Thursday, September 19, 2019

SVI: The Next Step 2 CS

Image credit: Pexels
Author: Haig Aintablian, MD
AAEM/RSA President
Originally published: Common Sense July/August 2019

I did great on my SVI. The day of, I had just gotten a haircut and shaved my beard. My top half was covered by a nicely pressed navy blue suit jacket my mom bought me 4 years ago but that I hadn’t touched since my undergrad graduation. Under the blazer, a white shirt I’d worn twice that week already, and a baby blue tie I’m pretty sure I’ve had since high school. Best of all though, my bottom half was covered with a pair of stereotypical grey Hanes boxers – the type you buy in a 6+1 pack because you get one for free. I sat behind a desk in the middle of my half disastrous room (the side not covered by the camera), prayed an Our Father, and I said what had become my motivational slogan at this point, “**** it, we’re almost done.” I looked great on camera. My upper body displaying a professional, well-groomed student against a clean room backdrop with undergraduate degrees newly hung on the wall. There were no tight pants to hold me back (away rotations made me gain weight like a CHFer off Lasix). Regardless of how I looked on camera, I felt a deep helplessness. During the hardest half year of medical school trying to prove myself on away rotation after away rotation, devoid of family, friends, and proper sleep or nutrition, I was expected to be a robot in front of a video camera for reasons no medical student understood, no administrator could directly answer, and almost no PD would actually care about (let alone watch).

I had just undergone this same scenario too – we all had! Step 2 CS, the money making scheme weighted on the backs of students already in the hundreds of thousands in debt to their name is commonly called the most expensive lunch on earth. And it had scarred my friends and myself significantly already. This though, was a different beast. For this, I had to play a computer game against my will with the threat that if I opted out, it may affect my chances of getting into residency. I sat in front of my computer (the device that usually harbored the good feels of “The Office” now being used to judge my soul) to have an interview with questions it seems no one had filtered, with the goal to convince an “HR employee” with a mystical rubric that was unpublished, that I was perhaps a good interviewer. (I’m actually not sure if that was the point – no one knows). Better yet, this HR employee would potentially be replaced with a computer generated algorithm in the future. “Hasta La Vista Baby.”

I remember finishing the ordeal. My armpits were sweaty underneath my blazer, and my brain was fried. I remember having a shelf to study for, but decided that I definitely needed a beer instead. That night I hung out with a few of my co-residents who were also going into EM and we vented. A few weeks later my SVI grade appeared in my inbox, and it made me smile. I wasn’t proud of myself for doing well – I was proud that the mysterious program didn’t weed me out for being the half-naked, half-messy, half-awake person I was in that “interview.”

Today, I’m the President of the AAEM Resident and Student Association, and a resident in an incredible residency program. I’m a little more professional in my meetings and interviews than what I and many of us did with the SVI (I just add a pair of pants now). Most importantly though, today I can air my grievances with these types of forced loopholes that so much of our medical education contains. We’re scared to speak out at the time given the fact that any retribution, no matter how small, could severely affect our chances at residency. For me personally, I feel as though the purpose of my presidency has been to cut out as much bureaucracy from our education as I and the RSA can.

I’ve heard enough about what stresses this SVI and of course, Step 2 CS are causing. I’m going to highlight a few brief points below as to why RSA specifically chose to call for the end of the SVI, and why we will do everything we can to advocate for our students and residents while on the AAMC SVI work group and elsewhere.
  1. Lack of evidence
  2. Very few PDs deem the SVI necessary
  3. EM is not a small specialty: We don’t need more filters
  4. EM residency spots are growing
  5. Potential for this to be an added cost in the future (cue: Step 2 CS)
  6. EM is a team sport requiring human interactions - no computer should grade that
Check out this and other resource for more:

If you agree with our stance, help our efforts and join RSA. Let us represent you in our battles toward making medical education more about the medicine and less about the pointless bureaucracy.

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