Medical Education: How are we failing? (Part-3)
As much as we want to race to the part where we can offer solutions, we should take our time pondering on the right issues. We have to perfectly grasp the importance of the obstacles we face and take one step at a time. That’s what the first 2 posts were suggesting.
One step at a time.
Agreeing that motivation is the engine igniter, we should now be able to predict that if it fails the whole medical education machinery can’t help but remain idle. The next logical step would be to explore the reasons that may be responsible of such failure in order to fix it and prevent it from happening again in the future.
The healthcare system can’t be held solely responsible for its own doom.
This post can’t claim to pinpoint all the possible origins on its own, but, it sure aims to uncover the main ones. And as you will probably notice, since the healthcare system can’t be held solely responsible for its own doom, it also can’t work on mending itself alone.
As 21st century medical students, we have a great deal of know-how to acquire, it’s nothing like in the 19th or even the 20th century. However, we’re not complaining, it is mostly our choice and we believe that’s the only fuel to further progress. Apart from that, we may come across one or more of the main disincentives I’ll be mentioning next. Dealing with these hindrances is preoccupying a lot of our college students and taking much of their precious time. It may be or may be not specific to our country or to our school.
Here is 4 treasured tools to demotivate students:
Coercion
Make them feel coerced.
Coercion is defined by the Oxford dictionary as:
“The practice of persuading someone to do something by using force or threats.”
In their book Why Nations Fail, D. Acemoglu & James A. Robinson talk about the origins of both prosperity and poverty. They do mention the act of coercing as a way for extractive institutions to get their way:
“ Contrast how people choose their occupations under inclusive markets to colonial Peru and Bolivia, where under the mita, many were forced to work in silver and mercury mines, regardless of their skills or whether they wanted to.”
In reality, it’s not only by force that coercing works. Under colonialism or dictatorship alike, giving people few options is also a great way to get them to do somethings they probably wouldn’t do by their own free will.
In Tunisia, it’s been the policy for as long as anyone can remember. Still, thanks to personal preferences of Bourguiba, healthcare was one of the lucky sectors that progressed under his rule only to witness a slump afterwards. Yet, our society is programmed to perceive medicine as the only vocation that was spared the degradation. And so, some — not all — students are coerced into opting for it.
Our society is programmed to perceive medicine as the only vocation that was spared the degradation.
In all fields, we’re able to acknowledge the stigmas of such approach. We have more and more doctors, engineers, architects and teachers who didn't want to become what they’ve become. They do not feel satisfied and consequently are hardly able to accomplish their tasks, let alone to overachieve. Surrounded by an extractive economy and regulations that do not grant them the possibilty to change course, they are trapped, possibly forever.
Just like that, an enormous amount of potential and talents are lost to coercion regularly.
No Purpose
Give them no purpose.
“Happiness isn’t a destination. It’s a journey.”
You’ve probably encountered this phrase a few times, right?
As cliché as it sounds, it’s correct. It enlights us on a part of the truth, but I’ll argue that it lacks one more thing: Happiness, it’s a journey alright but to where?
Although we might not be always aware of it, seeking purpose is imprinted in us. We have this human tendency to give meaning to everything we do. It is our way of feeling valued by valuing our deeds. Conversely, the instant we come to realize that what we’re doing doesn't have a goal we loose our equilibrium. Thus, craving a purpose, we’ll certainly go on another journey seeking it.
The whole world is witnessing a purpose-seeking crisis.
You can easily realize the urgency of such craving since our students are actively seeking a higher goal through joining causes, volunteerism, associative work, political affiliations and yes, in deplorable occasions, through joining terrorist groups. This is amplified in Tunisia but the whole world is witnessing a purpose-seeking crisis.
Consider this quote I’ve found in a book about motivation, Drive by Daniel Pink:
“One cannot lead a life that is truly excellent without feeling that one belongs to something greater and more permanent than oneself.” Mihaly Csikszentmihalyi
Our education system is lacking the tiniest interest in giving a perceptible meaning to what it teaches. Even if medicine is blessed by having a noble ambition that drives all of its recruits, it can’t be sufficient. A higer purpose is surely important but so is the little goals leading up to it.
“If people don’t know why they’re doing what they’re doing, how can you expect them to be motivated to do it?” Drive, Daniel H. Pink.
For a good part of their medical training, med students are unaware of the real goal of the informations they’re told to learn. Being intentionally crammed with so much info and left to sort out alone its usefulness throughout the entire curriculum is absurd. As a consequence, they actually might think they’re learning something pointless for a lengthy period of time. This illusion of no progress can be a powerful demotivator.
There is no impetus as powerful as a sense of purpose paired with a feeling of constant progress.
To sum up, we should take into consideration the fact that there is no impetus as powerful as a sense of purpose paired with a feeling of constant progress. There is no doubt that having a shortage in these incentives and being unconscious about it, is severely impeding our system.
A journey to where?
Happiness is the journey towards a purpose. If we want medical studies to be a happy journey we should garnish it with meaning all along the way.
No motivating figures
Let them not have role models.
“ Ethical adults may shape your character as a young person, but the more you’re out in the world, the more likely it is that your current role models will be the ones to shape your attitudes.” Psychology Today
Why is it important?
In 1961, Albert Bandura first had to demonstrate that children are able to learn through observing the behavior of others. Today, it is no secret and we call it vicarious learning. It explains why from when we’re toddlers till our teenage years we’re inclined to aspire to certain people. Anyone heard of Bieber fever?
Yet, as you may have understood from the quote above, this type of learning doesn’t stop at all throughout our existence, it just becomes less noticeable.
All great universities have prominent figures that are known and respected not only locally but also internationally. They are proud of their role models and they display it. Take these Harvard interviews for example, or Oxford’s website which gladly says: people are what make Oxford an internationally renowned university.
To be frank, we don’t have these motivating personalities in our faculty. Even if we have a few, they are largely surpassed by the negative role models, which is why it needs to change.
It is only through such contributions and the people behind them that our students would aspire to do the same.
A virtuous cycle needs to start with ethical figures who do researches, make exquisite discoveries and bring innovative ideas or at least, try to. It is by our significant additions to the world we’re living in that we’d have a shiny image, not by trivial decorations — as our legacy of dictatorship might suppose. It is only through such contributions and the people behind them that our students would aspire to do the same and feel proud of the school they’re in.
Corruption
Make them believe corruption is the only way.
In this section we should be harsh while condemning injustice just as harsh as it would be while defending itself. For at least 23 years now, corruption has been the norm in our society and make no mistake, medical institutions and schools were certainly not an exception and still aren't.
Have you heard of the corruption perceptions index?
Transperency International, a non governmental organization, has been ranking countries, since 1995, according to their Corruption Perceptions Index (CPI) where the higher the score, the cleaner from corruption the country is. From then and till now, the Tunisian CPI hardly got over 50 out of 100. The latest releases attribute a ranking of 79/175 and a score of 40/100. To say the least, it is a poor performance and the index haven’t changed at all despite the revolution.
Corruption is extremely unhealthy for it doesn’t only favor the unscrupulous but also rewards them. No wonder that when present, it gives the wrong motives and motivates the wrong people.
Consider corruption as a toxin that quietly cripples the organism it empoisons, it’s not enough to halt its march but enough to ensure it’s not going far.
Consider corruption as a toxin that quietly cripples the organism it empoisons, it’s not enough to halt its march but enough to ensure it’s not going far. The thing is, even the ghost of it impairs development and inhibits innovation. Therefore, it is important to evaluate how the community perceives the institutions’ degree of cleanliness and act accordingly. I believe this applies to states, organizations, companies and universities alike, where the higher the perception of corruption is, the higher the disincentive and the scarcer the achievements are.
“We all yearn for improvement, but positive change only comes slowly when the enemy is endemic corruption. Perceptions of levels of corruption do not change greatly from one year to the next. Positive results are only going to emerge from tireless and consistent multi-year efforts.” – Peter Eigen, Chair of Transparency International.
In our case, it’s not just the faculty’s staff who can be involved in corruption, but so can be students, either passively by not denouncing it, or actively by simply cheating in exams or taking part in other practices. This has no other result than to perpetuate the injustice cycle with all its repercussions.
We should then decide, sooner rather than later, to commit to a relentless fight against such dishonesties — whatever their aspects.
It’s time to conclude. Our medical education system needs to spend more effort on its motivation process or at least avoid the 4 disincentives mentioned above. Needless to say, it’s not by fine-tuning that great changes would happen, it’s only by what economists would call creative destruction.
What is creative destruction?
I’ll give you a hint, according to Wikipedia it is…
This is the third and last post of the series “Medical Education: How are we failing?”:
Part-1: Motivation we’re doing it wrong
Part-2: Are we conditioning our students?
