Reflections from the Dean: The regenerative power of teacher-learner relationships

News & Events

Thomas L. Schwenk, M.D.

Thomas L. Schwenk, M.D.

We have a crisis in medicine and medical education. We see seemingly daily reports on the deteriorating state of the mental health and well-being of medical students, residents and physicians. There is much we don't know, and much we could criticize about the general state of research in this field, but the data are clear that something serious is threatening the fundamental values of the medical profession.

I am proud to have been a physician for 44 years. I feel blessed every day that I have the privilege of practicing and teaching medicine. For that reason, I am personally distressed to see what seems to be a crisis of confidence and morale in physicians. I am sad that we are experiencing a fundamental threat to the integrity of the profession that I love. This crisis appears to affect the entire physician lifespan, from medical student to retiring physician.

Some experts in this field believe that medical education and medical practice are more demanding than in the past, and others blame the problem on the demands of electronic medical records and various regulatory and legal stresses. I do not support either assessment.

Medical practice and medical education have always been stressful and demanding and always will be. The various burdens of practice are simply of the moment, preceded by others in the past and likely to be replaced in the future.

What has changed is the weakening of the fundamental relationship of medical education—the teacher-learner relationshipand its corollary in medical practice—the physician-patient relationship. We have lost much of the regenerative nature of those relationships that buffered the stresses of the past.

One step toward solving this problem is emphasizing more strongly the fundamental role of mentoring and guidance from experienced educators and physicians. We know these roles are critical to helping medical students maintain their focus on caring, compassion, altruism and caregiving. The loss of those relationships exposes them to significant risk. In addition, the student body is far more diverse in all regards-gender, race, spouses, partners, children, socioeconomic status, financial stress and much more. This diversity leads to the need for more complex and more diverse sources of mentorship and support.

We subject medical students to enormous stresses, challenges, traumatic events, ethical dilemmas and highly charged emotions. In just four years, we expect students who are bright and talented, but have no actual professional skills to learn and grow into neophyte physicians who immediately experience the weight of making life-or-death decisions. This process, and these physicians, can only succeed with strong mentorship, guidance and support.

More than ever our students need wisdom, guidance, personal support, role modeling and mentoring by experienced attending physicians and medical educators who can put the students' experiences into perspective, who can counsel students about how to cope with the academic and clinical stresses they face, and who can demonstrate how wise physicians cope with tragedy and error.

At a fundamental level, I believe the role of a medical school dean and other senior educational leaders is to find the right balance between the relentless scientific and technological pressures on the medical school curriculum and on medical students on the one hand, and the humanistic, mentoring relationships that are critical to professional growth and health on the other. In a sense, we have to protect our students from the dehumanizing, fragmented, dysfunctional health care system, at the same time we prepare them to function in that same system.

We have to teach students how to care—for their patients, their colleagues and for themselves. Teacher-learner and physician-patient relationships have enormous regenerative power. As educational leaders, we need to figure out how to harness that power to the benefit of our students.

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The University of Nevada, Reno School of Medicine, Nevada's first public medical school, is a community-based, research-intensive medical school with a statewide vision for a healthy Nevada. Established in 1969, UNR Med is improving the health and well-being of all Nevadans and their communities through excellence in student education, postgraduate training and clinical care, research with local, national and global impact and a culture of diversity and inclusion.

Released: Tuesday October 15, 2019 @ 8:00 AM