NY Times artical on medical school success

Doctor and Patient
Do You Have the ‘Right Stuff’ to Be a Doctor?

By PAULINE W. CHEN, M.D.
Published: January 14, 2010

Not long ago, a friend confessed that her son, who spends much of his free time volunteering at a children’s hospital and who is applying to medical school, has been particularly anxious about his future. “His test scores are just O.K.,” my friend said, the despair in her voice nearly palpable. “I know he’d be a great doctor, but who he is doesn’t seem to matter to medical schools as much as how he does on tests.”
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Her comment brought me back to the many anxious conversations I had had with friends when we were applying to medical school. Over and over again, we asked ourselves: Do we really need to be good at multiple-choice exams in order to be a good doctor?

We were referring of course to not just any exam, but to the Big One — the Medical College Admission Test, or MCAT, the standardized cognitive assessment exam that measures mastery of the premedical curriculum. Back then, as now, American medical school admissions committees required every applicant to sit for the MCAT.

While medical schools have since taken pains to assure applicants that recommendation letters and essays also weigh heavily, many candidates continue to believe, erroneously or not, that the MCAT can make or break one’s chances. Competition to get into medical school remains fierce, with over 42,000 highly qualified individuals vying for just a few more than 18,000 slots at medical schools across the country.

With those kinds of statistics and no reliable standardized way to evaluate personality, it is inevitable that the MCAT will have a crucial role in medical school admissions. But does that guarantee that the applicants admitted are also destined to become the best doctors?

Maybe not.

According to a recent study in The Journal of Applied Psychology, there is another kind of exam that may be more predictive of how successful students will be in medicine: personality testing.

For nearly a decade, three industrial and organizational psychologists from the United States and Europe followed more than 600 medical students in Belgium, where premedical and medical school curriculums are combined into a single seven-year program. As in the United States, the early portion of their education is focused on acquiring basic science knowledge through lectures and classroom work; the latter part is devoted to mastering clinical knowledge and spending time with patients.

At the start of the study, the researchers administered a standardized personality test and assessed each student for five different dimensions of personality — extraversion, neuroticism, openness, agreeableness and conscientiousness. They then followed the students through their schooling, taking note of the students’ grades, performance and attrition rates.

The investigators found that the results of the personality test had a striking correlation with the students’ performance. Neuroticism, or an individual’s likelihood of becoming emotionally upset, was a constant predictor of a student’s poor academic performance and even attrition. Being conscientious, on the other hand, was a particularly important predictor of success throughout medical school. And the importance of openness and agreeableness increased over time, though neither did as significantly as extraversion. Extraverts invariably struggled early on but ended up excelling as their training entailed less time in the classroom and more time with patients.

“The noncognitive, personality domain is an untapped area for medical school admissions,” said Deniz S. Ones, a professor of psychology at the University of Minnesota and one of the authors of the study. “We typically address it in a more haphazard way than we do cognitive ability, relying on recommendations, essays and either structured or unstructured interviews. We need to close the loop on all of this.”

Some schools have tried to use a quantitative rating system to evaluate applicant essays and letters of recommendation, but the results remain inconsistent. “Even with these attempts to make the process more sophisticated, there is no standardization,” Dr. Ones said. “Some references might emphasize conscientiousness, and some interviewers might focus on extraversion. That nonstandardization has costs in terms of making wrong decisions based on personality characteristics.”

By using standardized assessments of personality, a medical school admissions committee can get a better sense of how a candidate stands relative to others. “If I know someone is not just stress-prone, but stress-prone at the 95th percentile rather than the 65th,” Dr. Ones said, “I would have to ask myself if that person could handle the stress of medicine.”

While standardized tests like the MCAT and the SAT have been criticized for putting certain population groups at a disadvantage, the particular personality test used in this study has been shown to work consistently across different cultures and backgrounds. “This test shows virtually none or very tiny differences between different ethnic or minority groups,” Dr. Ones noted. Because of this reliability, the test is a potentially invaluable adjunct to more traditional knowledge-based testing. “It could work as an additional predictive tool in the system,” she said.

One perennial question that personality testing could help to answer is whether hard work can make up for differences in cognitive ability. “Some of our data says yes,” Dr. Ones said. “If someone is at the 15th percentile of the cognitive test but at the 95th percentile of conscientiousness, chances are that the student is going to make it.” That student may even eventually outperform peers who have higher cognitive test scores but who are less conscientious or more neurotic and stress-prone.

But these standardized tests, personality or cognitive, can be useful only after medical schools, and the public they serve, decide what characteristics are most important for the next generation of doctors. “If a medical school is all about graduating great researchers, then I would tell them not to weigh the results of the personality test that heavily,” Dr. Ones said. “But if you want doctors who are practitioners, valued members in terms of serving greater public, then you have to pay close attention to these results.”

She added: “When you ask your friends, they will describe you in terms of your personality. Rarely will you get a description of your cognitive ability. Personality is what makes us who we are.”

Haiti Disaster Relief

This post is dedicated to ways in which you can contribute to the relief efforts taking place in wake of the devastating earthquake in Haiti. There are several organizations which are doing a lot of good and could use your help both on large and small scales. As many of you know Haiti is the most impoverished country in the western hemisphere and the death toll is projected to be in the tens of thousands. Please share these links with your friends and family so that the help can get to where it needs to be. Also if you know of any other ways to help please leave a comment below (no need to sign in or register).

PARTNERS IN HEALTH

If you are interested in learning more about this organization you should pick up the previously recommended book Mountains Beyond Mountains which was inspired by PIH founder Dr. Paul Farmer who falls in love with the Haitian people, so much that during medical school at Harvard he took his books with him to Haiti only returning to Boston to take tests.

PIH has been working on the ground in Haiti for over 20 years. We urgently need your support to help those affected by the recent earthquake.

Partners In Health (PIH) works to bring modern medical care to poor communities in nine countries around the world. The work of PIH has three goals: to care for our patients, to alleviate the root causes of disease in their communities, and to share lessons learned around the world.

Based in Boston, PIH employs more than 11,000 people worldwide, including doctors, nurses and community health workers. The vast majority of PIH staff are local nationals based in the communities we serve.

http://www.standwithhaiti.org/haiti

Haitian Health Foundation

The Haitian Health Foundation (HHF) relies on the support of individuals like you to provide health and social services to more than 100 impoverished mountain villages in and around Jérémie—increasing the health and well-being of 225,000 needy Haitians
http://www.haitianhealthfoundation.org/

UNICEF

Unicef is a charitable organization which specializes in providing aid to Children.
http://www.unicefusa.org/

American RED CROSS

One of the biggest relief organization in the world which does a lot of everything.
http://www.redcross.org/

FOXNews.com - Why Doctors Are Abandoning Medicare

FOXNews.com - Why Doctors Are Abandoning Medicare

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What is Your Favorite Medical Related Book?

Lets get some discussion going, I'm looking for some input here because in about a week I want to be reading a new book and bet others are interested in broadening their horizons as well, so share!

Winter Break Book List

As Winter Break draws closer fantasies about sleeping in and watching Christmas specials with the family you've become estranged from over the past 4 months become a consistent day-dream. We are less than 2 weeks away!! stick in there so you do well in your classes. I look forward to the break as its a time to put down that cursed Biochem book and take on some recreational reading, but may I suggest choosing a book that exposes you to an area of medicine you find of particular interest. I have found that as I read certain books my goal of becoming a physician gains greater resolve and that I become more of an insider. The fact is so much of the practice of medicine is a mystery to the pre-medical student, even if they have family members who are currently practicing medicine. Exposure removes much of the mystery but as a pre-med you are likely very limited in the types of exposure you can gain through first hand experience that is why I suggest picking up a good book. It has been said "wise people learn from their own experience, but super-wise people learn from the experiences of others".This is a brief history of open heart surgery and the personal story of a few of its pioneers. If you interested in cardiology this book is a must.

Mountains beyond mountains is the story of Dr. Paul Farmer who grows up in what many of of us would consider poverty to become a Harvard Medical School graduate who's compassion for the poor and passion to wipe TB off the face of the earth cause Dr. Farmer to start a non-profit medical organization 'Partners in Health' . If you are interested in public health, medical anthropology, or in serving medical missions as part of your practice, you will love this book. When I returned home from my mission and attended the 'mini-medschool' lecture series at University of Washington two of the presenters referred to this book which I later found out was required reading for all incoming freshman the year before.

Dr. Groopman shares his experiences as he is transformed from a medical student to a resident to a physician and ultimately to a medical educator teaching at some most prestigious teaching hospitals and schools in the country. Dr. Groopman provides insight into what goes into the decision process of correctly diagnosing and treating diseases. Groopman confronts many erroneous paradigms concerning modern medicine and offers ways to overcome these barriers when possible. Among other things Groopman discusses how the way information is presented and the order in which information is given leads to whether or not the majority of physicians will arrive at the correct diagnosis and ultimately administer the proper medical treatment. He also discusses how many errors in judgement occur from a lack in communication skills. He discusses practical matters such as the amount of time a doctor listens to the patient before interrupting correlates to successful diagnosis or the amount of distractions from unnecessary details and data cause in delay of proper diagnosis.
If you are interested in medical education, any medical practice, or even just as a patient want to know how to receive quality medical care you should read this book.


If you are considering practicing military medicine or just want the nice scholarship with stipend and signing bonus this book is for you. Dr. Jadick is a DO with a military background before entering the Navy as a physician. This story goes into great detail about what is now the cutting edge in battlefield medicine. Dr. Jadick was instrumental in implementing forward (front lines) mini portable trauma centers which allowed soldiers to receive medical treatment up to an hour faster than medivacs out of the battle. Jadick did this in one of the deadliest battles in the Iraq war, 'Fallujah'.

Atul Gawande's two books are fairly similar as they pertain to sharing with the reader his personal insight as a general surgeon at one of the prestigious hospitals in the world as to the current state of medicine. He explains everything from how Doctors have a history with spreading disease and how something as simple as washing their hands religiously could solve this problem, to the circus that is medical malpractice, to how a medical conference is like Disneyland for Physicians, to the decision making process of physicians, to nasty diseases, and cutting edge surgical procedures. These books are two of my favorite books of all time and if I had a medical school would be required reading before entering.Another Great book that delves into many different areas of medicine. Dr. Sanders is a great writer who was a non-traditional applicant, she was a journalist who decided later in life to apply to medical school. She attended Yale and hasn't really left because she is part of the Yale faculty now, as well as provides material to the TV show HOUSE. She is a renowned internist who shares some insight into the world of modern medicine.

Some of the ideas floating around about healtch care reform

The Health Care Boondoggle

The Main Stream Media has been bombarding America with coverage on the current "Health Care CRISIS" the President has made more than a few speeches declaring our need for government intervention concerning this our need to make health care available to all. Town Hall meetings and protests have brought out millions of Americans from across the country with passionate albeit emotional views over the type of action that should be taken, if any should be taken at all.
From my experience I have seen that the vast majority of practicing physicians are hesitant to make their political views made public. Perhaps this accounted for the fact that many doctors like many other Americans would are not interested in politics and would rather focus their limited time to their families, careers, faith, and hobbies. Maybe they feel its unethical to offer their political opinion in their position of power as a professional health care provider. For what ever the reasons doctors have for the most part stayed out of politics, until now.
By associating health care with the world "crisis" doctors who both agree and disagree with the president have been going public with their opinion as this type charged rhetoric brings out a sense of wrong doing and immediacy. The American Medical Association has for example has endorsed the House bill, only to pull the endorsement due to the fact that many in the AMA were outraged with the bill, while others felt that they should wait until the bill was published and they had time to read it.
It is safe to say that over the past few months you have had time to digest a lot of information concerning health care reform and have come to your own conclusions.
Please share those views with all of us. I am interested in knowing where you stand on a subject that won't only drastically affect your future career in medicine but also has the potential to change the way the entire health care process operates in America. Take a Second to leave your comments below.