The future of medical students appears promising and challenging at the same time. While there will be abundant opportunities for medical students to explore various fields of medicine, they will be challenged by high stress levels, financial burden, and unprecedented competition for prestigious residencies. How will they fare? In what ways will tomorrow’s medical students be different than past generations? Here is a brief overview of what medical school applicants can expect, and how their training will provide an advantage over previous graduates, in my opinion.
A main advantage comes from training prior to matriculation into medical school. Many of the standards for acceptance into medical school by which my generation (Baby Boomers) and others were judged are no longer relevant. The soft sciences — as opposed to the hard sciences — now have standing in premedical curricula, especially courses in psychology and sociology. At Philadelphia area medical schools, for example, calculus is required at only one of eight MD or DO granting institutions (Penn State).
The Association of American Medical Colleges (AAMC) added a psychology-sociology (“psych-sosh”) section to its MCAT standardized admissions exam in 2015. The revised MCAT reflects the importance of learning how to think and solve problems, with more questions requiring that future doctors use analytical skills rather than simply memorize material. Prerequisite courses in the social sciences may also yield students who are emotionally intelligent as well as clinically competent.
It’s telling that in a survey of physicians trained in my era — those graduating college between 1955 and 1982 — the greatest unmet need was “skill with people,” and my peers wished they had taken more courses in art, history, literature, and music while in college. Nowadays, some of those subjects are expected if students want to earn a spot in medical school, even if they reserve the right to “fall asleep in [their] seats during lectures,” writes acclaimed physician-author Chris Adrian, MD.
After decades of welcoming science nerds, medical educators have finally placed more emphasis on the humanities in medicine. Medical students need to be competent in the humanities in order to converse intelligently with a heterogeneous health-conscious public. Once accepted into medical school, students can augment their literary competence through narrative medicine programs, now offered at roughly 80% of medical schools. These programs aim to teach medical students sensitive interviewing and empathic listening skills, combined with storytelling and writing skills to acknowledge the struggles of their patients, as well as their own.
The AAMC has also created an optional exam to evaluate the “situational judgment” of students applying to medical school. The Professional Readiness Exam, formerly known as the AAMC Situational Judgment Test, consists of 30 hypothetical scenarios and 186 related questions that test the effectiveness of students’ remedies to hypothetical situations encountered in the classroom and practice. The appropriateness of students’ responses is a proxy for their readiness to enter medical school, as determined across eight core competencies such as service orientation, cultural competence, and teamwork.
Typical dilemmas presented to students include: (1) how to deal with a classmate who violates patient privacy on social media; (2) how to ensure a patient’s cultural customs are respected in the event something unexpected occurs following surgery; (3) how to seek help when the stress of a clerkship in emergency medicine is beginning to affect sleep and judgment; (4) how to address a lecturer who is quick to dismiss multiple valid perspectives on a subject; and (5) how to deal with a classmate who has assumed a deceased immigrant was “undocumented,” or a person’s stomach pain was fabricated because they were homeless.
Another similar test, made by Toronto-based Acuity Insights, is called Casper. This assessment evaluates aspects of students’ social intelligence and professionalism such as ethics, empathy, problem-solving, and collaboration. The evaluation offers admissions assessments that give each applicant the opportunity to showcase their attributes beyond their grades and to differentiate themselves from other applicants.
The removal of affirmative action admission policies by the Supreme Court of the U.S. (SCOTUS) this past June has not deterred medical schools from efforts to select diverse students, deemed necessary to reduce health disparities. Conducting holistic reviews of applicants and searching for unique personal characteristics complies with the SCOTUS ruling and supports diversity. In addition, some medical schools have instituted community outreach and “pipeline” programs to attract a more diverse applicant pool. The University of California Davis School of Medicine has maintained a remarkably diverse class of students by assessing their socioeconomic status rather than their race and ethnicity (affirmative action admissions have been banned in California public colleges since 1996). A heterogeneous workforce has been shown to improve patient outcomes and increase trust in the doctor-patient relationship. Furthermore, teaching diversity, equity, and inclusion across medical school campuses fosters a sense of belonging among staff and faculty and the patients they serve.
Tomorrow’s medical students will be vastly different from their predecessors not only due to their premedical training and selective screening for admission, but also due to changes in medical education methods, evolving technological advancements, and the continuously shifting healthcare landscape.
With the rise of digital health technologies such as telemedicine, artificial intelligence (AI), and machine learning, future medical students will be better technologically equipped. They will be trained in using advanced tools to diagnose, treat, and communicate with patients. In addition, improvements in virtual and augmented reality will provide students access to cutting edge learning tools. This will make their education more interactive and practical, potentially facilitating better understanding and knowledge retention.
AI in particular holds significant promise for medical students, training them to operate at a higher cognitive level and reducing time gathering data and information from multiple sources. According to Harvard Medical School educator Bernard Chang, MD, MMSc, “students ought to be able to move further along the developmental progression of reporter, interpreter, manager, and educator earlier in their training, reaching functional levels at which their cognitive talents will be most valuable in an AI-assisted clinical environment.”
Future medical students will increasingly learn to work within and lead multidisciplinary teams. As the healthcare system shifts focus from treatment to prevention, medical students will pay closer attention to the social determinants of health and emphasize preventive care.
The COVID-19 pandemic has shown the importance of adaptability in healthcare. By virtue of having lived through the pandemic, medical students will show resilience and flexibility to changes in the healthcare environment, including changes in the way medicine is practiced and health systems achieve their goals. The whims of private equity and the business of medicine will become second-nature to them. In fact, with the rise of healthcare startups and new medical ventures, future medical students will learn entrepreneurial skills to innovate and improve the healthcare system. In fact, approximately 80 medical schools in the U.S. offer a combined MD/MBA program.
Clearly, tomorrow’s medical students will be unlike any cohort of doctors in my time.
Arthur Lazarus, MD, MBA, is a member of the editorial board of the American Association for Physician Leadership, an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, and a former Doximity fellow. He is the author of Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.