Nurturing a child’s doctoring dreams
As I lay in bed recently with the flu, my two-year-old came up with her toy medical kit and asked, in her limited Vietnamese, “Mommy, are you still in pain? Let me be a doctor to take your pain away.”
Something clicked in that moment. As an Asian parent in North America, I’m cognizant of the burning ambition many Asian parents have for their children to become doctors, raising family social status. Many parents in many cultures push their children for the same reason, believing enrolment in medical school proves their children are among the smartest, having earned the highest grades and scores on standardized tests.
Compare that to the motivation of children who aspire to become doctors simply to care for the sick.
The last century or so has shaped the notion of what it takes to become a doctor. Much of the medical-school system we see today in Canada and the U.S. reflects the Flexner Report of 1910. Abraham Flexner surveyed every North American medical school then operating for a council created by the American Medical Association, with the purpose of reforming American medical education. The report recommended substantially raising admission and graduation standards and drastically reducing the number of medical schools.
As a result many medical schools shut down or merged, the number of total seats in medical schools fell drastically and standardized examinations were introduced.
The impact of these historical events remains apparent today in the fierce competition for entry to medical schools whose selection criteria focus predominantly on grades and scores on standardized cognitive tests such as the MCAT (Medical College Admission Test), reinforcing the association between doctors, intelligence and academic excellence.
It has become increasingly clear, though, that the health-care system falls short of meeting the needs of Canada’s increasingly diverse society. Many Canadians have been left without family doctors and those lucky to have one have been experiencing long wait times to access care. Worse still, marginalized communities and visible minorities have been suffering from inequalities in many broad aspects of health.
Responding to these needs, medical schools started recognizing that soft skills such as ethical decisionmaking, collaboration, and empathy are just as important to quality care as technical competencies.
As a result, assessments that focus on such nonacademic attributes, such as Multiple Mini Interviews and CASPer (Computer-Based Assessment for Sampling Personal Characteristics), were incorporated into medical school admissions.
The mandate also paved the way for addressing the lack of diversity in medical schools and its significant impact on public health. Interestingly, recent evidence showed that physicians with particular social identities (e.g., those who identify with particular racial, ethnic or underserved communities) are more likely to practice in within those communities and that patients demonstrate greater treatment adherence and health care satisfaction when they receive care from physicians with similar social identities to their own.
Such evidence further highlights the need to reduce barriers and encourage populations under-represented in medicine to pursue careers in the profession.
With respect to medical-school admissions, much research is still needed to define the scope of systemic bias and to locate where bias may exist admissions process or even earlier in the pathway where barriers may discourage aspirants from applying at all.
How can we use this developing understanding of what society needs from doctors to guide children interested in medicine? We can focus our children on caring and connecting to the communities around them, hoping their passion for service will grow. Such passion will guide and motivate them to build the intellectual and interpersonal capabilities central to providing quality patient-centred care.
I will work hard to protect and kindle my daughter’s pure intention to be a doctor who will “take the pain away” from the sick. If she pursues a medical career, I hope she will strive to be a skilled doctor who cares deeply about her patients.