I have to say I was pleasantly surprised upon entering OU med school this Fall. I hated most of the pre-meds I knew in undergrad at Cornell. They were largely self-absorbed geeks more concerned with a perverse view of achievement and status than learning to become healers (in addition, for many Asians, there was the pressure for parental approval). While I am self-absorbed, something of an overachiever (when not being a slacker), and Asian, that didn’t really apply to me. I won’t get into why I chose this path, but suffice to say that money, parental favor, and status played no role in this decision. Because of that experience, and the fact that I’ve been exposed to the medical community for most of my life, I have a bit of a cynical opinion of it all. I frequently doubt the quality of doctors we produce despite the rigorous process from pre-med to resident to ‘real’ doctor.
We just got through our first test block of second semester. Tested on Physiology, Neuroscience, Histology, and Human Behavior. I’m not going to lie, the tests were hard as hell. And a lot of people used to making A’s…didn’t. As you can imagine, there was a lot of ire. Here are people busting their butts, practically memorizing class notes and syllabi, and they’re making C’s instead of the A’s they made last semester.
Well, I’m not the only one who has a blog in our class. Another classmate addressed both of these issues in a recent post and made some statements and drew some conclusions that I find distasteful and misguided at best, and downright insulting at worst:
the difficulty of tests that I faced wasn’t what made me so frustrated. I grew increasingly agitated as the week progressed because of the response I observed my classmates having in regards to our results.
I was one of those classmates, playing traitor to my module and hanging out in his, and I did pretty darn well. Well above the mean in every test, and blew two of them right out of the water. I was bitching anyway. Not about my grades, which were my best of the year with the least effort put forth yet, but about the way we were taught and the way we were tested. I wasn’t the only one who did well that was critical of the test block, by far. While I did hear some complaining about grades (to be expected when you’re among overachievers), most of it was like mine; critical of what we were tested on because we felt it was irrelevant.
The trick is, most medical students are looking forward to the clinic and treating patients so much that they scorn the “basic science years.” They disdain the long hours of study, the memorization of “useless facts,” the testing over seemingly insignificant trivia…Most students don’t care about truly learning and understanding this stuff; “just tell us what we need to know to pass the tests” is the mantra they cry.
You know, the thing is, on two of our tests, Neuroscience and Physiology, we were tested on meaningless trivia. And many of the ‘conceptual’ questions were more focused on tricking us and confusing us with situations that either we weren’t likely to encounter or were physiologically impossible than they were about understanding the concepts of fluid dynamics in blood vessels or mechanics of the heart. That is what had us upset; the irrelevance.
On our physiology test, we had our first exposure to test questions that went beyond memorization into truly understanding the relatively simple concepts that make up our highly complex body systems…But I believe that this was absolutely necessary for our development as doctors-in-training. Most of my classmates disagree. “The test questions were unfair,” I heard many complain. “The f professor did a horrible job of teaching – he made it sound all easy, but the f test questions weren’t straightforward at all,” cursed many.
And again, I think he’s confusing tricky and ridiculous with conceptual difficulty. A lot of what we learned had to do with fluid dynamics. I have a pretty good conceptual knowledge of that field. One of my best friends designed a full aero-kit for racecars. For years I wanted to be an aero engineer and ate up some really technical material on wing and fuselage design and was a huge physics nerd all through high school. These questions didn’t necessarily speak to conceptual understanding and critical thinking; more often than not, they offered answers that were intentionally convoluted, dealing with secondary and tertiary effects rather than the primary effects that someone with a good conceptual basis should understand.
But these statements, while infuriating to a man with my prodigious temper, are more or less a result of being misguided and maybe lacking a view of what real medicine is. Where it starts to get directly insulting is further down the page.
Frankly, I think my colleagues are fools. If all there was to being a doctor was knowing diagnoses and treatments, I could make millions of dollars programming a robot to do just that. It’s such a low view of doctoring. It sickened me to hear that all week, and it angers me to think that patients are going to put their lives in these people’s hands.
I guess as one of the complainers, I’m a fool. I’d have liked to see him say that to my face instead of blogging about it. But here he really shows a lack of exposure to real diagnostic medicine. Diagnosis (and to a lesser degree treatment) is more art than science. Often enough a doctor can’t pinpoint why they think a diagnosis is right, but these gut instincts can catch a fast-spreading cancer before it becomes lethal. No robot in the world can do that. Which is why minutiae and trickiness don’t help us become better doctors. We need a feel for medicine, an idea of why the body does what it does. And that won’t come from the kinds of questions we were complaining about, the same questions he earlier lambasted us for complaining about. It’ll come from case studies, talking to real doctors and real patients, and being walked through the diagnostic process (which our medical school does an EXCELLENT job of considering we’re first years, overall).
But then he had to go bring religion into it…
What saddened me more than hearing non-Christians complaining in this way was the hearing the Christians I know in medical school whining the same way. It seems to me that what should set the Christians apart from the non-Christians in medical school is that we desire to become doctors because God has called us into the profession.
I guess as a dirty heathen I should be held to a lower standard. But you know, I can’t recall anywhere in the Vedas or Upanishads where we’re told to be materialistic self-serving douchebags. I guess I missed that passage. Unlike many other agnostics and evolutionary biologists, I’m on balance a fan of religion. I see more moral people come from a religious background than from secular backgrounds. But at the same time, I can point to self-serving, materialistic Christian doctors pretty much just as easily as I could non-Christians.
I’ve lived in the bible belt most of my life and most of my friends have been fairly religious Christians. We always got along well and didn’t fight much about religion because morality and who we were was more important than how we worshipped or if we worshipped at all. But this kid forgets that there was morality before Jesus. I belong to the oldest continuously practiced religion in the world, one that some (including me) contend is the oldest religion, period. We don’t worship the devil, condone stealing, rape women, or kill and eat babies.
The intimation that because I’m not Christian I shouldn’t be expected to be moral is prejudice of the lowest kind, it’s paternalism akin to Kipling’s White Man’s Burden. He almost overtly claims that Christian doctors are by nature more noble than others. Screw that and screw him. He should ask himself if Jesus would support such a sentiment. I went to a Christian school, I’ve read the bible, and you know what struck me about Jesus? Just like Buddha, or Krishna, he was a moral teacher. He taught people about right and wrong first, and about devotion to god second. But I’m a heathen, so I probably lack the superior Christian ability to interpret holy works. We have a saying in Hinduism: “The soul is the thing, and the whole of the thing.” The trappings around it don’t matter; it’s who you are inside that God cares about. Not whether or how you pray to him, but what you do.
But at least this I can agree with:
Medicine, with its highest goals requiring a high regard for human life, has left its sacred calling and rapidly degenerated into a business enterprise that are regulated by insurance policies and patient’s rights.
Ah, a martyr:
Who knows, maybe God has placed me where I am so that I can recast the vision of a noble medical profession to a population that is blinded by relativistic humanism. Whatever the case, I will continue to study this material with all diligence so that my joy will be complete. May God be glorified!
I can understand the idea of medicine being a calling. No one else played a part in my decision to become a doctor, parents, professors, mentors, friends, all wanted me to stay out of the profession. But a major part of the reason I’m here instead of playing with south american monkeys is that I was pushed by a sense of dharma, duty. I could even romanticize my decision as much as he did in his post. But I’d be lying to myself. Everyone is selfish–and that’s not just the evolutionary biologist speaking–everyone is moved by a selfish goal of some kind. They may do noble work, they may give more to the world than they take, but at the end of the day, everyone is motivated by their own desires.
But I’ll never be able to look this student in the face again without feeling the sting of that insult about my religion and about my moral character. All I can say is I’m glad the days when rage went straight to my fists are long gone.
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One of the reasons we scorn the first two years of med school (I’m actually looking forward to second year, but I do despise this year’s material with a passion) is because they really are irrelevant. It’s more a right of passage, just like a high GPA, a good MCAT score, and all those extracurriculars. Work your butt off, study hard, get good grades…then never use much of the material again. Obviously a good general knowledge of gross anatomy is important, as is a conceptual understanding of physiology and neuroscience, since those three fields more than any other contribute to what you look at in your clinical exams. But there’s a point after which what you learn no longer impacts your clinical skills in those areas.
This isn’t just students mouthing off but the words of doctors to us. Many of us have doctors in our families, many know their local doctors pretty well. When we discuss our curriculum with them, with residents, or with 3rd and 4th years, they often tell us that the material is irrelevant. This is why we complain. Why are we learning it if it won’t help us become better doctors?