Medical Education: How are we failing?(Part-1)
I’m a fourth year medical student in “Faculté de Médecine de Sousse”. In 2 days, it will be celebrating its 40th year of existence. In the midst of these “empty” celebrations, I would like to put my thoughts into words — many questions and a few answers. For ages, there have been a dearth of good questions, it’s a heritage of occupation and dictatorship. Generations have learned not to ask questions, not to seek answers and therefore, they learned to stagnate and actually celebrate it. What follows, is an attempt to shatter this pattern.
Ever heard of the half empty, half full cup?
The “half empty, half full” is a dilemma that this article is susceptible to face. Healthcare and Education have made progress in Tunisia since 1956 and I’m hopeful we have a bright future awaiting us after 2011's revolution. However, we’ve never been at our full potential and we still have a busy schedule of restructuring and fine-tuning. So this is not about a preference to paint things only in black or in white. It’s about painting progress, a thing we can’t do with a single color.
I’ve started thinking about writing this article since our Medical School launched a reforming program that never really took off. It wouldn't, unless the different actors of the medical education system in Tunisia radically change their perspective. For that, they need to sit together and ask themselves a serious question, it shouldn’t be “What’s the one thing we’re doing right?” in order to revere it, but rather “What are we doing wrong?” to try and deal with it.
In other words, the appropriate observation that should pop up is: “How did we manage to take a significant number of the successful elite and make some of them disinterested and failing students?!” not “We must be doing many proper things to manage to take a significant number of the successful elite and keep many of them successful”.
Our system has been constantly reassuring itself that it’s doing fine.
The truth is, our system has been constantly reassuring itself that it’s doing fine. In fact, while preparing an infographic for a magazine, a friend and I did an inquiry about our school’s statistics — which are not a secret but not easy to get to either. We realized that our med school, in its annual report have only written the percentage of succeeding students, not the failing ones. For example, the worst year in terms of success rate is the first pre-clinical year with 79.2% succeeding students. It is outstanding. Or not, depending on how you consider the remaining 20.8%. Whether it is done on purpose for the sake of getting positive or for other reasons remains debated.
It is commonly said that medicine is a noble devotion and many think of this conviction as reason enough to motivate medical students and keep them passionate about what they do. But the fact is, the incentive deriving from that noble belief seems to drain out gradually through the course of medical studies. So we awaken today on a healthcare system that is lacking two key ingredients that are interlaced: nobleness and motivation.
Motivation has been researched for a long time now and I’d like to share with you a definition I encountered:
“The dictionary Webster’s defines motivation as something inside people that drives them to action […] Motivation emerges, in current theories, out of needs, values, goals, intentions, and expectation. Because motivation comes from within, managers need to cultivate and direct the motivation that their employees already have.”
It’s quite an accurate definition, but I want to focus on two words in the last sentence, “managers” and “employees”… It’s about companies! I figured it out on my own!
It’s only fair, being always on the look for ways to motivate employees and improve their productivity, the business field looks like the first concerned when it comes to results of new scientific researches made on motivation. Still, Daniel Pick, in a quite known Tedx talk about incentives, kept repeating “there is a mismatch between what science knows and what business does”. He was trying to warn that science have established new facts while business didn’t really reflect it.
Is business not getting it right yet?
Hold on to that thought, because we need to get some other questions out of the way first. Aren’t we a medical school made of college professors, scientists, scholars and researchers? If I am right and we consider ourselves science people, it seems we’re definitely not taking advantage of our own studies — own studies? — while we should be the first concerned. So maybe business people are doing it wrong, but can you blame them?
Our education system in general, since the first grade until the day of graduation, doesn't in no way consider motivating its ever-changing targeted youth. Actually, it’s quite the opposite. Thus, for an individual to keep a sufficient drive throughout his education, he has to relentlessly fight against the flow. As different generations of students come and go, a direct result to this unchanging mediocrity is the common feeling of exhaustion and lack of motivation they reach after finishing their studies. These same students are the workforce that will build and lead the country, they will teach and train the following generation. It’s a vicious cycle of despair.
Demotivation spread just like a venom being actively pumped inside a non-reactive body.
And so demotivation spread just like a venom being actively pumped inside a non-reactive body. For years now, the lack of motivation has been creeping up on a multitude of sectors, corrupting them from the inside out. Medical studies haven’t been spared and began secretly crumbling long ago.
We might now agree that the most crucial deficiency in our system is its incapacity to reflect on, or at least to detect its flaws and weaknesses. Being this dramatically static, the same system that Bourguiba was praised for a few years ago, is now the most hindering factor to development.
So, “what are we doing wrong?”
This is the first post of the series “Medical Education: How are we failing?”:
Part-2: Are we Conditioning our students?
Part-3: 4 tools to demotivate students
