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Attending physicians?
January/February 2012
by Jenny Blair ’97, ’04MD
Since 1931, medical education at
Yale has held to a set of principles known as the Yale System, in which
students are treated as self-directed learners. One manifestation of this idea
is that attendance is not taken at classes; students can choose whether to go
to class. But a recent proposal to make attendance mandatory at small-group
sessions set off a debate last fall about teaching quality, autonomy, and
responsibility.
For years, attendance has been relatively poor at
small-group workshops held in March and April, and some faculty believe medical
licensing exams are to blame. Yale students usually take Step 1 of the
licensing exam around June of their second year, just before beginning clinical
rotations. The students see Step 1 as critical, because residency directors
often use it when they’re deciding whom to invite for interviews, and many
students start hitting the books and skipping classes in the spring.
In 2002, faced with the same problem, faculty tried to
goose attendance by creating a set of new mandatory tests, but relented after
students and alumni protested, making the tests optional and clearing seven
weeks of classes to allow students to study for Step 1. Nevertheless,
second-year students attended the small groups in extremely low numbers last
spring.
Faculty were not pleased. Associate professor Michael
DiGiovanna ’90MD/PhD, who helps direct second-year educational modules, explains:
“The goals of these workshops are not only to impart knowledge, but also to
teach the skill of clinical reasoning. That skill, we feel, can only be
mastered by continued practice with a seasoned mentor.” In September, deputy
dean of education Richard Belitsky proposed the new mandatory-attendance
policy.
Students reacted swiftly, organizing a working group
that surveyed the student body; most said they opposed the policy. Medical
student council president Billy Lockhart ’14MD says that while “boards fever”
is partly to blame for poor attendance, many students find small-group sessions
to be of “variable quality.”
For now, students and faculty are discussing the
problem, and classes are still optional. Lockhart calls mandatory attendance
the faculty’s “last resort, depending on how things go this year.”  |