Attending physicians?

Gregory Nemec

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Since 1931, medical education at Yale has held to a set of principles known as the Yale System, in which students are treated as self-directed learners. One manifestation of this idea is that attendance is not taken at classes; students can choose whether to go to class. But a recent proposal to make attendance mandatory at small-group sessions set off a debate last fall about teaching quality, autonomy, and responsibility.

For years, attendance has been relatively poor at small-group workshops held in March and April, and some faculty believe medical licensing exams are to blame. Yale students usually take Step 1 of the licensing exam around June of their second year, just before beginning clinical rotations. The students see Step 1 as critical, because residency directors often use it when they’re deciding whom to invite for interviews, and many students start hitting the books and skipping classes in the spring.

In 2002, faced with the same problem, faculty tried to goose attendance by creating a set of new mandatory tests, but relented after students and alumni protested, making the tests optional and clearing seven weeks of classes to allow students to study for Step 1. Nevertheless, second-year students attended the small groups in extremely low numbers last spring.

Faculty were not pleased. Associate professor Michael DiGiovanna ’90MD/PhD, who helps direct second-year educational modules, explains: “The goals of these workshops are not only to impart knowledge, but also to teach the skill of clinical reasoning. That skill, we feel, can only be mastered by continued practice with a seasoned mentor.” In September, deputy dean of education Richard Belitsky proposed the new mandatory-attendance policy.

Students reacted swiftly, organizing a working group that surveyed the student body; most said they opposed the policy. Medical student council president Billy Lockhart ’14MD says that while “boards fever” is partly to blame for poor attendance, many students find small-group sessions to be of “variable quality.”

For now, students and faculty are discussing the problem, and classes are still optional. Lockhart calls mandatory attendance the faculty’s “last resort, depending on how things go this year.”