Last week in lecture, our professor wryly mentioned that in his many years of teaching, he had never seen so many laptops out as well as so many people taking advantage of the option to watch videos instead of attending class. That was fine with him, he commented, as long as people were learning—although he was skeptical that students on laptops would learn as much, given the infinite internet distractions available, as well as skeptical whether the students who elected to watch videos would absorb the information as well.
I think most of my classmates, including myself, would agree with his assessment. There’s something about sitting studiously in class, with only pen and paper, that is more conducive to focusing on mind-bewilderingly complex molecular pathways than watching a lecture video in the comforts of home. But in many ways the fast-paced, perpetually distracting lifestyle of the 2011 medical student is also training us for a new world of medicine in a way that rigorous pen-and-paper lecture attendance will never do.
The last generation of physicians expected to work brutal hours but in return have intimate relationships with their patients, total control over their professional decision-making, and be fiercely independent. They were the masters of their own domain, and as insurance billing increasingly encroached on physicians’ time via complex billing practices and HMO utilization review, job dissatisfaction soared.
But our generation of medical students ignored those warnings to enter medicine anyway because we have a very different set of expectations. Many of us fully expect to never enter private practice and instead to be paid a salary by a hospital. Many of us know that our skill as an advocate for our patients before insurance companies may be as critical to our professional success as our physical exam skills. We have accepted that our performance will be measured against quality metrics, and that our medical decision-making will be scrutinized against evidence-based protocols. We expect not to be parochial small business owners but instead to be organizational leaders and national policy advocates.
In other words, we don’t expect to ever have the luxury of total control over our own schedules, sitting in front of our patients with pen and paper without other distractions. Instead, we’ll be asked to juggle a complex set of expectations and duties. But unlike the previous generation of doctors, we don’t resent these changes; instead, we’re preparing to meet them. Last week, I skipped class in order to follow-up with patients I had seen in our school’s free clinic and make phone calls to a specialty center on their behalf. Later in the day, as I watched the lecture video of our professor calling me out for not attending class, I recognized the truth in his statement. But I didn’t feel guilty, because I hadn’t been playing hooky. I had just been tending to a different part of my medical training.