A prescription for improving medical school culture

Medical school has never been a walk in the park, even for the most gifted students. But today's doctors-in-training have it particularly hard.

By the end of this decade, the total store of medical knowledge will double every 73 days. Those who graduate from medical school in 2020 will have seen humanity's collective knowledge of medicine double four times over the course of their education.

One would expect medical schools to do everything in their power to help students master this ever-expanding store of information and apply it effectively and compassionately.

Yet the hyper-competitive culture at most medical schools works against this basic goal. This ‘sink-or-swim’ mentality must go.

In its place, medical school leaders need to implement an educational approach that encourages students to collaborate with and seek assistance from teachers, administrators in student-support roles and even fellow students. Doing so will equip them to cope with the emotional challenges they'll face in their careers.

Competition and a demanding workload

The demands of medical school can be overwhelming. While keeping up with classes, lab work and examinations, medical students must also apply for residency programmes and research opportunities – and prepare for their national licensing exams.

This workload is often made more burdensome by a cut-throat, ‘learn-or-go-home’ culture. At many institutions, students who fall behind are vulnerable to shaming or bullying from their fellow students, instructors and supervisors.

More than 40% of medical students who graduated in 2016 reported being publicly embarrassed at least once during their training. More than one in five said they'd been publicly humiliated.

In such a high-pressure environment, it's unsurprising that many students suffer from depression or worse.

A medical school culture characterised by intimidation, fear and competitiveness can also lead to callous, uncompassionate behaviour towards patients. In one survey of third- and fourth-year students at six medical schools in the United States, 98% reported hearing physicians refer to patients in a derogatory manner.

Fortunately, several institutions across the globe are creating programmes that replace destructive classroom cultures with those that promote compassion and collaboration.

Compassion and collaboration

At the medical school where I work, St George's University in Grenada, our department of educational services provides students with extra academic support from the moment they begin their studies.

All are encouraged to join collaborative learning groups. The department's Academic Enhancement Programme, for instance, organises students in small groups, each with a faculty advisor who serves as a resource for non-academic issues. Students in these groups also meet weekly with an upper-term student to review content from their courses.

Our students can also work with learning strategists to address issues like time management, test-taking anxiety and long-term memory development. These support programmes aren't solely for those who are struggling; students at all achievement levels are expected to participate. Indeed, academic student support and collaboration have become key components of the culture at St George's, so there's no threat of being stigmatised for seeking help.

We're not alone. This approach is gaining steam at not just medical schools but universities worldwide.

At Nelson Mandela University in South Africa, for instance, students engage in small-group learning programmes run by upper-classmen. These sessions improve students' academic performance by giving them the space to discuss study strategies and other tips for success.

A similar programme has been established at the University of Guelph in Ontario, Canada. Trained student leaders serve as role models for younger students by helping them prepare for exams and develop efficient learning strategies. There are more than 20 Canadian universities that have implemented this type of programme.

The University of Wollongong in Australia provides another example. Its Peer Assisted Study Sessions offer students the opportunity to engage with their peers in a relaxed setting, while also helping them work through challenging academic subjects.

The benefits of group learning

Programmes like these offer numerous benefits. They provide students with ample opportunity to address academic weaknesses and anxieties before those issues can impede their progress. This makes it far more likely that students will successfully master the material – which should be the goal of every medical school.

Moreover, group learning teaches students how to communicate and collaborate with one another. Over-emphasising individual achievement, as some medical schools do, leads to a professional egocentrism that "inhibits team-building across disciplines and fails to acknowledge that most care is provided by teams of individuals", according to a recent report by the National Patient Safety Foundation.

It's time for a different approach to medical education, one that values collaboration among students and faculty – and provides future doctors with the support they need to become skilled, humane medical professionals.

Glen Jacobs, DEd, is vice provost of educational services and professor and chair of the department of educational services at St George's University, Grenada.