Just saw a very interesting article by Pauline W. Chen, MD in the NYTimes about what qualities are needed for being a doctor and a study that considered the issue.
Well, actually the study referred to the personality traits needed for medical students in Belgium followed through seven years of training. I am not an expert on Belgian medical education but my sense is that the training roughly resembles the United States' standard of four years of college and four years of medical school, but over a seven year period.
A quick look at the actual study's summary finds that just under 50% of the original students were still involved by the end; and I do not know if they actually tracked the students who left and what they proceeded to do with themselves; but I for one would be interested in that as well.
(Doug Menuez/Getty Images from NYTimes ... been there, done that!--TM)
This reminds me of my medical school days when I was a student representative, and full voting member, on the Admissions Committee. It was a great experience that I think of often; likely a better experience than I initially thought it would be when I was chosen by my classmates.
First, I had the opportunity to interview dozens of very bright, eager applicants with stars in their eyes about what they dreamed of for a medical education and career (all while fatigue of my own education was dimming the glimmer of the stars in my eyes! I wonder if they noticed). I for one enjoy meeting intelligent, optimistic people.
Second, I came to know a good number of attending physicians and medical college administrators behind the closed doors of committee meetings. They impressed me. And they helped shape me and who I have become today. I learned that they were often times brilliant, and down-to-earth; serious, but understanding of life's hard knocks; opinionated, but, when push came to shove, open to others' perspectives.
Third, I learned about the criteria used for medical school admission, the importance of GPA but only as a relative gauge compared to the undergraduate school attended, the weight of the MCAT (standardized medical school test), and the subjective criteria we tried to glean from supporting materials. In case after case before us in the admission committee meetings, I recall how we considered the GPA/MCAT and then really did dive into the interview, life experiences and letters of recommendation to consider the "whole person" and what she or he would bring to the school and the field of medicine.
At times, an applicant with numbers suggesting brilliance but weak or questionable supporting materials was denied admission while another who was judged "smart enough" was accepted due to our assessment of the personality and qualities not measured on standardized tests or in Organic Chemistry lab. A very imprecise science, but we felt it worked well. And the administrators had data to show what criteria predicted early academic success and decreased the chance of failing out in the first two years; and what correlated to assessments in the later clinical years of school.
So this NYTimes article caught my attention, stirred emotions, and brought up old memories and experiences that have shaped me.
Chen's article points out how the system here in the United States, on the surface at least, appears to focus on academic ability and standardized test scores. It hints that many people feel there is only lip service paid to the subjective measures of personality and applicant qualities culled from letters of recommendation, interviews and personal statements/essays. My memories of the years on the Albany Medical College Admissions Committee would argue against that, but I doubt applicants and their families, filled with anxiety, will believe me.
The research in Belgium tried to study, objectively, some of these questions by assessing personality traits and then following the students through the training years.
They found that success in the later years, when students were more involved with actual patient care and less in the classroom/lecture hall, was not associated with the same criteria as the earlier years. This speaks of the need for caution in choosing criteria for judging medical school applicants.
Over time the personality qualities associated with grade point average were "extraversion, openness, and conscientiousness." Those three traits increased in importance in the later years of education. And, they note: "Conscientiousness, perhaps more than any other personality trait, appears to be an increasing asset for medical students."
My guess is that these findings do not surprise many people when we consider what a doctor does. And, back in November, I commented in a blog post on this issue and noted that being "a compassionate and rational doctor is the crux of the matter" as a friend from college, who is now an internist out west, reminded me in a note about a clinical situation she faced.
We do need to consider that the students in the Belgian study were likely all considered "smart" to begin with. Then, in the end, more than half those "smart" students were no longer followed. But, assuming similarity to the American system, those early years were the most academically-based so the early attrition may have lost some students who might have proved excellent in the later years and then in their medical careers. That would be unfortunate.
As Chen notes in the NYTimes piece, if we want medical schools to turn out lab researchers we may need to consider different criteria for applicants than if we want practicing medical clinicians.
So, which is it? Smarts or personality? What do you want your doc to have, and in what balance? I guess that is the challenge for today's students and the admissions committees for medical schools. Their decision and methods of choosing will affect us for years to come. Hopefully the optimal balance will be found.
Perhaps that Belgian research and Chen's article should be required reading.
--Timothy Malia, MD
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