Letter: The medical school method is not a scam

TO THE EDITOR:

You don’t learn how to treat patients by first treating patients. 

A recent article in The Daily Tar Heel suggested that the first two years of medical education are both “a scam and a waste of resources.” 

But put bluntly, patients do not present themselves as multiple choice questions. Medicine is both science and art. The preclinical may appear to emphasize the science, but students equally focus on the art. 

The art of performing the basic physical exam, more fully developing and showing empathy, building confidence to ask very personal questions and refining the ability to uncover other important clues such as the social determinants of health. The faculty lectures in the preclinical years give you more than the script to solve a medical problem. They give context to and practice in thinking through real-life scenarios (it’s called “clinical reasoning” after all) before you are given real medical responsibility.

While the advancement of technology has improved the delivery of medical science instruction, it serves to enhance, but not replace, one’s baseline understanding of a subject matter. 

While spaced repetition is indeed a validated method to learn, if one lacks the clinical context for the information, then one is just learning factoids you can deploy when you watch Jeopardy on the couch with friends and family.

And for those who don’t have the luxury of time and money, dedicating two years to full-time study without the benefit of university aid or scholarships poses a significant, if not insurmountable, barrier to many students. The formal university structure allows for a learning environment without holding down a job to provide the basics such as food, housing and health insurance. 

I agree that learning from your medical role models during the first two years is a way to influence what your ultimate career will be and instill the set of values that will help guide the moral aspects of practicing medicine. 

However, it would be near impossible to absorb all of these “doctorly values” in years three and four alone. Time is at a premium during this phase of training, and we must come into it with a majority of our professional values instilled. 

And while the board exam (Step 1) that is taken at the end of the pre-clinical years plays a large role in where/what kind of residency you will obtain, it is far from the only factor that plays into residency programs’ assessment of academic readiness. 

Representing it as such discounts the entirety of the clinical training—something that UNC students are known for nationally.

While the point is well taken that the overall cost of medical education is high (I’d even say exorbitant relative to the systems found other well-developed nations), eliminating the preclinical training would come at a cost far greater than the $30,000 saved. 

That is why many countries who have low-cost/free training still have four or six-year programs (some of which is pre-clinical training). True, these countries offer an undergraduate medical degree in lieu of the 4+4 system we have in the US, but the pre-clinical curriculum is often two years at the minimum. In the preclinical years, one learns about future patients and their diseases from clinicians and scientist who have treated them or researched the underlying biology behind their disease process, all before you ever set foot on the wards.

Finally, let’s not forget the individuals whose life work it is to teach all of us about medicine. The science, the skill, the art; our professors pour their passion into helping each of us achieve our own dream of someday becoming them. 

Equating a Khan Academy video to an Ed Kernick or a Kurt Gilliland really misses the finest point in which medical education is rooted: People who have been trained in science and medicine teach us how to become doctors using their own personal experience as a guide. In short, that’s what the investment in preclinical education buys you: a top-tier medical training from world-class instructors. 

The field of medicine is far deeper and more complex than a bank of multiple choice questions, and it takes years, including a preclinical curriculum, to develop the requisite skills to be an effective and humble physician. 

Wesley Stepp

MS3

UNC School of Medicine