My Chemistry 101 professor opened his lecture to a room of medical school hopefuls saying, "I've heard complaints about how strenuous my curriculum is, but it's up to me to make sure only the pre-med students who are capable of becoming doctors progress. The rest of you will wash out. I'm simply protecting future patients." His sentiment -- that he was the gatekeeper to medicine -- was new to me, but it would soon become all too familiar as I would encounter a similar phenomenon again and again throughout my medical training.
Every step of my medical education I have met self-proclaimed "gatekeepers to medicine." People who see it as their duty to "weed out" those who are unfit to become physicians. Unfortunately, many of these guardians were instructors, preceptors, and physicians. People who were supposed to be teachers and mentors. Yet, instead of focusing on teaching and nurturing, they focused on whittling us down. They saw their classroom as a garden, and instead of cultivating the diverse plants they found and bringing forth fruit, they felt compelled to weed out any who did not fit the mold of what they perceived a "proper student" to be.
I have seen students be dismissed or drop out of medical school. I do not think this reflects their true capabilities. Typically, it is a failure or flaw of the medical education system when a student "washes out." In the ideal world, everyone who gets into medical school would make it through because each student would get the proper attention and training necessary to excel as a physician.
One of the problems is we look at the training as a definitive timeline. Why can't it be more of an individualized journey? There are older students. There are students who take more than 4 years. Students who are not privileged enough to avoid working a side job. Students with families. Students with prior careers. Students from different cultures or of a different color. In the current model of medical education, we do not give enough room for these students who do not fit the traditional mold. Wouldn't it be great if we could have mentors who assist all types of students to succeed in medical education? Instead, we get gatekeepers who try to weed out those whom they deem "unworthy" to practice medicine.
The unfortunate consequence is that we end up with cookie-cutter doctors. Some unconventional students might sneak through, but they will usually end up downtrodden and deformed from so many years of trying to fit the mold. And honestly, it is a tragedy.
We already have gatekeepers for medicine: the MCAT, USMLE, and COMLEX exams. We do not need more gatekeepers. We need more mentors to help students succeed.
I want to share a personal anecdote comparing the benefit of a gatekeeper versus mentor mentality. I recently wrote a about how we rate pain on a scale of 1 to 10. It was intended to make my 10 loyal followers chuckle, but it ended up getting 350,000 views. I was surprised at the different responses it received.
Some doctors cut me down, called me names, and decided, based on my tweet of fewer than 280 characters, that I was not fit to be a physician. Thankfully, there was an outpouring of helpful responses. A lot of medical workers took a moment to teach what they do and what works for them with regard to the pain scale. This silly tweet ended up being a huge learning experience for me on how to evaluate pain and help patients. I plan to integrate these learnings into my future practice. I am grateful for the people who sought to be mentors instead of gatekeepers.
Another experience expressed on Twitter is successful students or physicians talking about how their "pre-med advisor" in undergrad told them they would never become a doctor. It is a tragedy to think about how many students are told this, and then turn away from pursuing their goals when they could make great contributions to medicine. These "advisors" are acting as gatekeepers, keeping out those who don't fit the cookie-cutter image. It would be wonderful if they sought to mentor students and help them grow; if they helped them succeed and nurtured their unique qualities.
We need fewer gatekeepers and more mentors. We need less weeding and more nurturing in the garden of medical education. Instead of ripping out every plant that does not look like the ones that came before it, perhaps we should water them, tend to them, and help them find a place to flourish and grow.
is a fourth-year medical student at Trinity School of Medicine, and the author of .