Medicine Needs to Stop Eating Their Young

Session 535

When Dr. Paul Tran graduated from medical school, he noticed a negative trend in our approaches toward medical education. Now he’s fixing it fix it by encouraging a change.

A pediatric gastroenterologist known for his presence on TikTok, Paul initiated a discussion on “eating our young” in medicine. Today, we try to delve deeper into the issue and explore what he is doing to bring about change.

For more podcast resources to help you with your medical school journey and beyond, check out Meded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

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[02:45] Unveiling the Motivation: The Draw to the Field of Medicine

Paul explains that his draw to the field of medicine stems from the connection and intimate space one can have with patients. He is specifically interested in pediatrics, where he works with vulnerable patients, children, and their families.

There is a unique nature of the healthcare field. There is a tremendous responsibility and a sense of fulfillment in being able to provide care and support to individuals in such vulnerable situations.

[03:36] The Unspoken Absurdities of the Medical Journey

There are two aspects of the medical journey that he finds difficult to explain to others. First, the culture of the medical field and the intense amount of sacrifice expected from healthcare professionals without adequate consideration for personal well-being or family life. Second, he expresses the challenging nature of the job itself.

There’s this intense amount of sacrifice that you are just expected to make without real consideration of how detrimental it is to you personally or to your family life.

[04:59] Unspoken Pressures, Expectations, and Perpetuation in Medical Education Culture

The medical education system has certain expectations and a culture surrounding it. These expectations are either unspoken or communicated with the belief that “since I went through it, so can you.”

There is also a generational aspect to these expectations. Older generations tend to compare their experiences to those of current students, often suggesting that things were more difficult in the past.

As a new faculty member, Paul expresses his interest in changing the medical education culture because he recently went through the system and experienced the frustrations associated with it. He is devoted to researching and working towards transforming the culture he witnessed firsthand.

[06:46] Coming to Light with the Culture

Paul also describes his experience with the culture in medical school and how it started to become apparent to him during his third year. There is increasing pressure and responsibility as you progress through the medical training – from learning the language of medicine in the first year to feeling the weight of patient responsibility as an intern and senior resident.

During his medical student rotation, he was in an environment that lacked communication and feedback which led to misunderstandings and misjudgments in his evaluation. It would have been better if there had been clearer expectations and open communication from senior residents and attendings to foster a more supportive and constructive learning environment.

You may notice a culture where it seems like you can’t talk to people in a meaningful, kind, and empathetic way. It would have been helpful if a senior resident or someone had warned you about the decorum expected of students. Even if you disagreed, clear communication would have been appreciated. Setting expectations would have allowed you to know whether or not you’re meeting them.

[10:09] Revolutionizing Medical Education Through Kindness, Compassion, and Progress

Paul became interested in talking about and changing the culture of medical education because he noticed a gap in resources and positivity, particularly during the clinical years. He wanted to provide a source of kindness, compassion, and empathy in medical education, both in how students interact with patients and how they treat each other as colleagues.

He recognizes that the traditional model often involves more established individuals who may not be in touch with the current experiences of trainees.

The aim is to challenge the notion that complaints about training are invalid, highlighting the need for progress and questioning outdated practices. Paul is driven by the desire to make a positive impact as an educator and influence the future of patient care through the students and trainees he interacts with.

“You have a profound impact on people that your students touch… If I can, as an educator, influence for better, if I can inspire, if I can hold the weight or not like a culture, just even locally, that is moving the needle forward.”Click To Tweet

[16:17] The Role of Social Media

Social media has a role in shedding light on the issues and challenges faced in the medical field. It has facilitated conversations about these previously hidden or overlooked aspects of medical training.

Being a resident has an isolating nature. It involves working long hours and often feeling disconnected from the outside world. Through social media platforms, residents are now able to share their experiences and find solidarity with others going through similar situations. Somehow, this provides a sense of support and understanding.

[17:54] A Way to Change the Current Set-Up

There is a need to create a culture of collaboration and open communication in the medical field. According to Paul, there are two specific ways to foster this culture.

Firstly, advocate for a more informal and equal way of addressing each other. Emphasize the importance of using first names and removing hierarchical barriers. This approach encourages open and honest feedback and facilitates more constructive conversations.

Secondly, highlight the significance of acknowledging and valuing students and colleagues by simply paying attention and actively listening to them. Paul shared an example of a student who felt appreciated because he looked at her, gave feedback, and acknowledged her contributions during rounds, contrasting it with her negative experiences with others who ignored her.

By setting a low bar of respect and attentiveness, medical educators can make students and colleagues feel valued and create a more supportive learning environment.

Not all individuals in the medical education system are inherently negative, but there are systemic factors that contribute to burnout and a lack of engagement among some educators. His desire is to understand and address these factors to improve the overall medical education experience.

“A student, a resident, just looking at someone when they're talking… that's a really low bar. And if we can do that, it can make students feel valued.”Click To Tweet

[23:40] How Did We Get Here?

The demands and responsibilities placed on healthcare professionals, especially as they progress in their careers, can contribute to a lack of attention and support for medical students.

There is an increasing burden of patient responsibility and the cognitive load that comes with being an intern, senior resident, and attending physician. He also faced a lot of challenges in his own journey, particularly when he became an attending and had to make critical decisions with his name on everything.

It is a struggle to provide feedback and support to students due to the overwhelming demands of their roles. The system places significant burdens on healthcare professionals, making it difficult to give adequate attention to students. And it may take a lot of energy and commitment to prioritize students and create an environment that fosters their learning.

“People are overburdened and stretched in with the amount of things that we have to do… It takes a lot of energy, and a commitment to look up from your limit.”Click To Tweet

[27:40] How Students Can Improve the Medical Education Process

Students can make a positive impact in the medical education process by focusing on their personal “why” for pursuing medicine. Having a deep understanding of one’s motivations and values, beyond generic statements like “wanting to help people” is very important. Students must develop a crystallized mission and vision statement that guides their actions and sustains them through challenging times.

Paul’s own mission and vision statement is equipping and empowering patients to advocate for their own healthcare and learners to advocate for their own education.

Having a strong “why” can help students navigate the demands of medical training and maintain their curiosity and clinical reasoning skills. Understanding the underlying reasons behind medical concepts rather than simply memorizing facts is crucial. By embracing the “why” early on, students can approach the language of medicine with a deeper understanding and avoid becoming order-driven and focused solely on memorization.

“If you have a crystallized “why” early on in the process, that only helps you more later on.”Click To Tweet

Paul’s mission and vision statement is to equip and empower my patients to be better advocates for themselves for their own healthcare. He wants to equip and empower learners to be better advocates for their own education.

[32:39] The Impact of Testing and Rediscovering the ‘Why’ in Medical Education

Paul discusses the shift in medical education towards a focus on board scores and test-oriented learning. The emphasis on testing has led to a loss of curiosity and a lack of interest in understanding the “why” behind medical concepts. There is reliance on third-party resources and the devaluation of lectures, which may contribute to the perception that only board-relevant information is important.

A need for a shift in mindset is essential, emphasizing the importance of understanding clinical reasoning and the broader context of medical knowledge.

Patients are more than their numbers, yet medical students and professionals often define themselves by their test scores and academic achievements. Paul advocates for a more holistic view of medical education that values the individual and encourages curiosity, critical thinking, and a genuine understanding of patient care.

“You're so much more than a number and your grades.”Click To Tweet

[38:15] Fostering a Supportive Learning Environment

Paul emphasizes the importance of kindness and compassion which can make a difference in the medical education process.

Acknowledging and praising the good things publicly, while providing constructive criticism privately, is an easy way to promote a positive environment. If you’re working with students and residents, ask about their goals and expectations upfront and check in on their well-being regularly.

By showing genuine interest and concern for students and colleagues, Paul aims to create a supportive and nurturing educational framework.

[44:14] Final Words of Wisdom

Do not focus on the negative experiences and instead bank positive experiences and memories. Gather positive affirmations and encouragement from patients, colleagues, or mentors and create a “positive bank” to counterbalance any negative encounters.

Find satisfaction and joy in your chosen field and emphasize the importance of finding a profession that aligns with your skills and interests. Be clear on one’s purpose and have a strong “why” that can provide motivation and resilience in the face of external factors and criticism.

“Crystallize your “why” because your “why” will sustain you no matter what other people say and the extrinsic factors that come with it.”Click To Tweet