On Friday, one of the headlines in The Chronicle of Higher Education caught my eye: “Medical-Admissions Test to Look More Broadly at Who Will Be a Good Doctor.” The article states that, as of 2015, the MCAT, the nation-wide exam that is administered to students who hope to attend medical school, will be making some significant changes to its format. The writing sample, long the bane of science students but for me one of its most demanding and revealing sections, will be removed, a new section on explanations of human behavior will be added, and a new critical reasoning section will replace the old verbal reasoning section. According to the AAMC, “The new exam is designed to help prepare tomorrow’s doctors for the challenges, advancements, and reformations of our future health care system.” It seems the AAMC is seeking to strike a greater balance between scientific competency and humanistic care, with more weight now falling on the latter.
As someone who spent nearly a decade helping prepare pre-med students to take the MCAT, I have my doubts that the new test will be demonstrably better than the old one. During my tenure as a tutor, I met young kids, seeming adolescents, who had read nothing outside their discipline and knew very little in general; who, for 18 years, had been trained to take standardized tests and had become adepts at that; and who were generally kind, came from well-to-do families, and were more or less harmless. I admit; I liked them. Unlike GMAT or LSAT students, they usually thanked me and were mostly courteous, occasionally apologetic. They answered emails promptly and caught a few of my references and jokes. They could laugh so long as you tossed them a juicy softball. And their parents paid me without meddling or niggling or interfering and, compared with the parents of high school kids, kept themselves well off-stage. No drama, thankfully.
On the East Coast, tutoring is as commonplace as cell phones, both being monthly expenses built into the well-to-do’s family budget. Most students, if not all, were used to having tutors for most, if not all, of their educational lives. (“Mom, I can’t right now, I’m Skyping with my tutor.”) I wouldn’t say that any of them had really lived or felt or suffered greatly. Death, hard times, and setbacks were concepts, mere abstractions, classroom ideas like social justice and Africa. No, I would say that they were… nice, almost to a fault, as if life, having been frictionless so far, would remain frictionless to the end. Having been swept along for 21 years, having some idea that medicine was one of the few remaining noble professions, and having worked assiduously on touching anecdotes with which their personal statements were to win hearts and influence committees, they would expect that hard work would pay off for them again and that, all things considered, helping the unhealthy wasn’t such a bad way to spend a life. Besides, there would be plenty of interesting cases.
Hard work was what they lived by, hard work and a deep trust that a decent life lay quietly before them. While others partied, they studied; while others played it safe, they went all in. And yet if there were only one problem with this picture, it would have to be that hard work, helpfulness, scientific competence, test-taking prowess, and being generally decent are neither necessary nor sufficient conditions for being a good doctor. If the MCAT has never been a good measure of a student’s readiness for med school, then revamping the MCAT is unlikely to plug the hole.
It could be asked what makes a good doctor good. This is a matter I’ve discussed with my medical doctor friends on more than a few occasions, the latest occurring over email this past weekend. Below, I’ve clipped a part of that conversation out of a longer exchange I had with one estimable doctor friend. In my reply, I second his praise of Yale Medical School as being good preparation for residency.
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Dear Anton,
I think we two believe in apprenticeship. That is what I take from your Yale example. The rest of it–the labs, the grades, the recommendations–is but guesswork. Show me how he talks to patients. Let me see his hands and eyes. Ask her whether she has read Chekhov.
I am reading Chekhov’s My Life, the excellent translation by Pevear and Volokhonsky. The prose is lovely but the existence is heavy. (‘Twas ever thus with Chekhov…) I think when you and I first met a year ago the “struggle for existence” was very much with me. Now, I struggle rarely and think the “struggle for existence” should be reserved, for those of us fortunate enough to be living in the developed world, only for those times when we’re muddled and trying to slog through. If our lives are to go well, however, they must be made graceful and just; we must make them so. I can’t say the same of those living in the developing world. For them, it’s doubtless a veil of tears, and Chekhov their earnest muse.
Good students should know about the veil of tears. Good doctors should attest to it. Good persons should know and have experienced both struggle and grace, should have made both their own.
A
Catching a brief glimpse at a rerun of “Band of Brothers” recently, there we were in a German town in the Spring of 1945 and the populace was sorting ruble in rags with not enough to eat. Yet, right in the midst of them was an “out of work” string quartet playing Beethoven.
There’s so much to unpack from that, the easy bit – how could the land of Beethoven Brahms and Schiller have been reduced to mass murder and to orchestrating the near destruction of a continent?
What’s more to the point here is, how were they able to express “grace” in the midst of such “struggle?” Not how they had maintained their banal pride in the heady years of rising, but how, after all that had happened, after having fallen so far, they reacted this way?
The world of your aspiring med students, the world of your Yale educated physician, will not collapse with such grace, as I see it.
The difference might be the depth of exceptionalism in the two populations. Germans, europeans, africans, asians, south americans; have all had a mixture of struggle and grace throughout their cultural histories. People had it then, at least at that place and that time, enough personal exposure to the depths of what societal collapse can bring to personal life and somehow felt it in their bones that grace, as experienced through the expression of culture at its deepest and best, was not a “luxury,” but a necessity of life.
What’s missing from your doctor’s response is any understanding that this is a single world and that whatever temporary differences that have insulated his experiences from those who must feel with Chekov are transient and when they pass the people with the least understanding of the place of grace in any life, no matter how fraught, will have it worst.
I see this as the most fundamental question we face today, in America, and throughout the Americanized world. How do we disabuse ourselves of this exceptionalism and at the same time strengthen our ties with the best of what our cultural legacy has to offer us in the appreciation and acceptance of the need and place for grace as central to any life in any time, in any place?
“How do we disabuse ourselves of this exceptionalism and at the same time strengthen our ties with the best of what our cultural legacy has to offer us in the appreciation and acceptance of the need and place for grace as central to any life in any time, in any place?”
This seems like an excellent question, Tony. The need and place for grace.
I’d say that the very few of us in the developed world — and certainly in the US — truly have to struggle for existence; our lives are so much easier than that of all too many of the people on this planet. What we do tend to struggle for is not so much surviving, but meaning. Some of us gain comfort from religion — some, from philosophy — but I don’t think that’s ever enough. And a simple job seldom does it, either. There’s a wonderful quote about purpose in Shaw’s “Man and Superman”:
“This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy.”
Which brings me around to “Unlike GMAT or LSAT students, they usually thanked me and were mostly courteous, occasionally apologetic.” Maybe the difference was that they saw a career in medicine as a purpose, a noble one — yes, noble, an old fashioned word and value, and one sorely lacking in our world nowadays. I have to wonder if the same can be said of GMAT or LSAT students here.
I taught GMAT when I was first living in Tokyo, where just about all of my students did have that sense of purpose — and they were also very courteous and often apologetic — but that’s also part of the culture of Japan, or at least had been until recently. Have been working in finance for quite some time now, and it seems to me that all too few people in this industry have any sense of purpose — other than simply making money, I suppose, which is certainly not very noble.
Have you ever read Siddharta?
1. I agree with the Shaw quote. One of the oft-lauded claims is that authenticity (let me venture a quick stipulative definition: to be authentic, P must live according to P’s most deeply compelling desires) is necessary and sufficient for leading a meaningful life in an after-the-death-of-God world. We know that’s nonsense because P’s most deeply compelling desires could be… to commit murder. If it’s then said that leading an authentic life amounts to having one’s deeply compelling desires put in coherent order such that desires X, Y, and Z (etc.) don’t contradict each other, then it could easily be objected that consistent desires does not entail GOOD desires. Again, a religious fanatic’s desires may be entirely coherent but be not good fullstop.
So we’re back to puzzling out what meaning could be in post-theistic world. Well, I write more about the question of meaning in my piece, “Practicing Philosophy,” which is coming out in The Philosophers’ Magazine oh in a month or so.
2. You’re right about the GMATers and LSATers. They already begin in ‘bad faith’ and the rest was soul sucking world. Ditto people in finance. They’ve no telos, i.e., no final end, toward which their lives can be aimed in order to be answerable to anything outside of making money. And you and I know that the acquisition of wealth has never been a good account of a flourishing life. The wealthy man, on his death bed, can only say, in full honesty, that his life was either wasted or trivial or both.
3. Reply with a link to Siddharta. I’m not familiar, but I’m as eager as a child to learn. My background, you’ve undoubtedly gathered, is in Western philosophy. About the rest I’m in the dark.
Definitely read Siddharta (by Herman Hesse) — you’ll find that there’s a lot in the novel that resonates with much of what you’ve said lately, esp in the posts on the Tao and on nomads. Have managed to read a couple of previous posts this afternoon, esp these two I’ve mentioned, but there’s so much going on in them that resonates with me and so deeply at that, that I found it hard to gather my thoughts and write.
Thanks, Alexis. As I write, the Hesse is on the way. Do you know (well, I’m sure you can divine) that I used to not like it when people recommended books to me? Not anymore. Let’s call that philosophical progress. Warmly, A.