What makes a good doctor?

The attributes of a good doctor vary according to the population surveyed. Patients value communication and care, colleagues seek competence and camaraderie, medical students prize cheerfulness. By contrast, admission panels focus on chemistry grades, as if knowledge of ionic bonds is somehow a proxy for the complex human and organisational bonds between doctors, their patients, and colleagues. As a result, most people seeking a career in medicine must first master chemistry; those who cannot do so are unlikely to become doctors. This ritual was played out on Aug 19, when university applicants in the UK, including those aspiring to medicine, received examination results and wondered breathlessly if their chemistry (or other) grades would be satisfactory. In today's The Art of Medicine, Donald Barr questions whether medical schools' scientific bias actually selects the best doctors.The tyranny of basic science over admissions dates from the Flexner Report 100 years ago, which redefined medical education in the USA. By emphasising the importance of scientific study before medical school, and then a science-based medical curriculum, Abraham Flexner improved the quality of medical education, practice, and research. But at what cost? The measures transformed medical schools into the exclusive and expensive institutions they remain today, and by 1925, Flexner himself worried that the pendulum had swung too far towards science and away from the humanitarian aspects of medicine.To their credit, many medical schools seek balanced intakes from a diverse pool of highly talented applicants. But at a time when universities prefer to be known for their research rather than their education, there is a danger that scientific in-breeding will produce cadres of doctors who are neither content nor emotionally competent to provide the daily clinical care that underpins health systems. To get the chemistry right for future generations, a more holistic and sophisticated approach to selection—based on predictors of care that are both valid and patient-relevant—needs to be developed and applied. The attributes of a good doctor vary according to the population surveyed. Patients value communication and care, colleagues seek competence and camaraderie, medical students prize cheerfulness. By contrast, admission panels focus on chemistry grades, as if knowledge of ionic bonds is somehow a proxy for the complex human and organisational bonds between doctors, their patients, and colleagues. As a result, most people seeking a career in medicine must first master chemistry; those who cannot do so are unlikely to become doctors. This ritual was played out on Aug 19, when university applicants in the UK, including those aspiring to medicine, received examination results and wondered breathlessly if their chemistry (or other) grades would be satisfactory. In today's The Art of Medicine, Donald Barr questions whether medical schools' scientific bias actually selects the best doctors. The tyranny of basic science over admissions dates from the Flexner Report 100 years ago, which redefined medical education in the USA. By emphasising the importance of scientific study before medical school, and then a science-based medical curriculum, Abraham Flexner improved the quality of medical education, practice, and research. But at what cost? The measures transformed medical schools into the exclusive and expensive institutions they remain today, and by 1925, Flexner himself worried that the pendulum had swung too far towards science and away from the humanitarian aspects of medicine. To their credit, many medical schools seek balanced intakes from a diverse pool of highly talented applicants. But at a time when universities prefer to be known for their research rather than their education, there is a danger that scientific in-breeding will produce cadres of doctors who are neither content nor emotionally competent to provide the daily clinical care that underpins health systems. To get the chemistry right for future generations, a more holistic and sophisticated approach to selection—based on predictors of care that are both valid and patient-relevant—needs to be developed and applied. Science as superstition: selecting medical studentsI entered medical school in 1968, hard on the heels of anti-war demonstrations and civil rights activism. There weren't many student-activists entering the University of California San Francisco (UCSF) that year. Those few of us quickly sought each other out to set our agenda. High on the list was the need to demand of the Dean of the medical school that students be placed as full members on the school's Committee on Admissions. They chose me to confront the Dean with our demand. Full-Text PDF