Students are not customers

The author argues that the student-as-customer model of medical education has many failings that result in interactions that are educationally dysfunctional. Ten "pathologies" resulting from the adoption of this model are presented (e.g., "The student-customer model seduces students into believing that they know what is best for them"). Part of the reason for the unprofessional conduct often demonstrated by students and faculty alike may be a result of the influence of this model on medical education and the consequent inappropriate empowerment of students in the role of customers, the diminishment of faculty in the role of workers who provide instruction, and the view that instruction is the service or product of medical education. The author proposes a new model of medical education in which faculty are managers of instruction, students are learning workers, the product is successful learning, and the customers are faculty, residency supervisors, patients, managed care organizations, and society. The implications of this new model are profound and are described in terms of Deming's 14 principles for achieving quality in business. The author maintains that the proposed model is the critical first step in clarifying and identifying the proper roles of all those involved in the medical education process, which in turn will diminish or eliminate the pathologies that currently plague medical education and lead to the achievement of real quality.