AAMC Reporter: May 2006

A Word from the President: "Minting 'Good Doctors"

As we enter the graduation season, the time seems right to reflect on the kind of doctors we hope to "turn loose" on the public. All of us are aware that our newly minted physicians must know and be able to do what is necessary to help their patients. And to that end, we spend a lot of time planning and implementing educational programs to be sure that they include the scientific information and the clinical skills we deem essential for our students to master.

But all of us also are aware — or should be — that having the requisite scientific knowledge and technical skills are not sufficient for our graduates to become truly "good doctors." Good doctors are defined not only by what a physician must know and do, but, most important, by a profound sense of what a physician must be. That existential attribute goes by many names: character, integrity, honor, moral fiber, professionalism. Given the contemporary threats posed by the onslaught of commercialism in medicine, the need for physicians to be professionals — to place the interests of their patients always ahead of their self-interest — has never been more crucial. Absent allegiance to this core value of medicine, the elemental trust that sustains the doctor-patient relationship ceases to exist.

Ensuring that our graduates are fully prepared to be physicians requires a good deal more than planning and implementing appropriate educational programs. For openers, it requires that our students start out with a set of virtues (e.g., altruism, honesty, empathy for those in pain, fervor for social justice, commitment to self sacrifice) that form the building blocks for their expected development as confirmed professionals. Indeed, our initial challenge as medical educators is to structure our admissions processes to assure, as best we can, that successful applicants possess the character traits necessary to fulfill that expectation.

Those attributes are obviously much harder to assess in the application process than is evidence of academic prowess. That is why admissions committees often appear to give more weight to science GPAs and MCAT scores than to other, "softer" measures of merit. Despite our rhetoric to the contrary, I fear that many of the "best and brightest" — i.e., the intelligent idealists we seek as our students — perceive that medical school is for grade-grubbing Philistines, but not for them. If they thought we would give as much weight to what's in their hearts as to what's in their heads, a career in medicine would no doubt attract them strongly.

There are several steps we might take to convince prospective applicants that we are, indeed, seeking those with a capacity both for high-level learning and for deep-seated caring. For example, we could:

• Assess applicants' personal characteristics first, and leave the GPAs and MCAT scores 'til later. Rather than looking first for reasons to reject an applicant because of concern about academic achievement, why not look first for reasons to accept an applicant — like evidence of heartfelt social awareness, of having triumphed over adversity, of personal sacrifice for the benefit others — and only then consider the statistical predictors of mastering the challenging curriculum. If the task is approached this way, admissions committees might well find many instances in which truly compelling personal characteristics would trump some concern about the academic record.

• Look even more favorably on those applicants who chose some other field at the end of college, but who awakened later to medicine as their true calling. Such applicants often manifest a depth of motivation and a level of maturity that not only predicts success as future physicians, but also provides inspiration to their fellow students.

• Use past experience to improve the ability to spot the truly outstanding prospects. Look back at the entering credentials of those students who turned out to be the most caring, the most compassionate, the most humanistic, the most admired by their peers. See if some common characteristics can be found that might sharpen the ability to identify such stars among future applicants. And use even more of those star students as recruiters and as full-fledged members of the admissions committee.

Ensuring that our graduates leave us with a deeply rooted awareness of what they, as professionals, are expected to be takes much more, of course, than ensuring that they have the "right stuff" to begin with. It requires that we do everything we can to nurture and not extinguish those nascent virtues during the course of their education. Acculturating our students to the transcendental values of our profession is an unrelenting, multi-pronged process. It entails:

• Explicit attention throughout the formal curriculum (e.g., lectures, seminars, case-based discussions) to professionalism's critical role in sustaining medicine's contract with society and to the multiple challenges physicians face in maintaining their fidelity to its precepts

• Even more explicit and determined attention to what goes on in the informal, hidden curriculum, where the everyday interactions of faculty, residents, staff and patients etch our students' attitudes and harden their perceptions about the real expectations of the profession; directing professional development with conscious, conspicuous and conscientious role modeling is indispensable

• Formative and summative assessment of each student's professional development, including peer evaluations (anonymous or otherwise) to garner the unique and insightful perspectives of fellow students

• Appropriate sanctions for instances of unprofessional behavior; tolerating violations of professional standards by faculty and/or students communicates nothing so much as hypocrisy

• Public, celebratory recognition of those individuals (faculty, students and staff) who exemplify the virtues of professionalism; such special recognition sends a powerful message to everyone about what the profession truly believes is important.

If we've done our job well, we can claim no greater reward as medical educators than knowing that those newly minted physicians we celebrate at graduation are well prepared to be the "good doctors" everyone deserves.

Jordan J. Cohen, M.D.
AAMC President

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