I have been a faculty member for sixteen years.
I spent most of this time in university hospitals, clinics, wards, operating rooms. I trained residents, educated students, cared for patients, and tried to do science. I also worked in teaching hospitals abroad for three years. So I can easily say this: Medical education in Turkey has not been in the right place for a long time.
Everyone knows this, but no one wants to say it out loud. The problem is neither the students nor the teachers. The problem is the system.
Today, two different things are expected of faculty members at university hospitals at the same time. On the one hand, you are expected to be a scientist, give education, conduct research and produce publications. On the other hand, like a service physician chasing performance points, you are expected to see more patients, perform faster procedures, and generate revolving funds. Let me be clear: These two cannot melt in the same pot. Because these two worlds do not work with the same logic.
It is not possible for a faculty member who is forced to earn money within the performance system to be an effective part of the teaching process. This is not a matter of personal skill, but a structural problem. The duty of a faculty member in a medical school is not to count patients. It is to train physicians. To transfer clinical wisdom. It is to do science. These cannot be done in a hurry, under pressure of speed, with the calculation of points. I have been experiencing this first hand for years.
Why don't education and performance go hand in hand? Because the performance system demands speed, numbers, measurable output. Education, on the other hand, requires time, thinking and repetition. The assistant's question “Why did we act like this with this patient?” is not a question that can be answered in a few minutes. But those few minutes are where medicine is learned. It may not appear on the performance chart, but the essence of the profession is there.
Another fundamental contradiction arises in the question of error. Training needs controlled and supervised errors. The performance system sees error as a risk. As a result, the assistant either cannot touch the patient at all or is left alone. Neither is education.
Performance likes what can be measured. Education, on the other hand, cannot always be measured. The maturation of a resident's clinical judgment, gaining ethical reflexes, learning to stand in the right place do not fit into the scoreboards. What you cannot measure, you devalue in the system. This is exactly what is happening.
There is also another reality that no one wants to talk about out loud. Very good professors are leaving universities because they cannot find economic and professional satisfaction. These people are not easily trained. They are formed through years of labor and experience. As the system normalizes this loss, universities are emptied. However, the system should both retain good professors and make universities attractive places to work.
I know that the systems abroad are not perfect, but there is a common wisdom: Academic medicine and service medicine are functionally separated. Faculty members have clinical service, but this service is organized to support education and research, not to maximize income.
In our country, while university hospitals are crushed under the burden of service, education is pushed to the point of “anything goes”. This is not sustainable.
We now have to make a clear decision. Will university hospitals be service production centers or education and science centers? It is not possible to run both together in their current state. It is not realistic to employ faculty members under performance pressure and expect them to provide quality medical education.
Medical schools are not institutions that hand out diplomas. Nor can university hospitals be businesses that turn patients away. If education remains at the margins of the system, only titles remain.
We may train physicians, but we cannot train “good physicians”.