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MEDICAL STUDENT

PERSPECTIVES

MEDICAL SCHOOLS HAVE CHANGED,
MOSTLY FOR THE BETTER

By Meredith Furst

Ah, medical school. Something that all physicians, regardless of generation, can relate to. Dreams of
white coats and helping patients have driven us to work through those sleepless nights and endless hours
in the library. As a 2nd year medical student at UT Health San Antonio (UTHSA), I’m currently experi-
encing the trials and milestones each physician has dealt with during some point in their career. Interestingly
enough, both of my parents are physicians who attended Texas medical schools, so I have heard my fair
share of stories about what it was like “back in the day.” Many physicians are aware of some obvious
changes in medical education, such as hospital hour restrictions and over-head paging, but hearing my par-
ents’ stories from medical school in the 1980s has shown me that there are several other differences between
what it was like then and now.

Medical school has never been a bargain. At UTHSA for example, tuition and education fees alone can
rack up to $79,970 for four years. Throw in the cost of living, travel expenses, and board exams among
other things, and you are looking at a significant cost. In an AAMC report from 2017, the median cost of
attendance for a four-year public medical school came in at $232,800, and the median education debt for these schools was $180,000.
In a similar analysis from 2011, the AAMC found that medical school graduates from 1978 on average owed $13,500 in education debt
(or $46,500 in 2011 constant dollars). My mother recalls her father, who was also a physician, complaining about the “exorbitant” se-
mester tuition fees of $385. Imagine what he would think of the semester tuition now! Of course, everything is bigger in Texas, but
medical school education debt overall isn’t part of that. A recent report by USA Today College ranked 5 Texas medical schools in the
top 10 most affordable, with UTHSA as #10 and with an average debt of $120,529.
With evolving technology and resources, teaching and testing the science and practice of medicine has also changed. As every young
medical student knows, nothing can be more anxiety provoking than the USMLE STEP 1 board exam. This exam, the first board exam
taken as a medical student, is used to evaluate our competencies in basic medical science and now is a major determinant in matching
to residency programs. These medical board examinations have been continuously evolving. Back then, the NBME part examinations
and FLEX like my parents took were a requirement but were not weighed as heavily during residency selection as the exams are now.
It seemed like just another hurdle each student needed to pass in order to be licensed. Today, the USMLE STEP exams function as a
uniform educational process evaluation, allowing all residency programs to evaluate applicants on a level playing field regardless of
medical school program. Some major changes have occurred in licensing exams such as the transition from paper to computer based
exams, and the addition of the clinical skills standardized patient exam. Due to this, patient interaction and clinical skills is being intro-
duced much earlier in medical training. Our first week of medical school, we start practicing physical exam skills on standardized patients
and going to the hospital once a month to practice these skills on real patients. Most medical students in the 1980s didn’t see a real
patient until the start of clinical rotations.
A change that I personally am very excited about is the increase in female medical school students over the years. When my mom
was in school, there were only 17 girls in her approximately 100-person medical school class. In fact, the AAMC found that from 1982-
1983, less than a third (31.4%) of medical school matriculants were female. That number has increased over the years and from 2011-
2012, females made up 47% of all medical school matriculants. My class at UTHSA was approximately 48% female, so I get to see that
progress on a day to day basis!
Of course, this is merely the opinion of one medical student with insight and stories from another medical student (who happens
to have a 1980s perspective). I’m sure there are countless other things that have changed in medical school, similar to how the
practice of medicine is changing constantly. I do know that changes and advancements in medical education have given us new
challenges and new opportunities that others might not have had in the past. As a different generation of students, we are fortunate
enough to be able to work through the unique experience of medical school with the advice and guidance of other physician pre-
ceptors and mentors. Despite the changes, they know how to survive medical school and are the best people to learn from. Even
if it’s through a “back in the day” story.

Meredith Furst is a second-year UTHSA medical student from Austin, who has enjoyed learning about and exploring San Antonio.

30 San Antonio Medicine • January 2018