November 21, 1997

Balancing act required to cope with demands of medical education

Balancing act required to cope with demands of medical education

Are residents and medical students being asked to do too much during their residencies and education? Can the long hours and demands actually harm the students, turning them into exhausted, uncaring physicians?

These questions were put before a panel at last week's Ethics Conference, hosted by Vanderbilt University Medical Center's Center for Clinical and Research Ethics. The panel consisted of a resident, a medical student, a department head and a dean of students. The title of the conference was "First, Do No Harm. Does this Apply to Medical Education?"

Clark Galbraith, a fourth-year medical student, said that although the demands placed on medical students are great, they are not unreasonable.

"Medicine is much more than a career. It is a profession and a calling, one that requires significant commitment and dedication and sacrifice of personal convenience. Because of that, I don't believe we can fundamentally condemn the great personal demands of medical education as unreasonable," Galbraith said.

A 41-year-old father of three, he said that balancing medical school and a family is difficult.

"My children are not just little tykes that need some tickling and hugging to carry them through. I have two teenagers and a nine year old, all with very sophisticated relationship needs. I, especially, had to count the cost carefully before I started medical school and now live a daily battle between professional and personal demands. But even so, I still say that, in general, the commitment and dedication required is most worthy of the profession," he said.

Dr. Deborah C. German, associate dean of students for Vanderbilt University School of Medicine, said that teaching and taking care of patients should take place in an atmosphere that fosters mutual respect ‹ respect for students, patients and the physician.

"The behavior of the faculty toward patients and students is a powerful example of ethics in action," she said. "Likewise, the behavior of students toward faculty, patients, and each other is also a powerful example of their own personal ethics in action.

"Physicians and students are privileged, and with that privilege comes responsibility. The core of this issue is balancing the welfare of the students and the welfare of the patients. Where each finds balance depends on judgment," she said.

"The welfare of the student should always be optimized because a happy, healthy, well-adjusted student will do the job better. The welfare of the student should always be optimized as long as patients are our number one priority."

German compared the jobs of medical students and residents to jobs of other professionals who work long hours, like the utility workers who repaired a power outage at her home one Christmas Eve.

"When I was thinking about how hard the students work and about their nights on call, I was also thinking about these electric service workers. I thought about the privilege they have in our society compared to the privilege we have as physicians," German said. "I don't think there are many people who sit around talking about how much they respect people who work at the electric company, and yet their responsibility to society is not much different, in some ways, than is our responsibility."

Dr. James A. O'Neill Jr., John Clinton Foshee Distinguished Professor and Chair of the Department of Surgery, said that a physician's education is ongoing.

"A medical education is to a large degree self-motivated," he said. "It's not just something you're passive in. We're all students. That's the nature of what we do. We're constantly educating ourselves, just at different levels," he said.

O'Neill said that a medical education, however time consuming, can be made more positive by people simply treating each other well.

"One of the obligations we have to take, and I hope we've taken it seriously, is to bring together a group of people in the educational process who care about people. I believe if we don't treat each other well, then we won't have the environment and example of treating patients well."

Balancing a medical career and a personal life can be difficult, O'Neill said.

"How do you prepare yourself for a life of service? That's what medicine is. You have to balance many other things. It's not an easy job. Just like any discussion of ethics, there's no cut and dried answer. It's a juggling act."