What is happening to medical education?

A guest submission from a medical student with common sense

Prior to the pandemic, I naively thought the goal of medical education was to learn human anatomy and physiology and apply that knowledge to help people heal from an illness. While still true to some degree, medical education, since the time I graduated in 2003, has now broadened to include woke social agendas. This is aptly demonstrated by the modified Hippocratic oath chanted by the graduating students at the University of Minnesota - doctors now must pledge to be ant-racist among other things.

An excerpt: “Our institution is located on Dakota land… We commit to uprooting the legacy and perpetuation of structural violence deeply embedded within the healthcare system. We recognize inequities built by past and present traumas rooted in white supremacy, colonialism, the gender binary, ableism, and all forms of oppression.”

Last weekend, I had a long discussion with an academic pediatrician whose students reported her for not being woke enough. She was forced to take an IDI survey - a series of questions to determine how racist one is - and when she scored a 4 out of 5, was encouraged to spend time writing self-reflective essays on how to be less of a racist. The irony is that she is not white… her father immigrated from Buenos Aires and her mother from Prague.

I communicate regularly with like-minded physicians and from our online chats, I know these incidents are happening throughout medical academia. We all wonder if there are any students out there with common sense who just want to learn how to be a good doctor, and when one comes along, we celebrate.

I had cause for celebration a few days ago when I received an email from a fed-up pediatric resident in NYC. Residency - the 3 to 5 year training period after medical school - is a stressful time for everyone, but on top of the regular rigors of the job, young doctors now must choose sides… with the caveat that there’s only one side to choose. He wrote this essay to give a glimpse of what’s happening and to call for transparency and discussion. Sadly, we decided he should stay anonymous to preserve his job.

Medical Ethics:  Jerry McGuire

Sometimes it can be very difficult to navigate the ethics of medicine today.  Maybe we should pay some more attention to that, no?  Let’s be honest, it’s 2022, and the world is rapidly evolving on nearly every front known to mankind.  I am a pediatric resident physician in New York City, and I must say, the social diversity here is possibly unlike anywhere on Earth.  New York City isn’t just New York City, it’s a global collection of all walks of life.  America was considered a social experiment, and NYC is the capital of that experiment.  I digress, on a day-to-day basis we must deal with true barriers, for lack of a better term, such as faith, religion, ethnicity, sexuality, gender, personal identity, language, disposition and innumerable other factors. We must also follow the Hippocratic Oath in every single decision that we make, while remaining true to our own faith, religion, and so forth.  Currently, we are in great debate openly, yet somehow behind the curtains. Hot topics include gender affirming care and abortion, which affects pediatricians and obstetricians, given that we must operate from at least three foci: The Hippocratic Oath, personal beliefs, and the legal system.  To paraphrase, Patient, Faith, Law.  These MUST coexist for optimal benefits of all parties involved. 

Puberty blockers, gender reassignment surgery, and gender affirmation therapy are being utilized at unprecedented levels, at younger ages every single day.  Therapy can be started and even completed before the age of 18.  In some cases, parents are unaware that their child is living as the other gender.  Parental rights and informed consent becomes another hot topic by direct extension.  There is a young patient by the name of Chloe Cole, who, like many others, had irreversible hormone therapy and bilateral mastectomy, also referred to as “top” surgery.  Others have undergone penectomy, vaginoplasty, and other affirming care but now regret the choice very publicly and very vocally, directly affecting the LGBT community as one of their own is struggling through hard times.  Some have shown support, and some have not, which is simply the way the world works.  The brain is well developed by 25 years of age.  While still neuroplastic, developmentally we are generally considered to have an adult brain.  With this in mind, much of our identity is determined before the age of 25.  Primary examples of “life lessons” are often manifested as mistakes from our youth (tattoos, piercings, unplanned pregnancies). 

Abortion is a hot topic that seemingly few in healthcare are inclined to discuss.  Some groups believe life begins when the egg and the sperm meet, it is woven into faith and identity. Some believe so deeply in this that they are willing to try everything and anything to save a life that has nearly zero statistical probability of living, and often with a very significant reduction in quality of life and against medical advice.  Contrasting groups believe that a fetus is not truly a life until born.  Some believe this so deeply that even if a mistake is made during the abortion and the child is born, the child should still be aborted.  Hence, there is no such thing as a “botched” abortion. 

In my humble opinion, the medical community needs to come together, as one, and openly discuss these topics.  Without public trust, the house that is Medicine cannot stand.  I have had real people reach out to me and embrace me by the thousands by speaking about these topics, from all walks of life.  Therefore, I have faith that this will be received well, a personal belief of my own.  The only way forward is truth, transparency, and honesty.  And these are individually very different things.  Each will require our great attention, from not just doctors but all who interact with patients. 

This profession is not ours.  We do not own science, faith, or thought.  We serve humbly, under the Hippocratic Oath, for the preservation of the sanctity of life and its intrinsic, inherent value.  We treat that life, all life, with respect, the greatest respect.  Even in medical school, our cadaver lab was a sanctuary of the dead: those that gave their very bodies so that we may learn and become better for the future.  It seems we are at a place in medicine, where the medical student in the cadaver lab, disconnected from the living patient but connected to passion and purpose, respects the dead body so much, but honestly, are patients receiving the same level of respect?  My answer is unequivocally, “No.”  These are very difficult things to hear, but are they not the truth?  And is it not our sole purpose, not only as physicians, but as human beings, the most advanced and magnificent species on Earth, to seek truth to the questions that so many are simply afraid to ask?  Perspective is everything.  These questions will certainly make individuals uncomfortable, however, is that not part of our objective if we wish to serve an ever-diversifying population?  We should move forward, embrace the future as cautiously curious, the way we always have, for over 150,000 years, and I suppose to some extent, as far as about 3.5 billion years.