“Does all this medical education make you more or less authentic?”

by Tony Tsai

Not long ago, I was talking in front a large group of students. I asked them, “Does all this medical education make you more or less authentic?” I had meant only for them to contemplate this, but a loud voice came from the back of the room and stated, “LESS AUTHENTIC!” I was initially taken a little aback by the emphatic nature of the statement. However, it was clear that this student was speaking the truth.

For students, the experience of medical education is an alienating one. Looking at it through their eyes, the process is a series of tests and hoops where they must “prove themselves” over and over again. The underlying culture and message is: performance is the only thing that matters. In this environment, an environment that educators (me included) have created, students are pressured to abandon the development of their authentic professional selves in order to go through the motions, jump through hoops and play the game.


I refuse to blame the students. We as educators are responsible for the learning environment in our schools. Period.


As an educator, we ourselves didn’t necessarily have the best upbringing. Many of us grew up in paternalistic systems of education. We know what we ourselves have experienced and try to bring the best part of that past to our present practices. We are often afraid of engaging and confronting students because what they seem to want is not aligned with what we want for them.

For educators, the first step we have to take is to look within. We need to ask ourselves, “How congruent are we between what we say we want and how we actually act?” Take for example, healthcare. There is a lot of talk about patient-centered care, but look at the decisions being made in healthcare organizations, decisions which makes it harder for doctors to care for patients. What is actually going on between the words and the actions? We have the same issue in education. We claim to want what’s best for the student, but the environment we have created is a deeply alienating one which drives students further from their authentic, professional selves. We need to hold ourselves accountable for our results, and not to excuse ourselves for the difficult situation that we are in (and the situation is indeed difficult!).

Students need for us to love them. This love comes in the form of the knowledge and skills we teach them to prepare them to be competent as a physician. The love ALSO comes in the form of nurturing in students, an authentic sense of themselves. We need to kindly and gently observe students and give them encouraging and constructive feedback about their unique talents and strengths. We need to ask questions, and not just give answers. In asking questions, they begin to understand their values and their professional responsibilities for themselves, for their patients, and for one another. They begin to make choices in their lives which are congruent with their values.

Some cynical people may say, “Well, students just care about test scores.” Within the current culture of performance, they are driven to care about that. It is the role of those in education leadership to create the learning environment where students have the space, safety, and inspiration to care beyond that.

So…does all this medical education make you more or less authentic? The answer to this question is the standard we must hold ourselves to.