medical school


Docs In Training Confide Their Feelings On Performing Abortions

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol July 9 in Austin. (Eric Gay/AP)

Abortion can be hard for the patient. But it can also cause turmoil for the doctor performing the procedure.

Janet Singer, a nurse midwife on the faculty of Brown University’s obstetrics-gynecology residency program, found herself acting as a confidant in many discussions with residents about abortion.

“Over the years, when a resident felt confused, overwhelmed or thrilled about something to do with abortion care, they often came to me to discuss it,” she says.

Tricky questions continued to arise: Where does life actually begin? How do doctors’ personal beliefs play out in their clinical care? And, what’s really best for mothers?



Singer thought the general public would benefit from hearing more about the complexities of the young doctors’ experiences. So she asked four residents to write about their feelings about abortion training and services, or as one resident characterized it: “one of the most life-changing interventions we can offer.”

These personal stories are published in the July issue of the Journal of Obstetrics and Gynecology, headlined: “Four Residents’ Narratives on Abortion Training: A Residency Climate of Reflection, Support, and Mutual Respect.”

I asked Singer to offer a bit more background on the project, and here, edited, is her response, followed by some excerpts from the residents’ narratives:

Janet Singer: The abortion debate in the U.S. is so divisive, making everything seem black and white; but the real life experiences of doctors and women are much more complex. I am a nurse midwife and though personally committed to increasing access to abortion services, I believe that abortion is not a black and white issue. I speak openly about my personal beliefs with the obstetric residents I work with.

My thinking about the grey areas surrounding abortion care are the result of many conversations with colleagues and residents. One came to me overwhelmed on a day when she had done a late-term abortion and then been called to an emergency C-section for a fetus/baby just a week further along.

She needed to talk about how overwhelming it felt to try to decide where the cusp of life was, why it was OK to take one fetus/baby out of the womb so it wouldn’t live and one out so it might.  Continue reading

Pre-Med Stress Hits New Heights As MCAT Exam Changes Loom

By Alvin Tran
Guest Contributor

Becoming a doctor was never easy. There’s stress, there’s no sleep, there’s life and death. But now, that already tough career path will get even more complicated with the introduction of a new, far longer version of the Medical College Admission Test, aka, the MCAT.

Just ask pre-med Charles Denby, who panicked when he recently went online to sign up for the test and found all the sites in the U.S. were booked into January 2015. Why is that a problem? Well, that’s when the old, familiar four-hour MCAT takes a short hiatus and then morphs into a newfangled, nearly seven-hour version of the test that most students must take in order to get into medical school.

(Marquette University/Flickr)

(Marquette University/Flickr)

Denby, a 36-year-old consultant who is now pursuing a medical career, was not amused by the prospect of facing the new test. It’s “a curveball I wasn’t expecting,” he said in an interview from his home in Providence. Denby is hoping someone local will opt out of taking the test at the last minute so he can get a spot, though he briefly considered getting on a plane to avoid the new exam. “Germany and Israel are available for January right now,” he said.

Germany? Israel? Isn’t the MCAT stressful enough without getting on a plane and switching time zones?

Barbara Moran, a pre-med student in Brookline, who recently completed Kaplan’s MCAT prep class, was stunned to hear that her classmates were planning to travel to Indiana and South Dakota to take the exam. Moran, who took the exam Oct. 21, had reserved her seat in Boston months ago. “I suddenly realized I was sitting on the hottest ticket in town,” said Moran. “It was like having a seat to a Red Sox World Series game.”

The soon-to-be-extinct four-hour exam now tests students’ knowledge of chemistry, physics, biology, organic chemistry and verbal reasoning; and also their nerves, as they watch the clock tick down while struggling to recall obscure equations. Now they’ll have to endure that anxiety even longer: the new test is nearly seven grueling hours long.

The Association of American Medical Colleges (AAMC), which administers the MCAT, approved changes to the test in 2012.

One of the most significant changes is the inclusion of the new section that tests students’ understanding of the socio-contextual determinants of health — essentially asking students to think beyond the specifics of the patient’s body, and consider how income and social status, education, home and work environments and other factors shape health outcomes. Continue reading

Paying Tribute To A Doctor’s Invaluable Teacher: A Dead Body

For many doctors, the most important person on their journey from pre-med to licensed healer is dead.

“When you start medical school, you begin to learn the details of cells and tissues and development and disease,” said Jared Wortzman, president of the Tufts University School of Medicine class of 2016. “But if you ask anyone here they’ll tell you, you don’t really become a medical student until the moment you meet your cadaver.”

Edmund Chilcoate in his Coast Guard days (Courtesy)

Edmund Chilcoate in his Coast Guard days (Courtesy)

Wortzman spoke at an unusual gathering last week — a memorial service for the men and women who donated their bodies to the anatomy lab at Tufts and a reception for their families.

One of the donors was 83-year-old Edmund Chilcoate.

“This is when he was a baby. He was cute, wasn’t he cute?” said Kim Begin, one of Chilcoate’s two daughters. Begin flips the plastic-covered pages of a brown leather photo album while three of the first-year medical students who probed and dissected Chilcoate’s body lean in to look.

Continue reading

Why Not Educate Med Students About The Cost Of Care?

Dr. Neel Shah, an advocate for more transparency, value and rationality in the medical system, makes a persuasive case here that medical students are in dire need of instruction on how to think about the cost of medical care.

Dr. Neel Shah

Dr. Neel Shah

Writing for the blog “Wing of Zock” (if you’re not a doctor and don’t get the reference, click here) Shah points out that these days, physicians are compelled to consider costs through a variety of incentives, “top-down from policymakers who want more accountability in how we are using resources; bottom-up from patients who want more transparency in how we are spending their money.”

But, writes Shah, a chief resident in obstetrics and gynecology at Massachusetts General Hospital and Brigham & Women’s Hospital and the founder and executive director of the nonprofit Costs of Care, incentives are not enough. “We also need to give physicians the skills, training, and support they need to consider costs responsibly.” He continues:

Most physicians learn very little about health care costs during their training; in many cases, they are specifically taught not to consider costs while caring for patients. The traditional concern is that thinking about costs automatically means sacrificing the ingrained physician ethos to do everything possible for our patients. At the same time, many existing teaching methods may exacerbate the problem by embedding a “hidden curriculum,” leading to costlier diagnostic workups and rewards overutilization. Continue reading

Report: Medical School Debt Should Not Preclude Primary Care Career


Medical school debt can be daunting: The latest data shows the average med school graduate owes over $166,000.

But according to a new report published in The Journal of the Association of American Medical Colleges, that debt alone should not steer young doctors away from primary care, where their services are now desperately needed.

WBUR’s Sacha Pfeiffer spoke with the senior author of that report, John Wiecha, assistant dean for academic affairs and an associate professor of family medicine at the Boston University School of Medicine. Here are some interview highlights:

SP: So you wanted to try to figure out if various levels of med school debt actually are manageable on a primary care salary. What did you find?

JW: By and large, except for the highest levels of debt, with careful financial planning, they actually should be able to pay off their debt, purchase a house at a median house price, and even save some money for eventual retirement.

SP: So even making about $145,000, but owing about $160,000 to $170,000, you can pay for your kids to go to college, have money in retirement, and still pay off your loans?

JW: It looks that way. I will say, though, that about 27 percent of students in private medical schools had debts of $250,000 or more. At that level or above that, we’re really seeing that students need to be very careful about financial planning, and they may have to make some compromises in terms of the practice environment that they’re in…

SP: But can we conclude from your study that if a med school grad is avoiding primary care because he or she is afraid they’ll struggle too much to pay back their student loans, that could be a false alarm, depending on the debt level? Continue reading

Why Primary Care Matters

Third year medical student Joe Nelson (with his family) writes about why primary care is key to fixing the broken health care system.

Primary Care Progress is a two-year-old Cambridge-based nonprofit that seeks to revitalize the primary care field and motivate more medical students to enter the primary care fold — with passion.

One of those students, Joe Nelson, in his third year at Baylor College of Medicine in Houston, recently wrote eloquently about why he is pursuing a career as a family physician and why primary care is the key to fixing the broken health care system.

Nelson’s “aha” moment, he writes, involves his own father, a biomedical engineer who lost his health insurance and so delayed seeking followup medical attention on an abnormal colonoscopy that revealed some pre-cancerous polyps. A few years after the test, Nelson’s dad, now experiencing some troubling symptoms like weight loss, weakness and fatigue, sought advice from his medical-student son.

Nelson writes:

In what kind of health care system can a learned, health-literate individual make an educated decision not to seek medical care in such a high-risk situation? Why is a man like my dad relegated to asking medical students for health advice?

In the medical community, we talk about access to care as though it were a separate issue from medical costs. In fact, we usually refuse to discuss cost at all. Instead, we have behemoth yet inadequate government programs like Medicaid, CHIP, and Medicare to help improve access to the care that we’ve been told is fundamentally expensive. But the elephant in the room is that if medical care were inexpensive, everyone would be able to access it. Continue reading

Latest Data: Average Med School Grad Owes Over $166K

Know a virtuous young person who wants to become a doctor for all the right reasons? Think their soaring idealism might need a bit of ballast from financial reality? Here it is: The latest figures on medical school debt, just out today from the Association of American Medical Colleges.

The mean debt load for students from all medical schools is $166,750, up 3 percent from last year, and the median is $170,000, up 5 percent from last year. And it doesn’t much help if you go to a public medical school — the mean debt is about $156,000, compared to nearly $184,000 for a private school.

Depending on your repayment schedule, the new AAMC data show, your total repayment after graduating could total as much as $476,000. And we wonder why health care is so expensive in this country? Doctors’ salaries are of course only one element of our high price tags, but it’s an element that sets us apart from Europe, where medical education tends to be lower-cost or free. reported recently here:

Meanwhile, tuition rates continue to increase dramatically. The median cost of attending a private allopathic medical school has grown at 1.8 times the rate of inflation during the last 13 years. At public schools, it has grown more than twice the rate of inflation, the AAMC said.

Public medical schools have been particularly hard hit, as states have reduced funding in a poor economy.

Readers, what is to be done? See the full AAMC data below. One interesting note: 30% of graduates plan to enter loan forgiveness or repayment programs: Continue reading

Study: No, Medical School Grading Is Not Fair

(Samir, via Wikimedia Commons)

Well, actually the study found that the grading standards vary widely among medical schools, but if you’re competing against other students with inflated grades, that’s not fair, right?

These findings immediately reminded me of a prominent local doctor who recently told me, sotto voce, that people in the know say students who come from a certain maximally prestigious medical school actually make lousy residents.

If nothing else, this study adds an additional “buyer beware” warning to hospitals choosing among med students with stellar grades. The press release from Brigham and Women’s Hospital:

Boston – A first-of-its-kind review of grading systems at United States medical schools has led a team of researchers from Brigham and Women’s Hospital to detect a dramatic variation in grading practices.  The findings depict an imprecise system that lacks transparency and may contribute to grade inflation.  The findings were published online this week in the journal, Academic Medicine.

The researchers, led by Erik K. Alexander, MD, the director of medical student education at BWH, analyzed final course grades, known as clerkship evaluation reports, from 119 of 123 medical schools accredited by the Association of American Medical Colleges.

“Our research shows that there are no standardized requirements for evaluation and grading at accredited medical schools across the United States.  This has led to a confusing national picture of what individual grades really mean and how physicians in training should be judged when applying for residency training or their medical license,” Alexander said.

Researchers found eight different types of grading systems in place at schools across the United States that use 27 unique sets of descriptive grading terminology.  For example, grading terms such as “honors”, “satisfactory” and “good” have different meanings at different institutions.

Additionally, the researchers found that 97 percent of all students were awarded one of the top three grades at their institution, regardless of the grading system or how many grading choices were available to the faculty.  This suggests that when the number of grading choices is increased, grade inflation likely results.

“I hope that this study will prompt medical schools to take action and adopt a national standard,” said Alexander.  “A consistent, transparent and reliable grading system is needed to improve the student evaluation process.  This will lead to a better assessment of each student’s individual performance and benefit all involved.”

Med students, current and recent, does this ring true?

Downward-Facing Docs: Med Students Study Yoga To Help Patients, Selves

BU med students attend yoga class as part of their professional and personal training.

Ben Tannenbaum, a wiry first-year medical student, is under pressure.

His typical day involves about five hours of lectures and test prep — physiology, genetics and histology on a recent weekday; a mad dash off to a clinic to practice as a doctor learning physical exams and basic medical history-taking; and then, after getting home around 8:30 pm, a few more hours of work reviewing the day’s material before it all starts again the next morning.

“And that isn’t including elective courses, student organizations, research, volunteer work, or extracurricular activities that almost everyone is trying to find time for as well,” says Tannenbaum, a-24-year-old student at Boston University School of Medicine.

But on Tuesday night, the perpetual motion of Tannenbaum’s life stopped. He entered a packed classroom, rolled out his blue yoga mat and plopped down on the floor. Alongside 25 other barefoot medical students, Tannenbaum listened to a half-hour talk on “the relaxation response” and how the technique — a simple type of meditation that reduces the activity of the autonomic nervous system — can alleviate stress-related maladies, from migraines to depression.

Then everyone took a deep breath and stretched into downward-facing dog. The yoga part of the medical school’s weekly yoga course had begun.

As everyone knows, medical students are a singularly stressed-out lot. “More than 20 percent end up with depression, more than half suffer from burnout, and in any given year, as many as 11 percent contemplate suicide,” Dr. Pauline Chen writes in a New York Times report on the “toxic” nature of the medical education process.

So it makes sense to offer these overwhelmed kids de-stressors like yoga and meditation. But here, at the BU medical school’s first-ever yoga elective the aim is even broader: The faculty and instructors who launched the class hope these future doctors will be able to exploit their knowledge of yoga and its research-based benefits to someday help patients and to feel as comfortable prescribing yoga as they do Prozac. Continue reading

Daily Rounds: Health Law Myths; SJC On Confidentiality; Med School Shift; Michael Douglas’s Cancer

Health Law Myths: Outside The Realm Of Reality : NPR Some pretty far out, Including: hospitals must fire fat employees and high-calorie fast food will be banned (NPR)

SJC backs doctor on patient confidentiality – The Boston Globe Case concerned a psychiatrist's prescription records for pain management (Boston Globe)

In Medical School Shift, Meeting Patients on Day 1 – NYU seeks to 'humanize' patients for doctors-to-be (The New York Times)

UPDATE: More details on Michael Douglas’ diagnosis From Celebrity Diagnosis, a cool local site that uses celebrity diagnoses to spread good medical information (