Medical Education: How are we failing? (Part-2)
“What are we doing wrong?”
isn't that an easy question?
No, it’s not that easy, I’m afraid — considering that we’re actually doing more than a few — but the most obvious fault is the absence of incentives. As I previously stated, it is the core issue, so it will be my focus. And the more precise question I’ll be trying to answer here is as follows:
Are we conditioning our students to become unable to change the system in the future?
According to Maslow’s motivational theory, climbing up the 5 stages of the pyramid of needs is what drives people.
Why is it upside-down?
Now, we, as medical students have studied the Maslow’s hierarchy and as Tunisian students in general, we actually experienced moving up the pyramid. Only in our maybe-not-so-specific-case, it was upside-down. I believe that our system is using a method which makes students gradually progress — towards surviving mode. This “progress” isn’t only dangerous for individuals but eventually for the society.
When the first year medical students complain to fourth, third or fifth year students they mostly get a typical “You’lle get used to it!”. Actually, as we’ve seen before, these first year students have the worst success rate by 79%. However, I didn’t tell you that the best rate is 94%. So, take a wild guess on which year has that rate? If you suspected it is the 5th year students, you were right. They have been successfuly conditioned, they are the survivers of the system.
And that’s what I meant by upside-down Maslow’s pyramid. It’s about taking individuals at the upper levels — self esteem, self actualization — and bringing them down to the lower levels — survival, safety. Medical students, through-out their studies are subject to diffrent negative stimuli, although they resist at first they ultimately succumb. Some will call it learned helplessness, and it is.
Learned helplessness, As defined in Encyclopaedia Britannica :
In psychology, a mental state in which an organism forced to bear aversive stimuli, or stimuli that are painful or otherwise unpleasant, becomes unable or unwilling to avoid subsequent encounters with those stimuli, even if they are “escapable,” presumably because it has learned that it cannot control the situation.
Could it be “The Method” of our education system?
The aforementioned theory is tightly tangled to the motivation process, the aversive stimuli of the former maybe a negative factor to the latter. And It goes without saying that the unpleasant stressors to which a college student may be exposed are numerous.
While it shouldn't be the case, self-motivation has been for long, the only form of motivation there is in medical education.
I also find it important to note that the impact these factors induce varies with individuals and their personalities. A little read in Wikipedia offers an insight, as it suggests that those who have a pessimistic explanatory style tend to resist less and succumb faster. Here, I should point out another flaw in our education system: Not only it’s graciously offering demotivating elements, it has been also relying on the frail individual efforts of its students to walk through the minefield it created. So, while it shouldn’t be the case, self-motivation has been for long, the only form of motivation there is in medical education. And we never even had a course about it!
At the end of the day, the whole system has become way too burdensome, making its own people aloof from sticking with it any more than necessary. More importantly, made helpless, most are unintrested in fixing it.
Now, I must admit that I may have deceived you. In the first paragraph above, I stipulated that the abscence of incentives is our paramount failure. In reality, I wasn’t accurate. To be more precise, I should’ve replaced abscence with lack or shortage. Because, let’s be honest, there still are motives. Though, one could ask are they the right ones? Do they motivate us in the right way?
For all this, I’ll be focusing on the most common and least questionable demotivating factors in our system. Although I’m unable to specify the full cast, I’ll try to unmask the important actors, from a student perspective.
Till the next post, I leave you with a few questions:
How did you choose your vocation?
Why did you choose it?
Who do you want to be?
Do you believe in justice and honesty?
This is the second post of the series “Medical Education: How are we failing?”:
Part-1: Motivation we’re doing it wrong
Part-3: 4 tools to demotivate students
