When he was an undergrad, Jonathan Y. Wong, OMS III, heard years-old, oft-repeated anecdotes of the cutthroat competitiveness of medical school. According to one story, med students about to take a histology exam discovered that their microscopes’ focusing mechanisms had been tampered with.
When she attended the Philadelphia College of Osteopathic Medicine (PCOM) nearly 30 years ago, Kathryn C. Lambert, DO, heard rumors that students at a nearby school would sabotage test tubes and anatomy lab cadavers to gain a competitive advantage over perplexed classmates.
“Those kinds of allegations have been out there for decades,” says Dr. Lambert, now a school administrator. “But I know that in my personal experience attending an osteopathic medical school and working at one for more than 20 years, I have never seen this sort of behavior.”
Brian M. Fishman, DO, noticed a big difference between his undergraduate experience at Johns Hopkins University in Baltimore and the student culture at the Lake Erie College of Osteopathic Medicine (LECOM) in Erie, Pa.
“At Johns Hopkins, where every exam was graded on a curve and the only way for you to do well was for other people to do poorly, there were plenty of cutthroat students,” he remembers. “My notes were stolen from the library on one occasion. I left them out when I went to the bathroom and when I came back, they were gone.”
In his first two years at LECOM, in contrast, he found his fellow students to be especially supportive. “Once you get into medical school, it’s more like everyone is in the bunker trying to help each other make it out alive,” says Dr. Fishman, who is serving a traditional osteopathic rotating internship at University Hospitals Richmond (Ohio) Medical Center.
The pressures of having to learn vast amounts of material in a short time can instill in medical students empathy for their peers and a desire to reach out for companionship. In addition, technological advances have made it easier for students to share notes and advice, further fueling a propensity for cooperation. But osteopathic medical schools may naturally foster collaboration among students through the bonds formed in osteopathic manipulative medicine lab and the types of personalities attracted to osteopathic medicine, members of the profession say.
Of course, some osteopathic medical students, particularly those pursuing highly competitive specialties such as orthopedic surgery, dermatology and radiology, strive harder than others for top grades and test scores, glowing letters of recommendation, and choice rotations and residencies. Though perhaps more single-minded than the average medical student, these “gunners” typically are not malicious, students and administrators say.
“There may be a handful of medical students on our campus who are very competitive and don’t share information, but they don’t do things to be disruptive,” says Thomas Moorman, EdD, the vice president for student affairs at the University of North Texas Health Science Center in Fort Worth.
Maria S. Swetech, OMS I, says she tries to be friendly with everyone at her school and they, in turn, have been friendly and helpful to her. “Even the people who want to get really competitive residencies are still helpful to other students because being able to teach somebody else something or share something with somebody else makes you understand it so much better,” notes Swetech, who attends the Michigan State University College of Osteopathic Medicine in East Lansing.
Osteopathic medical students, usually wearing nothing more than shorts and tank tops, practice osteopathic manipulative treatment on one another during OMM labs. Such intimacy with one’s peers breeds camaraderie not seen in most other school settings.
“From Week 1, our students touch other human beings through their OMM classes,” says Dr. Lambert, the acting assistant dean for student affairs at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine in Stratford. “This gives them greater connectivity with their colleagues and, ultimately, with their patients.”
“A lot of our training involves working on our peers, which promotes closeness,” Dr. Fishman adds. Students hone their skills not just in class but also through the informal groups that they form.
Beyond practicing OMT, many students break into study groups to tackle difficult basic science and clinical science coursework.
Ryan Nguyen, OMS I, says he regularly studies with a half dozen or so students he has become close friends with. The study sessions intensify before examinations.
“We’ll share notes and the mnemonics we’ve made,” says Nguyen, who attends the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, Calif. “And right before an exam, we’ll study for a couple of hours, questioning and quizzing each other. I actually get a lot of points on exams just from those pre-exam study sessions.” Each person in Nguyen’s study group will bring up unique insights regarding the material they are reviewing.
“Most students feel that with the volume of information you need to absorb in med school, you just can’t tackle it all by yourself,” Nguyen says.
Study groups also help prevent isolation, frustration and, for those who are vulnerable, even depression among med students.
“In the first two years of med school, you spend so many hours studying. I’ll sit in front of my computer and watch lectures and read material, going hours without saying anything to anybody,” Nguyen says. “I like the social aspects of getting together with my study group.”
The president of the Student Osteopathic Medical Association, Wong has observed how hard the beginning of med school is for many students, who go from being a top student at their undergraduate institutions to being just like every other physician in training.
“There’s no debating that to get into medical school, you have to be smart. A commonly quoted figure is that medical students rank in the top 5% academically nationwide,” says Wong, who attends the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Ill. “Suddenly, you’re surrounded by an entire class of students with high academic achievement, and this can be an intimidating feeling.
“We all want to do well. But I believe that the majority of medical students have no desire to achieve better grades at the expense of their classmates.”
Sharing notes, tips, cases
At some osteopathic medical schools, students use class Facebook to share tips and ask questions about poorly understood concepts.
“At CCOM, Facebook pages serve as a forum for bringing forth anything you aren’t understanding,” Wong says. “Someone will post, ‘I don’t understand this. Can someone explain it to me?’ And sometimes within an hour, several people will post suggestions to help that student understand the material.”
During his first and second year, Wong and his classmates frequently shared homemade study guides. “The general feeling was, ‘If I’m going to take so much time to make a study guide, why should I be the only person to benefit from it. I should share this with my entire class.’ ”
Besides Facebook, osteopathic medical students use Dropbox and class listservs to share notes and other study resources.
Following different schedules, dispatched to different sites, third- and fourth-year DO students may lose some of the camaraderie developed in the first two years. The clinical years are also when gunners come to the fore—arriving early for their shifts, staying late, reading textbooks in advance to appear more knowledgeable and enthusiastic than their peers, trying hard to ingratiate themselves with attending physicians and residents.
But for the most part, osteopathic medical students remain collaborative during their last two years of school, Dr. Lambert maintains.
“For example,” she says, “I recently talked to a third-year who told me about a fellow student on rotation calling colleagues’ attention to an intriguing case that came in. That student said, ‘Hey, you guys have to come and check out this case because it is really interesting.’ ”
Students on rotation, moreover, have been known to use social media to share notes and advice regarding their shelf exams. The notion that students vying for residencies are just out for themselves is unfounded, Dr. Lambert says.
But is there a downside to so much collaboration? Can strong student solidarity, coupled with new ways of collaborating online, lead to more cheating?
“I have not found cheating to be on the rise,” Dr. Lambert says. “I’m not saying that it never occurs. When it has, we’ve disciplined those students, and we’ve kicked some students out.”
Dr. Lambert points out that it is usually weaker students who cheat. Sometimes they are students who got into medical school fraudulently because they cheated on exams as undergraduates.
Banning cell phones and backpacks from exam settings helps prevent cheating, Dr. Lambert says, as does using software to scramble test questions so that each student takes a uniquely configured examination on his or her computer.
“At the undergraduate level, academic dishonesty is at a record high because there is a lot of pressure for high grades,” says Dr. Moorman. “So at UNTHSC, we give students an ultimatum on Day 1: ‘If you’re caught cheating at our institution, you are going to be dismissed.’
“We have only occasional instances of cheating because we stress that it is not tolerated. We stress that we don’t want people in the community that we’re serving to be injured by a physician who has been taking shortcuts.”
Osteopathic medical schools do what they can to promote teamwork among students at all levels. Most curricula incorporate small-group learning to some extent, and many schools offer formal peer-tutoring programs. Some DO schools have done away with class ranks—and many do not grade on a curve—specifically to prevent stressful and ruthless competition.
But osteopathic medical students overall may have a natural penchant for collaboration, some administrators say.
“I think many students not only at my school but also at other osteopathic medical colleges have chosen osteopathic medicine because they are interested in working in primary care with underrepresented populations,” says William P. King, the associate vice president for student services at the Edward Via College of Osteopathic Medicine—Virginia Campus in Blacksburg. “These are students who have good interpersonal skills, who enjoy working together and don’t have the attitude that someone else has to do badly in order for them to do well.”
Even DO students who aren’t interested in primary care may place a premium on cooperation and congeniality.
Scott D. Miller, OMS III, who plans to pursue the highly competitive specialty of anesthesiology, says he has never viewed his classmates as rivals.
“I don’t see myself in competition with other people but rather in competition with myself. I’m always pushing myself to be better,” says Miller, who attends the Des Moines (Iowa) University College of Osteopathic Medicine. “At DMU, my classmates are very collegial and willing to help and I try to be the same way. This environment helps me aim higher and achieve more in my professional pursuits.”