This question has been circulating in the academic medical world for years. As an intern and resident, I would hear complaints about how “unready” they seemed. The grievances often include adjectives like ill-prepared, lazy, or uninterested. The complaints have burgeoned over time, and the examples are numerous in my institution: Students show up late to rounds with coffee in their hands; one med student had the gall to go directly to the attending and request early dismissal because he “had nothing to do.” The problem seems to permeate all schools. Beyond the effects of this behavior on student culture, it results in underprepared interns and residents.
As a chief resident, I have set aside weekly teaching conferences with the students, and I think I have begun to better understand the issues. Just 5 to 10 years ago, medical school expectations were high. You were expected to show up early to rounds, leave late, be at the beck and call of your resident, and have absolute respect for an attending physician. Respect for the process of education was standard. You dressed appropriately. You studied to impress, and you came to rounds prepared to try your best. So why have these standards changed recently? Because none of these qualities are rewarded appropriately in a student’s medical school “report card.”
Medical student grades, and, therefore, class ranks, theoretically are based upon two major components: clinical evaluations and test scores (i.e., shelf exams). But the truth is, in medical education today, evaluations completed by residents and attendings of students on their medical teams are essentially useless. Most evaluations result in clinical grades that are essentially the same, no matter how hard-working or lazy a student was on the floors. Many reasons are put forward to explain why this occurs, but I think the most important is evaluation burnout.
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