AAMC Reporter: October 2009

Viewpoint: A Window Into the Student Experience

By John Prescott, M.D., AAMC chief academic officer

John Prescott, M.D., AAMC chief academic officer

When it comes to figuring out what does and does not work well for our nation's medical schools—and their students—our community has a powerful tool at its disposal. This tool informs the debate on tuition, student debt, curricula, diversity, specialty choice, physician workforce issues, campus life, and much more. Medical school deans, faculty, student government bodies, and other groups can directly benefit from the data this tool provides. And yet, this tool remains relatively obscure. It is the AAMC's Graduation Questionnaire, or GQ.

The GQ was established in 1978 as a way to identify and address issues critical to medical education and the well-being of medical students. As its name suggests, every graduating medical student has the opportunity to take the questionnaire, and is encouraged to be candid in his or her opinions and assessments of the educational experience. To put it another way, think of the GQ like the U.S. census, which the nation will again undertake next year. They are similar in the sheer richness and breadth of information they provide on the populations they survey. And like the census, the GQ needs the highest possible level of participation to be successful. Our participation rate for 2009 was 79.9 percent—that is a good number, but there is certainly room for improvement, especially as it represents a decline from last year's rate of 82.7 percent. We can draw no firm conclusions on the reasons for the decrease, but it may be due in part to a lack of student awareness about the survey.

The GQ allows our schools to take the pulse of their internal workings through the eyes of the students— their most important client. The GQ also provides a chance to compare data between schools as a measuring stick of performance. Ultimately, this information can reach into almost all phases of medical education.

Just about every GQ presents our community with causes for satisfaction, and causes for concern. The 2009 GQ data are no exception. Overall, we are pleased that about 87 percent of all graduates were satisfied with their medical education. Furthermore, we were encouraged to see that student debt, which has been skyrocketing over the past decade, is showing signs of leveling off, as GQ respondents reported an increase in medical student debt of about $2,500—from $141,330 in 2008 to $143,870 in 2009—which is very positive when compared with a jump of nearly $10,000 from 2007 to 2008. This suggests that medical schools are taking a serious look at the debt that a student incurs during medical school. Another positive sign on the debt front is that it played less of a role this year in determining students' specialty choice, with about 6 percent fewer than in 2008 saying it had a moderate or strong influence on their career aspirations. Interestingly, about 75 percent of those surveyed said role models in school had a moderate or strong influence on their career— a key fact for all physicians!

One area of concern the GQ has helped illuminate is that of student mistreatment. A lot of different people and groups pay attention to this issue, and rightly so. The AAMC and our schools pay close attention as well. This is yet another issue on which the GQ helps shape and inform our understanding.

According to GQ data, student perceptions of mistreatment have been increasing in recent years—2 percent to be exact from 2006 to 2008. However, the 2009 GQ data show a major slowdown in that growth, as perceptions of mistreatment rose by only 0.3 percent from 2008 to 2009. Furthermore, the proportion of students indicating knowledge of a mistreatment policy at their school is rising, and now stands at about 79 percent. A persistent trouble spot in the data, however, is that 54.4 percent of students who did not report mistreatment declined to do so because they feared punishment or reprisal.

Our overall rates of student perceptions of mistreatment are fairly low (17 percent in 2009), but if even one student is having a real problem, then we are not where we need to be. Typically every first-year class receives information on mistreatment reporting procedures during orientation; that information should be reiterated throughout the four years of medical school. Leaders can also put in place "zero tolerance" guidelines regarding abusive behavior on the part of faculty, residents and staff and it is important that students know their complaints will be addressed while maintaining confidentiality. Mistreatment of medical students is clearly wrong and must be handled accordingly, but it may also be valuable for students to learn that, plainly stated, a lot of unreasonable people are out there, and that certain behaviors, while perhaps distasteful, may not amount to deliberate abuse or mistreatment. As future doctors, it is important that students learn how to deal effectively with all types of people and behaviors.

These are just some of the issues for which the GQ serves as a crucial guidepost. Student perceptions on topics ranging from diversity to science education also are contained in this valuable yearly report. With the continued vigilance of our medical school leaders, faculty, and students, we can find out more about what we are doing right, and get better in the areas that need improvement. There is virtually no limit to the ways in which the GQ can help light the way toward the future of medical education.

Editor's Note: The opinions expressed by the authors do not necessarily reflect the opinions of the AAMC or its members.