When we go to the doctor, we like to think he or she was at the top of the class and learned everything there is to know about medicine. Even if it were possible for every med student to be at the top of their class, there would still be some vital knowledge that they were not exposed to in med school. For a variety of reasons, sometimes important skills like the 10 listed here fall through the cracks and either aren’t taught at all or are only given a trifling amount of coverage.
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Chronic pain management:
Chronic pain is a $635 billion black hole of medical treatment and lost worker productivity every year. Part of the reason for the enormous amount of money thrown at the problem is that doctors aren’t trained in treating the problem, which, unlike acute pain, often begins with no obvious injury and lasts long after an injury heals. A sizable movement has begun to require doctors to be educated in the prescription of pain management drugs known as opioids, an increasingly popular and abused drug that as much as 90% of doctors have no formal training in.
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Bedside manner:
We now have the evidence to prove that a positive attitude promotes better overall health. For many patients, how the doctor behaves around them has a huge influence on their outlook. A happy, friendly, sensitive doctor is much more likely to foster hope in a patient, whereas a doctor who is aloof, too busy, or downright rude is blowing an opportunity to promote healing. Dr. Pauline Chen refers to bedside manner as a part of the "hidden curriculum" at med school; students learn how to behave around patients by watching experienced doctors. Unfortunately, as the only source of instruction in this area, if the role models are brusque and distracted, the lessons young doctors learn are not positive ones.
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Management skills:
Doctors across the country that have been or are hoping to be appointed to administrative positions at their hospitals are heading back to school to fill in an important skill set they did not acquire in med school: management. The "false notion" that being a medical expert equated with successfully managing a department has been discredited and has revealed the need for more business management training in med school. Even doctors who will only have a few other doctors or nurses beneath them need to know how to effectively delegate, reprimand, and perform other tasks required of managers.
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Nutrition:
With American obesity rates through the roof, and unlikely parties like Wal-Mart and McDonald’s promoting healthier eating campaigns, the silence from medical academia is deafening. One of the most routine knocks on medical schools is that doctors aren’t adequately taught nutrition, the No. 1 aspect of preventive medicine. A 2004 survey showed that in 17 schools, students got fewer than 10 hours of nutrition education over their entire med school duration. Only 38% of the schools polled required the minimum hours recommended by the National Academy of Sciences, and nearly 90% of instructors felt more nutrition education is needed.
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Wilderness medicine:
Although some schools are beginning to offer the courses as electives, there is no American medical degree in wilderness medicine. In this area of study, doctors learn to perform in emergency situations or extreme outdoor settings like ski slopes, with little to no equipment or help. While we might think of this as an entirely appropriate and necessary field of training for doctors in other countries, knowing how to treat in an emergency is not a critical skill … until it is one. We would prefer to see doctors taught a skill they never use than have no doctors with that skill when everyone needs them to have it.
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Physical diagnosis:
The ability to practice medicine without the help of machines and computers has seen a huge decline at medical schools. The physical exam, long a staple of medical care, has been replaced by CAT scans, blood pressure machines, and MRIs. A recent study showed neither medical students nor established physicians could diagnose better than 20% of heart problems using a stethoscope. Professor Abraham Verghese of Stanford Medical School is trying to restore the importance of physical diagnoses; students at Stanford must learn 25 physical exam skills.
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Treating soldiers:
Approximately one in six soldiers returning from war suffers from post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI). As part of the Joining Forces campaign, First Lady Michelle Obama has secured pledges from 130 medical education institutions to train doctors to recognize and treat PTSD and TBI, a skill that is not currently taught by most medical schools. And because as many as half of returning service members choose to go outside the VA medical system for treatment, it is critical that civilian doctors have the skill to cure these ailments.
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Patient safety:
A recent panel made up of 40 medical experts and students produced a report titled "Unmet Needs: Teaching Physicians to Provide Safe Patient Care." The report highlighted the fact that the typical medical education focuses so much on science and clinical knowledge that the safety of the human beings being treated is often put at risk. Specifically they derided the "cycle of power" enjoyed by doctors, who are rarely questioned and who tend to shape medical students to also be dispassionate about patients’ safety. The panel recommended med schools change their cultures to make patient safety a top priority.
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Treating musculoskeletal disorders:
Musculoskeletal (MSK) disorders are the No. 1 cause of primary care and emergency room visits. And yet half of family doctors say in surveys that they don’t feel they have had adequate training in MSK treatment. This disconnect points to a dearth of training in medical school. In a famous 1998 study, 82% of incoming residents to the University of Pennsylvania failed an MSK competency test. Inadequate training of this common area of illness leads to delayed or incorrect diagnoses and referrals, high costs to patients, and lost wages from missed work.
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Teamwork:
Sadly, horror stories of patients who die because doctors and medical professionals failed to work together are common. Doctors tend to be assertive, independent people who make unilateral decisions, and that’s a good thing in pressure situations where every second counts. However, in cases like cancer or other long-term illnesses that require multiple doctors, the ability to work as a team is a vital skill that doctors don’t learn in med school; in fact, they often learn the opposite. Meanwhile, studies have shown that programs at hospitals that train doctors to work together result in significantly lower numbers of patient deaths.
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