Preparing for standardized tests by yourself using high-quality resources is both effective and a little bit soulless. There’s a reason why much of medical education could be streamlined in both time and cost to what amounts to an old-time correspondence course—that’s because it’s long been sold as an information problem, and the core question for schools has been how to best transmit the holy information to the student.
This was probably historically at least partially true, but in the 21st century, this conception misses the point: information is no longer the core skill that needs cultivation. It is social intelligence, human skills, and the bringing of information to bear for problem-solving. It’s critical thinking, and doing it while working with people. And yes, the information is important (it really, really is!)—but the information is not where very expensive medical schools really shine. With the advent of better qBanks, Anki decks, and commercial lecture products, we are increasingly choosing a factory schooling model over one that prioritizes a social experience of working with caring teachers, motivated peers that are important to you, and patients with meaningful tasks to provide motivation and centering.
The schools and students spend lots of money on pieces of paper and question banks and other forms of curated video content, and these are all wonderful things. My point is not to suggest that using better lectures and better questions is a bad thing for education—it’s certainly not. It’s that those things do not preclude the need for the other part—not in some token problem-based learning format or anything so prescriptive—but real, meaningful, non-tedious, in-person work.
Whatever it once was, it is no longer mainly an information problem. As the cliche goes, you can lead a horse to water, but you can’t make it drink. We need to encourage people to be motivated (or find motivated people), and we need to help curate and support sustaining that curiosity—that people can do and internalize the need to continue doing that type-2 fun of hard work. The fact that students would rather be at home studying instead of working in the hospital shows the fruits of our system: the triviality of many students’ clinical experiences (the clerkship as performance art) combined with the pressure of Shelf exams as the defining feature of their grades.
The world is full of heavy objects, and yet most people are not ripped. We are the limiting factor, and we need systems to help us and support us to be our best selves. Burnout is a system that snuffs out our soul’s flickering flame.
There was a time in my radiology training where people were encouraged to incorporate multiple-choice questions with audience response into their lectures instead of taking hot-seat cases where people were put on the spot. That is more comfortable, to be sure, but I can tell you the fear and anxiety of wanting to perform for your colleagues and mentors was much more inspiring. Not every time you’re wrong in public is unfair pimping/humiliation.
Any ability to take those hits on the chin when you flub a case is also important. Psychological safety doesn’t mean never being challenged—it means being supported enough that you can bounce back from your inevitable failures. We have forgotten how important resiliency is, and we’ve allowed undergraduate medical education to remain dominated by the factory information paradigm while neutering the chance for more students to become respected members of the care team more of the time.