As I continue my trek across the country, I recently ran into Kevin, a second-year medical student who hails from South Central Los Angeles. He is currently working his way through pharmacology and had this to say about the course:
Why in God’s name does this have to be so hard? Who in their right mind gave these names to drugs anyway? They’re always so confusing. I can’t recall whether tetracycline is birth control or an antibiotic. And is there really a difference between atenolol and metoprolol? I’ll just have to let the drug reps tell me which is better.
There sure is a lot of memorization. Some people use flashcards. I use dirty mnemonics. I don’t know if “killing prostitutes for fun and pleasure” is a true statement, but it sure does tell me the different types of benzodiazepines.
When I told my cousin back home that I was studying pharmacology, this trick asked me if I can give him some OxyContin. I’m not a street pharmacist. And speaking of pharmacists, did you know that they get over $100,000 a year just to dispense pills? They are doing the job of a high school graduate with a computer and are making a killing thanks to the certification laws of our country.
And some people make this their life. I realize that you can make a million bucks by discovering a new drug, but who would want to go through all that time and effort?
I’m spending a month traveling across the country in search of guest authors from different medical schools. This week I ran into Jeff from Alabama. He is a first-year medical student who just finished his anatomy class. He has this to say about the experience:
I can’t believe that we just got done with anatomy. Things are all disgusting and nasty as shit in there. From the very first day I knew that we were going to have a tough time. When we got our cadaver, I saw he had an Ozzy Osbourne tattoo on his upper arm, making me wonder what my Paw Paw was doing as a dissection body. But then we dissected the vagina and I knew it couldn’t be him.
If you’ve never seen a dead body, it looks a lot like a deer when you run it over with a pickup truck. But when you cut it open, it looks like chicken. I guess that would explain why am always so hungry at the end of each lab.
I try to be very respectful of the bodies. I always unwrap them carefully before taking out their innards. I heard that some people like to have sex with corpses. That shit’s just plain nasty. Now I’ve had some regretful encounters in my life, but that’s just crossing the line.
The girls in my class have been particularly scared of these cadavers. I got paired up with two ladies who don’t want anything to do with sawing the face in half. I said, “git,” but they just wouldn’t budge. I guess that women just shouldn’t be doctors. Shoot, I just went right to work and manage to get that skull right open. COPS comes on at 7:00 and I needed to get home.
I guess there’s a lot to learn in this class. I never knew that there was both a small and large intestine. That must be why my aunt Geraldine is so fat. She says that she’s big boned, but I think it’s because she has too many intestines.
So I’ll keep working on the dead bodies and one day I’ll be able to cut on the live ones.
I’m sure that many of my readers are wondering how they can be successful once they enter medical school. I thought I’d take the time to tell you some of the habits I picked up which will guarantee your getting AOA and landing the residency of your dreams.
The first step is to hoard all of the information for yourself, and make sure that none of it lands in the hands of your classmates. Common examples include creating an outline for all of the month’s lectures and then refusing to send it to the rest of the class; finding a website that is helpful in clarifying concepts and then neglecting to tell anyone about it; learning that someone else’s patient has had a change in status and then forgetting to tell your classmate so that he’ll be embarrassed on rounds the next day. These techniques may sound rude at first, but remember that your goal is to get your top pick for residency. And remember that all of your class to your competitors.
The second step is to take on extra patients. The higher the patient load, the more the residents and attendings will notice your hard work and will reward you for it. If all of the other medical students are assigned two patients, then you should get a third. You should readily and willingly take additional patients, even if it means pre-rounding on one of your classmates’. Don’t worry, you’ll do a better job of taking care of that person then the other third-years will anyway. That patient is now in better hands.
Finally, you should make sure that you are always visible, even when the resident has already told you to leave twice. When your classmates all agreed to go home after the afternoons lecture, you should very loudly state that you agree with them and that you will promptly leave campus once class is over. The moment everyone else is gone, you should immediately return to the hospital and ask the resident if there is anything else you can do. When the chief inquires as to why you were the only student who has returned, be sure to give some passive-aggressive answer such as, “I don’t know. I just sort of assumed that they got tired of being here.”
Don’t worry about what your classmates say about you. You’ll encounter many people who are jealous of your success. You might even hear sounds of “click click boom,” but you should ignore these. Remember, you’re the one who’s getting to go to the residency of your choice. Everyone else is going to end up in primary care out in the middle of nowhere.
Since you’re a reader of this website, you can print out these tips and keep them in the pocket of your whitecoat. Don’t share it with anyone, ever. In fact, don’t ever tell anyone that you’ve been to this website. Your competition will learn the secrets and may even employ them against you. You need to stay ahead of the game.
(Half M.D.: I wanted to post this on April 1. However, I will be out of town then and am forced to write it now. It’s a joke. Please don’t e-mail me asking if I’ve tried any of these methods.)
In the past I’ve written about characters you’ll come across in medical school such as Patient Killer and Surgio. This week I want to address the God Squad, a group of fundamentalist Christians who are so hard-core in their beliefs that they make Billy Graham seem like a Pagan.
This is the group who schedules Spring Break trips to Latin American countries in an effort to convert the Spanish-speaking savages to their way of thinking. Awkwardness abounds when they finally realize that 99% of the residents are already Catholic. As witnessed, “You must turn from your god Haysus and believe in Jesus!”
In class, these people are the groaners whenever a lecturer mentions evolution, abortion, or women’s equality. First, women started wearing pants. It’s straight to devil worship from there.
Anatomy lab becomes problematic when they see a naked person for the first time. (I actually know a girl in my class who sincerely wished that she had been married before beginning medical school so that the first penis she would have to see would have belonged to her husband.) If paired with one of the prudes, expect a conversation like this:
Her: Is that the penis?
Her: Do they all leak like that?
Me: Yes, all penises leak embalming fluid. But it usually occurs only during ejaculation. That’s why women are so stiff after sex.
Luckily, schools are able to put a dampening on prostletyzing patients so things don’t get too out of hand. But watch out when Dan Brown’s Angels and Demons comes out in theaters…
After having been on the wards for a while now, I’ve seen the importance of having a strong background in the basic sciences before moving on to seeing patients. While many students and physicians alike bemoan learning the mechanisms of action and half-lives of medications, this information is important in creating a useful drug regiment for treating disease.
The traditional med school curriculum uses two years of lectures and classwork to teach the basic sciences, followed by two additional years of clinical experience. The thought is that students need a firm foundation in book knowledge before applying that information to patients. Occasionally, universities get students into the hospital to practice on patients. At my school, we have a course called Physicianship Training that teaches students necessary skills for clinical encounters. The school throws us this bone to keep us interested in continuing the lectures that drag on for those first two years. The only problem is that medical school costs about $30,000 a year for those lectures.
I’ve come to realize that the first two years of med school were largely a combination of wasted time in lecture and physicianship training exercises. I’ve noticed that my school charged $60,000 for students to teach themselves from textbooks for two years. Many of my readers who are already in medical school or are doctors are all too familiar with the self-teaching that occurs. Professors are notoriously bad at teaching about mitochondria and the brachial plexus, leaving the student with the task of clarifying the material later.
Given that the students are already self-teaching, I propose that we eliminate the first two years and leave the basic sciences up to the textbook authors. We’ll make the Shelf and Step exams the determining factor of who gets into medical school. The top 17,000 scores get in, while everyone else has to re-take Step I. Naturally, research experience and rec letters will play a role in admissions, but this method will bring in a steady supply of doctors with a strong basic science background.
Some critics will claim that Step I’s 350 questions do not cover enough information to fully assess a person’s ability to become a doctor. My first response is to point out that Step I is already used as the primary indicator of knowledge from the first years. Second, we can extend the exam to cover two days and double the number of questions if there is any concern that the test is not an adequate measure of science comprehension.
Companies such as Kaplan will emerge with their own medical schools to prepare people for these exams. Critics will claim that test prep groups teach to the test and not to the material. While there is some credibility to this argument, I certainly won’t miss out on all of the surgery lectures I saw where the surgeon shows before and after pictures of his work. Further, I am sure that Kaplan would hire better lecturers, would be more efficient at teaching, and would be cheaper. Similar to a cell phone contract, at $30,000 a year I’m currently locked into my school where the professors have a monopoly on my education. Under my plan, when universities are forced to compete against each other, the quality of lectures would improve drastically. Then, after Step I, future doctors could move onto the wards—and the real two years of medical school.
I just finished STEP I. Time to start studying for STEP II. Sarcasm and humor to follow.
For crying out! I spent the last two years busting my ass to get through med school and now all I’ve got is a consistent series of mediocre performances on practice tests. Christ, I’ve never worked so hard to be average. All of that time spent in Physician Training made me realize what a raw deal I’ve gotten with respect to medical school. Instead of teaching us valuable things like vascular abnormalities and biochemistry, my school wanted us to write reaction papers to television shows and practice PowerPoint presentations via PBL. Lot of good those exercises are doing now.
You presided over a group of motivated medical students and managed to crush their will to the point of learned helplessness. In the beginning, our presentations were good enough to study from. But by the end of the semester, I spent less than an hour on my PowerPoint presentations. My classmates similarly had a steady decline in quality.
Whenever a student tried to contribute to the differential diagnosis, you didn’t just lead him away from erroneous thinking, your typical response was, “Think before you speak. Why would you even say such a thing?” You successfully management to keep us all from ever trying to add to the discussion. Surely you didn’t realize something was wrong when you kept asking at the end of the course, “Why is everyone so quiet?”
I know you went to an Ivy League school. You couldn’t help yourself in reminding us every week that you attended Harvard and know all about the PBL process. I wonder: did Harvard also teach you to be rude to everyone? Was one of the learning issues about crushing people’s will?
We had multiple guests drop by to see how PBL works. You demonstrated the opposite of what the school was hoping for. I think you even scared away two professors who could have done a lot for our university.
Your evaluation of me was the lowest eval I’ve ever received. While most of my peers gave me perfect scores and noted that I give great presentations, you wrote that I need to stop throwing out ideas without thinking of the mechanism of disease. I was only doing what I had been taught by earlier instructors. As I recall, formulating a differential diagnosis involves listing every possible disease, even the zebras.
You convinced me that I want to go back to lectures, where I could at least stay home if I didn’t like a particular speaker.
The worst example of your arrogance and inability to look introspectively came when you decided to give us advice about third year. Included in your talk were don’t be arrogant and acknowledge your shortcomings.
In summary, I hope that future generations of students don’t have to put up with your non-sense. You are a shining example of the physician that I hope that I never become.
As doctors, you’ll notice corporate sponsors everywhere. It can be pretty simple, from a pen that says “Seroquil” to a stethoscope that says “Bayer aspirin.” I’m just waiting for boxer shorts that say “Correctol laxative.” And just look at drug companies. Life is hard. If you want to be thin, you have to exercise and diet appropriately. But drug companies take the work out of life. Don’t feel like exercising? No problem! Just take Lipitor to bring down your cholesterol. And we’ve got Viagra and Cialis. Boner pills for men who’ve given up on back massages, foreplay, and deep, meaningful, metaphysical conversation. All we need now is a pill that causes orgasms and we’re set. I can imagine some of the women reading this blog are nodding their heads in agreement. “Uh huh! Sign me up for that clinical trial.”
The drug companies run amazing commercials to convince people to buy medicine. Most of them feature a field of grass and make it seem if I take their pill, I’ll get a beautiful wife and a puppy. I want that disease! The commercials have me convinced. I go to my doctor to ask about the latest drug I need. He says, “You don’t have this disease.” I say, “What do you mean I don’t have… restless leg syndrome? This is my life we’re talking about!”
I’m following up on the previous post with some more characters you should avoid in med school.
My Parents are Doctors, so I Guess I Should be One, Too = this person doesn’t really have a defined reason of why he/she is in medical school. Usually, the rationale is rather vague until you hear, “Well, I wanted to become a chef, but my mother told me to go into medicine instead.” Ironically, even though this person has grown up around medicine, she will have the worst physician skills in your class.
Patient Killer = this person will be the first person in your class to kill a patient—usually during orientation. This person will be so inept, that he will not know that he lacks skills. Having this person on your team is a true nightmare because he will not know the basic tenants of medicine such as how to take a blood pressure. The hospital’s nursing assistants will constantly follow behind this person, carefully keeping the patients out of death’s grip.
The Giver = this person will bemoan everyday that passes without Socialized medicine. He will cry out for patients all across America, saying that every person deserves access to free care, that the Republicans are out to kill poor people, and that he will flee to Canada after graduation because the Canadians have it figured out. Hypocritically, this person will never volunteer his time while in med school.
Hypochondriac = every week this person will suspect that he has a new disease. If a lecturer gives a presentation on Lupus, this person will demand an ANA test, even though he does not have a rash. If you’re studying thyroid disease, he will want to be tested for both hypo and hyperthyroidism. Eventually, a random laboratory study will confirm that this student has pernicious anemia.
New Specialty Each Week = similar to the hypochondriac, this person gets more out of lecture than just notes. If an ear, nose, and throat doctor gives a talk, this person needs to become an otolaryngologist. When the radiation oncologist shows up, this person immediately starts talking about dosages of radiation. He will become a pediatrician.