If I was able to radically change the medical school admission process, I would deemphasize MCAT scores. What I would emphasize, if I could adequately measure would be to choose people who have impeccable sense of human kindness, ethics, and morality. Please do not read any religious meaning behind these words. Just as in life, decisions and choices come up often and logical rational thinking can lead to multiple competing “answers”. So we need other skills which enable us to make choices. In medicine choices are often important and complex, as they involve the lives of others, sometimes multiple lives and adjusting for unique situations. In phase 1 trial design of novel medications, one can often make biological predications that completely contradict each other, because the biology of cancer is very complicated. So to transition from lab based experimentation to human trial involves needing the skills to see multiple possibilities in outcomes. Part of good trial design means putting in early analysis rules and tools that allow for the information from the first few patients to be used if needed to make minor adjustments to improve the trial design going forward. Part of writing a successful grant (as taught to me by my mentors) is being able to identify potential pitfalls in hypothesis and rationale based on early result finding and how you would make adjustments once more information in known. In order to design trials this way, one needs a mind that is intellectual but also a mind open to having its ideas challenged, that does not bias toward personal academic success but can prioritizes beyond oneself to more important issues such as patient safety. I would choose those individuals who fully grasp the privilege of being able to run human trials that can impact lives and the future of medicine.
Recently I came across some young doctors, who were being disrespectful of their patients, speaking in a tone of being critical of how they handle stressful situations, and were complaining about them being “difficult”. As it should happen, I was also recently reading an expat forum that I was previously a member of and found that there was a group of people that felt conflicted on how to treat their “helpers”. I am coming to the realization that fundamentally there are two types of people, those who world view is “us” versus “them” and those that see the world as a community of “equals”. A community of equals to me can still have leader and followers. Leaders arise because of particular skill sets that allow them to have authority in specific situations. But to me the best leaders understand the situational nature of their leadership and see more in common with those who are following them than differences. I mean in the end of the day we are just all humans who bring different skill sets to our various communities that we interact with. To me both of the above actions were lapses in remembering the “golden rule”. I wanted to reply to the expat forum, don’t feel conflicted, just treat your “helper” how you would want to be treated, simple. To young doctors who find it hard to put themselves in the position of a patient, I want them to just stop complaining and really contemplate the situation. Being a patient is extremely difficult, and it takes a lot of self-advocacy to get the treatment interventions that you needed. In my field of pediatric oncology, we are talking about parents advocating for their children. I of course would not allow the conversation go on without saying something. I added that what would scare me would be someone who disengages from the discussion. A parent or a patient that is advocating and fighting for themselves to me is the best kind of patient because they are fully engaged in the process. Being questioned, if by patients or colleagues, is how we grow, hone and improve, because it gets us to think more, think differently and engage more too. It makes us and our treatments better. To me this is why I love pediatric medicine because parents are often engaged much more then patients themselves, and the love that they feel for the children often palpable. So if I was able to choose medical school candidates based on their world view being closer to “them” versus “others” or that we are just all equals, I would chose the latter. Caring is such a huge part of medicine, and if you see part of yourself in others, compassion and caring just may come a little more naturally.