Picking Only 'Smart' Medical Students Is Stupid

The way we choose medical students often times boils down to performance on standardized tests, even though that's not a very good indicator of who will be a good doctor.

at the University of California at Los Angeles, believes that too many faculty members “have come to value merely being smart more than developing smartness.” That line comes from his new book, “Are You Smart Enough? How Colleges’ Obsession With Smartness Shortchanges Students.

His thesis is that when higher ed and graduate and professional schools give favored status to smarter students, it denies others equal opportunities. The true metric, he believes, should be in how much students learn during school, not how smart they are when they entered. Faculty should be held accountable for the delta.

This dynamic is pervasive in medical education, where medical students are, for the most part, chosen because of their academic performance on standardized tests (which, for the convenience of those doing the choosing, might have some correlation with performance in medical school, but none when it comes to performance as a practicing doctor). Standardized test scores, of course, are based on students’ ability to memorize large amounts of information.

There are several problems with the process:

1. It creates a culture of competitiveness that is counterproductive in medical care delivery.

2. It marginalizes those who do not have the benefits of socioeconomic class that is associated with academic performance.

3. It assumes there is only one way to measure “smart.”

4. It results in medical school classes that do not reflect the populations graduates are trained to serve.

5. The reality is that doctors don't really need to be that smart to be effective. In fact, "smartness" is dropping down the list of competencies needed to practice 21st-century medicine, e.g. empathy, team-building, and emotional intelligence.

6. Smartness is too often associated with conformity, not creativity, imagination, and innovativeness.

7. It rewards memorization and recall, a lower level of learning when compared to problem solving and interpretation.

8. It creates a misperception about the value of smartness. How many times do we need to hear, "Every doctor I know is smart, but..."

9. It deludes the smart person into thinking that smartness creates a sense of entitlement and a pathway to life and career success based simply on their smartness.

10. Given the fact that the knowledge base is expanding beyond the comprehension of any human and that machine learning will probably be better at making sense of things than people, no person can stay smart forever without a sense of curiosity and the motivation to stay smart. Even then, smartness is not wisdom.

I've suggested that a portion of every medical school class be chosen by lottery. My guess is that the outcomes won't be that much different and demonstrate that many faculty, like myself, are merely educational placebos.

We all know that many smart people do stupid things and many drop-outs and flunk-outs do incredible things. Picking only smart students is stupid. We should be creating movies, not a scrapbook of snap shots. It makes a much better story.