Thursday, February 14, 2019

Pack 'Em In

Lecture Hall at an Italian Medical School, 2014

When I first moved to Italy, any high school graduate who thought they might like to be a doctor had the right to give medical school a whirl. Because of this open admissions policy, ten times more physicians were churned out each year than the country needed. And because there was no way those hordes of students could get individual attention from their teachers, and far too few bodies for them to learn on, you could graduate from med school without having ever touched a patient. Literally. Italian medical training was so notorious that when the European Union started recognizing degrees and specializations across borders, Italy risked being the only country excluded.

The threat of that humiliation goaded Italy to begin a minor revolution. By the turn of the century a system of selection for medical school had been introduced (based on a multiple-choice test), freshman classes had been slashed by 90%, and students were starting to be taught at patient bedsides instead of only from books. Italian medical training was making giant strides toward joining the rest of Europe.

Now, twenty years after Italian doctors began their Long March from laughingstocks to world-class clinicians, the Italian Health Minister, Giulia Grillo—a physician previously known mainly for waffling on the need for vaccination—has been crusading to turn back the clock by bringing back open admissions for medical school. No more tests. No more selection process. Anybody who made it through high school would again be welcome. Come one, come all!

Dr. Grillo, from the Five-Star Movement, has even added a sour cherry on top: the downgrading of postgraduate training. She points out, correctly, that due to sloppy planning Italy has gone from too many prospective General Practitioners to too few, and trains far too few specialists in emergency medicine to keep hospital Emergency Rooms properly staffed. Her proposed solution? Stop requiring docs hired for those jobs to have any residency training. Instead, she says, hospitals should be able to employ anybody with experience, such as night coverage (Guardia Medica) on the National Health Service, assuming they’ll have picked up their trade by osmosis. Even worse, she’s suggested maybe those ER docs and GPs could be hired fresh out of medical school. Anywhere in the world that would be a mistake, given the complexity of modern medicine, but in Italy—where medical school is still relatively weak on the practical—it would be madness.

Already many young Italian medical graduates flee the country, headed for nations where they expect superior specialty training, higher stipends, and eventually a better chance at real jobs. And already Italian specialty training is uneven, turning out specialists whose levels of competence range from superb to iffy. If even that spotty training is turned into an optional, with self-taught doctors handling heart attacks and accident victims . . . poor Italy!

Pardon my rant. I’ve never been good at buddhistic acceptance, and the coronation of Donald Trump reset my indignation threshhold even lower. By now even a considerably less dangerous Italian Minister of Health can trigger it.

P. S. The picture of a medical school lecture hall at the top of this post was from 2014, when the admission process was highly selective. Imagine how packed those halls used to be when ten times as many students were enrolled, and how they will be again if Dr. Grillo gets her way.


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  1. Che cosa ti aspetti da una classe ora dirigente che propone corsi di esorcismo nelle scuole?
    Ma l’esorcismo lasciatelo fare ai professionisti! Immagina un’ intraprendente studente che fa un tentativo esorcizzante: non potrebbe il diavolo uscire dal posseduto per possedere l’esorcizzatore? Chi paga in tal caso?
    Puo’ essere considerato rischio professionale? C’e una assicurazione?
    E per noi medici c’e’ rischio mentre guardiamo una gola o peggio mentre faccio una esplorazione rettale?
    Forse mi assicuro subito contro ogni imprevisto e consiglio di farlo anche te.

    1. vedrai che dopo aver visto il tuo commento ho aggiunto un posto proprio sull'esorcismo. Hai notato che questi corsi sono aperti anche ai medici?

  2. With so many smart people around, why is it that governments are often full of idiots?

    1. in the case of a certain Superpower that shall remain nameless, I'd say it's because the President prefers hiring people at least as dumb as himself

  3. I am glad to see that there is some recognition of the need to limit numbers of people attending medical school and perhaps the amount of time given to get the degree (one friend took 19 years to get through). My American husband who could not get into an American medical school (medicine was the only draft deferred graduate training), but he took advantage of the open enrollment in Padova Italy in late 1973. Seven years later he was a doctor, having seen 7 live patients, countless autopsies, did not know how to draw blood, rarely attended lectures, but studied from the Italian booklets and English language medical texts. Memorized every footnote in those books. His first 6 months at a NYC public hospital were tough. But he got a fabulous education in Italy and we never regret his going there. He was an internist until we retired two years ago. (practicing medicine as an independent doctor is no longer possible in our BIG Corporate medicine country). Reading your posts makes me wonder what would have been had we stayed in Padova. And I adore your current ones, on Covid, your fun, sane, methodical way of cutting through all the misinformation out there. Thank you for all your intelligent posts.

    1. Thank you for this story. I was struck by the "countless autopsies." I had been pretty sure that med students weren't allowed to touch dead bodies either for autopsy or for dissection. Though recently I read that the U. of Bologna had brought back dissection in gross anatomy class, unique in Italy. And thank you for your kind words. Have you and your husband read my memoir, Dottoressa: An American Doctor in Rome? I guarantee you'll enjoy it!