Over the last 5 years, we have spent considerable time directly teaching students and housestaff and have been involved in numerous meetings of academic physicians concerned about the apparent erosion in quantity and quality of medical student and resident teaching at our medical schools and teaching hospitals.
The causes of this progressive deterioration in what many consider the best medical education system in the world are myriad: Economic challenges forced faculty to spend much of their time doing direct clinical work rather than teaching; program directors have needed to spend more time and effort on regulatory documentation; administrative restrictions have been placed on medical student participation in patient care; duty hour constraints have been placed on resident work schedules, thereby decreasing the amount of time that residents can devote to teaching students as well as each other; and inpatient physicians are given performance metrics that emphasize efficiency of patient flow at the expense of bedside teaching and role modeling. Departments of medicine have evolved into business centers or “product lines” instead of the medical center’s academic compass.
Teachers have less time to teach; residents have less time to learn; and medical students are often relegated to the role of voyeurs. And from this environment we hope to find the solution to reverse the trend of dwindling number of students seeking careers as general internists and academicians.
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— Joseph S. Alpert, MD, Brian F. Mandell, MD, PhD
This article was originally published in the November 2009 issue of The American Journal of Medicine.
