I studied more than 100 hours a week to enter medical school. Nine years later, with more than $100,000 in student loans, a medical degree, and publications in eye surgery, I decided to leave clinical medicine and become a full-time educator.
Over the past several years, I’ve worked with thousands of medical students worldwide, observing a startling issue with how we train our future doctors.
Globally, employment rates among new medical graduates are the highest compared with other professions, exceeding 90% in the first year.
However, pursuing a career as a doctor is one of the most challenging pathways. While it’s a societally prestigious profession, medical graduates are globally reported to have higher rates of stress, burnout, career dissatisfaction, and depression than other occupations. Not only do they suffer from mental health issues, but they’re also more likely to make medical errors and have worse job performance.
These are the doctors you rely on when you or your loved ones need an operation. When I left clinical practice, I received dozens of messages asking “Why?”. Yet not a single doctor asked me that. Instead, they asked “How?”.
New Zealand, Australia and many other countries face an epidemic of burnt-out doctors, especially since the emergence of COVID-19. Therefore, insights into the employability trajectories of medical graduates, and the role of higher education (HE) in facilitating them, is essential.
These insights support relevant stakeholders to have better strategies to address the chronic problems of struggling medical graduates.
So, how are medical students trained, and what do their employability trajectories look like?
Quantity over quality in medical training
Medicine equips students with an enormous amount of specialised knowledge and skills. Consequently, medical programs are longer than other bachelor degrees, and medical students tend to spend more time and energy on acquiring vocational knowledge and skills in comparison to other majors.
This knowledge and skills is called “human capital” among employability researchers. Theoretically, acquiring rich human capital should be a significant advantage in enabling graduates to perform their job effectively. However, ironically, despite the heavy focus on specialised training, medical graduates still feel underprepared for clinical practice.
Two following areas have been documented as the main reasons for medical graduates’ under-preparedness for clinical practice.
First, medical programs at some universities are insufficient. The traditional curriculum is heavily theoretical. It’s only recently that medical programs have started embedding “integrated curriculums” that incorporate clinical application at very early stages so graduates could be better-prepared for clinical work and increase their study engagement.
However, due to unclear guidelines on what constitutes effective integration, the significant investment required for curriculum redesign, challenges with effective measurement of integrated curriculums, and general resistance to change, adoption of an integrated curriculum is still not the norm, with considerable variability in its implementation.
Second, unprofessional and ineffective training programs and practices at hospitals create significant hurdles for meaningful learning and practice. Since the primary function of hospitals is as a public service established for treating patients rather than teaching new doctors, systems and structures for facilitating education during these transition years have tended to be poor, with substandard learning environments, and reports of unsatisfactory teaching quality and feedback.
Further, while supervision, mentorship and the learning environment play an essential role in developing competent medical doctors, bullying in hospital workplaces is rampant, with 30% to 95% of junior doctors being bullied, often by senior doctors.
This unhealthy training environment hinders medical graduates from learning from their mentors, and contributes to a high level of burnout and job dissatisfaction.
Doctors convert their wellbeing into yours
Medical programs are academically packed with a high volume of content, practical assessments, internships, the emotionally-charged nature of working with patients, and increasing levels of workload and patient responsibility every year.
There are limited opportunities for medical students to learn what’s beyond their specialisations, such as “psychological capital”, which refers to the skills and competencies to look after one’s wellbeing.
Medical students are constantly stressed by heavy study loads, but have little knowledge and skills to look after their mental health. Consequently, as reported in some studies, about 6% per cohort of medical students drop their course, with 40% attributed to psychological morbidity and recurring themes of failure and despair.
When entering the profession as a doctor, medical graduates are globally reported as having higher rates of burnout and career dissatisfaction than other professions.
Despite these well-documented problems and repeated calls to better-prepare medical students with effective mental strategies, current medical training still doesn’t embed programs to sufficiently support and enhance psychological capital, leading to medical graduates feeling disproportionately underprepared regarding the coping skills they need for life as a doctor.
Hospitals as employers: A non-negotiable career trajectory
Medicine has a combination of high demand for doctors, high demand for medical school acceptance, a tight bottleneck in which most candidates aren’t accepted into a medical program, and a unified employment entity that controls the spaces available and employment positions at the end of training.