchers
in Medical Scientist Training Programs,
my MD–PhD education is heavily
underwritten by the taxpayer. Like
other young physicians, my graduate
medical education will be funded by
the Centers for Medicare & Medicaid
Services. However, unlike most of my
future colleagues, I will not graduate
with hundreds of thousands of dollars
in student loans and other debt, as my
education has been heavily publicly
funded. Their debt burden will distort
their specialty and practice choices for
decades.2 As others have noted in this
journal,3,4 single-payer national health
insurance has the potential to cover tuition
for medical school and allow all young
physicians to pursue their true calling,
like me. Although important factors such
as patients, physicians, and government
programs must be considered, a “Medicare
for all” single-payer system has the
potential to reduce insurance company
administrative fees, the savings from which
could be used for tuition.
Beyond the potential personal benefits
of a single-payer system, students are
interested in disruptive innovation.5
We do not want to practice in an unjust
system, where tens of millions of patients
are uninsured and underinsured because
a market-based system benefits large
private insurers, their investors, and
their executives. We have found our
voice through Students for a National
Health Program within Physicians for a
National Health Program.6 Students want
to transform today’s broken health care
system into something extraordinary for
the future of individual patients and for
the betterment of the entire society we
will serve. We want to help achieve health
equity. We want to serve as professionals
grounded in lifelong servitude to our
patients for the betterment of society.
Please ask us about our support for a
single-payer system and work with us to
make our vision a reality.
Disclosures: None reported. The author wishes
to thank Dr. Marcia Angell, Ida Hellander, and
Emily Henkels at Physicians for a National Health
Program for helping him find his voice for this
collective request.
Andrew M. Harrison, PhD
Year 7 student, Medical Scientist Training Program,
Mayo Clinic, Rochester, Minnesota; Harrison.
Andrew@mayo.edu.
References
1 Leep Hunderfund AN, Dyrbye LN, Starr
SR, et al. Role modeling and regional health
care intensity: U.S. medical student attitudes
toward and experiences with cost-conscious
care. Acad Med. 2017;92:694–702.
2 Rosenblatt RA, Andrilla CH. The impact of
U.S. medical students’ debt on their choice
of primary care careers: An analysis of data
from the 2002 medical school graduation
questionnaire. Acad Med. 2005;80:815–819.
3 Petersdorf RG. Financing medical education.
Acad Med. 1991;66:61–65.
4 Gold JP, Stimpson JP, Caverzagie KJ.
Envisioning a future governance and funding
system for undergraduate and graduate medical
education. Acad Med. 2015;90:1224–1230.
5 Schiff GD. A piece of my mind. Crossing
boundaries—Violation or obligation? JAMA.
2013;310:1233–1234.
6 Woolhandler S, Campbell T, Himmelstein
DU. Costs of health care administration in
the United States and Canada. N Engl J Med.
2003;349:768–775.
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