Medical Education – Does it Need to Think Different?

Aathman Swaminathan is a third-year medical student at the University of Vermont, Larner College of Medicine.

In the following blog post, Swaminathan writes about neurodiverse students and medical school education.

Aathman Swaminathan is a third year medical student at the University of Vermont, Larner College of Medicine.
Aathman Swaminathan

“We are all guilty of making assumptions that have questioned the classical definition of what a doctor “looks like,” but have we ever pondered just how a doctor’s brain learns and processes information?”

Like many medical students, my iPhone is filled with apps of many flavors. One app I routinely check is called Motivation, which provides me with a quote of the day. One morning, as I was getting ready for an early start at the hospital, the quote was “Everyone is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.” While this popular quote is often misattributed to the famous German theoretical physicist Albert Einstein, regardless of its origins, it prompted me to reflect on how intelligence is defined and perceived, and how this pertains to the medical education system.  

Diversity in Medical Education

When one thinks about diversity in medical education common themes that typically surface include race, gender, sexual orientation, and cultural identity. As important as these factors are in assembling a diverse cohort of medical students and next generation of physicians, one often-overlooked theme is neurodiversity, a term that has garnered more visibility in the world recently. Its origins can be traced to the late 1990s with the rising awareness and acceptance of those with autism spectrum disorder. It describes individuals with diverse neurological phenotypes – encompassing biopsychosocial differences and the nature vs. nurture paradigm, while calling into question what is truly neurotypical. 

What Does a Doctor “Look Like”?

We are all guilty of making assumptions that have questioned the classical definition of what a doctor “looks like,” but have we ever pondered just how a doctor’s brain learns and processes information? Common assumptions include being “fast on one’s feet,” having flawless recall and application of medical knowledge, being dogged about clinical decision-making, and having the ability to successfully multitask numerous responsibilities and roles. For some individuals, fitting into the stereotype comes easily and is rewarded, while others find themselves needing to use brute force and willpower to fit into this standard. However, for a small subset of individuals, who either don’t conform to these “norms” or are unable to meet these cognitive demands, medical school can be a difficult and isolating experience. 

Neurodiverse Reality

During my third year, I have had the opportunity to interact with attending physicians, residents, and medical students who have characterized themselves as neurodiverse. It was beyond inspiring to see several of these individuals work and function at such high levels to provide excellent patient care, and hear their stories of how, as students, they had to use unique and unconventional measures to progress through their education. It was also quite saddening to hear some of the negative experiences that these individuals have faced to reach the positions they currently hold. 

There is often self-perceived guilt and stigma attached to receiving in-house accommodations for exams, in addition to being labeled “stupid” by peers and educators. There is also the burdensome process of receiving extra time for the boards (which requires months and months of paperwork and negotiating), and often harsh evaluations from clinical preceptors who unfairly judge these students as lazy or unprepared. The already stressful and draining demands of medical education increase for trainees who could benefit from more support rather than obstacles placed by the system. Even worse, many of these individuals are led to believe that they will not become capable doctors and are shamed, leading to a jaded worldview, low self-esteem, and even depression. 

The Larner Learning Environment

I believe that the learning environment created by the Larner College of Medicine has been supportive in fostering a diverse student body. I am proud to know that several of our faculty members and peers are not only accepting of those who may be different but are also receptive and understanding of the need to implement and increase access and resources to those who may be struggling with certain aspects of their identity. However, like most medical schools, we need to find additional ways to support medical students who are neurodiverse. Possible solutions warrant a separate reflection, but we can start by recognizing that not all students process information and/or learn the same way and that this difference – which does not harm patients or the training environment – is not an intellectual deficit. 

Time to Think Different?

Of course, this does not mean that meeting baseline medical proficiency and knowledge should be compromised, but does it really matter if a student perceives a problem differently, learns using unorthodox measures, or takes a little longer to process information compared to their peers? At the end of the day, we need to be honest with ourselves and accept that how a medical student learns and approaches their education is less important if they ultimately possess the knowledge and qualities needed to make a good physician. 

“Think Different” said the iconic Apple marketing campaign. As the goal is that we all arrive at the same destination, I’d argue some just take an alternate route, perhaps a slightly circuitous one, but will arrive safely. We should embrace that difference.