The College Fix

Gone are the days when rigor in medical school weeded out the weakest links. When it comes to med schools today, credentials are the commodity, students are the consumers.

Michigan State University physiology professor Stephen DiCarlo and research assistant Heidi Lujan recently wrote in Advances in Physiology Education that administrators and students are both “increasingly considering preclinical medical education as a market.”

“Preclinical medical education has lost its way,” they wrote. “In fact, it seems that preclinical medical education has forgotten its mission and has become focused on assembly line efficiency and profits.”

According to the authors, “once banned, for-profit medical schools are on the rise in the United States,” while medical schools more broadly have adopted corporate models focused on cutting costs, making profits, and providing students with the product they want rather than teaching future doctors the skills they need.

“The ‘corporatization’ of medical education and satisfying the customer creates an environment where a university is selling socioeconomic stability, professional status, and success, rather than a setting for the formation of character, intellect, and critical thinking,” they wrote.

To attract their student-customers, medical schools invest heavily in branding and obsess over improving often superficial metrics like school-rankings that may not necessarily reflect the quality of the education a school provides but can be used for marketing purposes, they wrote.

Similarly, for matters pertaining to faculty retention, promotion, tenure, and salary increases, considerable weight is given to student comments on faculty evaluations that amount to little more than customer satisfaction surveys, they added.

In doing so, medical school administrators incentivize early career faculty “to design courses, grading standards, and course content to improve faculty evaluations,” although they also acknowledged that the Liaison Committee on Medical Education accreditors “base much of their concern” on student evaluations, which in turn, “also causes some administrators to provide students with what they want at the expense of what they need.”

Steven Templeton, an associate professor of microbiology and immunology at the Indiana University School of Medicine–Terre Haute, echoed many of these points in an Oct. 4 article published on his Fear of a Microbial Planet Substack.

Spurred by the DiCarlo and Lujan op-ed, Templeton highlighted how the focus on customer satisfaction by medical school administrators and educators has led to greater uniformity in medical education, as well as attempts to cater to student demands that “courses be as easy and straightforward as possible, with all of the information distilled into exactly what they ‘need to know.’”

DiCarlo and Lujan had noted that another major practical consequence of this corporate model is an increased focus on pre-recorded lectures delivered through distance learning platforms to students completing preclinical coursework remotely or on satellite campuses.

As such, remote learning opportunities appeal to some student-customers while also saving schools money on faculty salaries and the costs of maintaining physical campuses.

Yet, the authors warned, such changes come with a cost to would-be physicians as opportunities to interact with professors directly are lost, as are opportunities for professors to train students in skills like communication, collaboration, inquiry, discovery, and innovation.

Other problems with the corporate model of medical education include cutting preclinical basic science education from two years to fifteen months or less and moving more training to outpatient facilities where there is less of a focus on scholarly or scientific pursuits by those charged with training students, they wrote.

Clayton Baker, an experienced physician and former Clinical Associate Professor of Medical Humanities and Bioethics at the University of Rochester, told The College Fix in a telephone interview that although he did not think there was a problem with the physicians overseeing medical students in outpatient settings per se, he does believe that because medical schools generally provide little to no compensation to these physicians, these physicians do not have much time to work with the students they supervise.

“The [physicians] who participate, who do that outpatient clinical training, are generally more or less volunteers and so you’re not really reimbursing them for what they’re providing,” Baker said. “Historically, they do it out of the goodness of their hearts.”

Even with the best of intentions though, Baker said “they can’t afford to change the number of patients they see that afternoon to get more time to work with the students. [The physician] can’t have a twenty minute talk with [the students] before or after the clinic because, already, the students are going to make him later than he would be than if he were working alone.”

In their op-ed, DiCarlo and Lujan wrote their “hope is that administrators, educators, and students will reconnect to the greater purpose and value of learning.”

The College Fix reached out to Dicarlo, who is cited as the corresponding author for the op-ed, asking whether he believes his piece generated the kind of conversation for which he and his co-author were hoping but did not receive a reply.

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