Before you can start classes, you need to understand that not everyone who enters medical school can be as cool as me. You’re going to run into a lot of a-holes, archetypes whose personalities are so extreme that you’d think that they are fictional characters from the latest Frank Miller novel. Here, I present a summary of the type of people you’ll encounter.
Assistant Dean = although he’s a student, he feels the need to direct student behavior, advocate particular punishments, and pre-emptively answer questions posed by students to faculty. If you’re in a PBL school, he will lead the discussion of the day’s topic, while a timid physician sits by. He could also be called the Policeman.
Laundry Day = this student will show up to class so horribly dressed that you will think he ran out of clothes and is doing laundry. He will then show up in a ratty T-shirt, sweat pants, and flip flops every day for the rest of the semester. He will typically shave only once a week for added effect. Then, on patient-encounter days, he will come in Armani and Gucci.
My Big Fat Greek Classmate = based on the father in My Big Fat Greek Wedding, this person will remind you regularly about the history of his grandparents’ culture. Mind you, he’s never actually been to the homeland, but he will gladly tell you about the unique cuisine, non-orthodox forms of Christianity, and the language that isn’t spoken by anyone else in the world—not even in Greece.
I’m Old Enough to be Your Father = the one non-traditional who really is old enough to have fathered a few of the younger students. This person will bring his children to school functions in attempt to introduce them to new friends. With all of his years of experience, he could easily qualify as the wisest person you know. Away from his family, he will be the most immature person in class.
Surgio = this person has such a one-track mind when thinking about career choices, he will quickly give up all other opportunities. He will show up to class in scrubs, even though he’s an M1 and not taking anatomy. At social gatherings, he will sit in the corner and practice tying surgical knots.
Once a Sorority Girl, Always a Sorority Girl = showing up to orientation with bleach-blonde hair, not much time is required for her roots to start appearing. She’ll use everyday as a reminder of when she used to go out as an undergrad—and then her true colors will start to appear. If you’ve ever seen Mean Girls, she’s all three of the Plastics.
Everytime I glance through the pre-med forums on SDN, I’m constantly amazed at how many college students want to jump into problem-based learning. My real concern is the misunderstanding that many people hold about PBL. For one, how do all of these people know that they’ll be happy in PBL if they’ve never experienced it before?
My school uses a mixture of lecture and PBL—and PBL has got to go. While some lectures are painful to sit through, attendance is not required, and therefore, I can always opt out of going to class. PBL, on the other hand, is absolutely mandatory. In fact, our whole grade is based upon participation. We don’t even have to get the diagnosis right; we just have to learn “the process.” I’m not so sure patients would be comforted by the thought that I can’t diagnose their disease, but at least I know how to make a PowerPoint presentation of a differential diagnosis. Summary point number 1: you will spend lots of time writing a presentation on one illness, when you could be studying dozens more during that same time period.
What’s more, your faculty mentor may not be a specialist in the particular case that you’re studying. This past week, I had a patient with diminished senses in her extremities, but intact motor function. She was also hyperreflexive. I quickly came up with a differential diagnosis that included multiple sclerosis and vitamin B12 deficiency. I even stated that this patient in no way had ALS (Lou Gehrig’s disease). Unfortunately, our facilitator is not a neurologist and had not seen a neuro patient in many years. You can imagine my annoyance when she stuck me with ALS as my presentation topic. But hey, I got to learn “the process.” Summary point number 2: your faculty mentor may not know what he/she is talking about.
Instead of having experienced faculty to write lectures with direct objectives of particular information to teach, medical schools get students to run lost through a sea of information with no idea of what’s pertinent. Many times, I’ve given and seen presentations where important steps of pathophysiology or treatment are omitted because I (or other students) were ignorant of the salient points. Summary point number 3: PBL is the blind leading the blind.
I’ve come to realize that PBL is the biggest scam that medical schools can run. Instead of the universities paying professors to teach, the students pay tuition so that they can teach each other information that may or may not be important, pertinent, or even correct. With all of the lectures that I’ve given, I demand that I be given a faculty appointment with tenure. Also, I should get my own office. I hold office hours by appointment only.
Luckily, I’m not alone in my frustrations with problem-based learning. Some students at Upitt came up with this video of their PBL sessions. It mimics The Office and is very funny.
Continuing with the theme of picking a medical specialty, I present a summary of the most popular systems to go into, and how I was able to narrow down my list. Here is a transcript of a speech I delivered to the first-year medical students at my school.
First, stay away from internal medicine unless you enjoy sitting around a table and discussing abnormal lab values. Figuring out the cause of an electrolyte imbalance is mental masturbation to an internist. And low magnesium is girl-on-girl porn.
Preventive health is a great field to go into. It’s 9-5 and there’s no call. There’s never an epidemiological emergency. No one ever calls an epidemiologist at 2 in the morning to say, “We’ve got bird flu everywhere!” The preventive medicine doc will reply, “Okay, I’ll look into it next week.” The bad thing about preventive medicine is all of the public health and outreach service you might get pulled into. You’ll work with low income populations with lots of health problems and minimal education. These patients may not know much, but from the treatment they’ve received, I’m sure that they can spell “bigotry.” Well, probably not.
Pathology is also a great field. But men can’t become pathologists. I look at a slide and someone asks what I see. I say, “I see pink.” Then along will come some woman and say, “It’s not pink. It’s mauve.”
If you really want to impress people, go into dermatology. It’s not all acne. We learned during the dermatology module that the foreskins of circumcised men can be used to make skin grafts. But did you know that foreskins can also be used to make replacement eyelids? That makes me wonder: with all of those nerves now running to the eye, have you ever seen someone with erotic blinking?
If skin isn’t you thing, you can join the psychiatrists and might even become a regular guest on Oprah. When you take the psych class, you start to notice certain quirks about others. Like a man who rubs his beard whenever he’s nervous. “Hmmm… I don’t know the answer to that question.” Then he starts rubbing more of his face as situations get more intimidating. “I hope that girl will go out with me.” Finally it all ends with the job interview and full face rub down: “I feel that I would be a very valuable addition to this company.
Pediatrics? I can’t do pediatrics. It’s not that I hate babies, it’s just that newborns aren’t potty trained. You can’t housebreak them like a dog. You can’t rub their nose in the mess and hit them with a rolled up newspaper hoping that they’ll learn.
Help wanted. I need a babysitter to serve as a “problem-based learning” mentor. Your job responsibilities will include taking role, steering medical students into incorrect diagnoses, and making people feel inadequate for their presentations.
No experience necessary! When a student asks you a medically related question, you should reply, “That sounds like a good learning issue to me,” or, “First, tell me what you think.”
We have immediate openings. Starting pay is based upon lack of experience. Prior work as a fisherman or military drill sergeant is a plus. Inquire at 555-…-….
Eager pre-meds often want to know what a typical day is like for a medical student. Below, I provide a breakdown of what we do during class:
Since we do other things throughout the day, subsequent posts with touch upon patient contact, reading notes, brushing our teeth, and the other exciting things that we routinely get to do.
The environmentalist group The World Wildlife Fund recently released a study claiming that humans are growing at a rate so quickly that by the year 2050, we will be out of food. This leaves us with only one course of action: to eat the homeless. That’s right, according to the Eat The Homeless Project, men and women in severely impoverished economic brackets could act as food staples for the rest of us. The FDA has conducted studies showing that the homeless have less fat than beef, more vitamins than chicken, and that their knapsacks make great surprise grab-bags. It would be like a hobo Christmas. Just imagine on December 25th when children come running down stairs saying, “What did I get, what did I get? Pots and pans, oh boy!”
Unfortunately, cannibalism should be reserved for Plan B. Plan A is finding unique opportunities to keep the population going. Hence, I entered medical school. From classes to patient encounters, let me tell you about my first year here at the University of the State.
Things were going well enough in the fall until along came anatomy. Now I knew that the human body was complicated, but when we started dissecting the peritoneal area, things got messy. There are so many veins, arteries, and nerves just in the sphincter that it would seem as if potty training is what separates us from the animals. Here I thought that it was the brain, but it seems as if the butt is the pinnacle of human evolution. And if that’s not bad enough, you have apply this knowledge in the clinical setting.
You’ll get thrust into a room where a 4th Year will invariably say, “I want you to listen to this heart murmur.” And just like that, the story of The Emperor’s New Clothes comes into effect. “I hear a murmur. Only smart people can hear a murmur. Do you hear it?”
“Um… yes. Yes I do. Just to make sure we’re listening to the same thing, what does a murmur sound like?”
“You know, like a murmur. It’s very murmurish.” And then she’ll quickly change the subject to avoid a real explanation.
After class, you’ll then get the opportunity to test your new knowledge on real patients at a variety of health fairs. You’ll get to see new cultures and even learn a new language. I, for one, have become quite fluent in Spanish since moving here. I can now say, “no habla espanol” much more convincingly than I could in the past. I also got to see what happens when we have limited supplies for helping the poor. I went to Central America for Spring Break where we gave ibuprofen for every disease our patients had. We even gave ibuprofen for gall stones. Giving Advil for gall stones is like using hugs to fight cancer. Mmmmmm… take that melanoma!
So enjoy the first year. It’s the most fun you’ll never want to have again.
In the 1930′s, the United States suffered through a horrible depression. Many Americans were jobless, food was scarce, and the nation needed someone to lift them out of this decade of misery. President Roosevelt came up with The New Deal to rejuvenate the economy. His plan involved giving jobs to people just for the sake of having employment. For example, a person might dig a hole on Monday, and then fill the hole back up on Tuesday. These employment systems were put into place to take up time so that people would have something to do during the day. In a similar fashion, my school created a course entitled Physicianship Training for no other purpose than to keep us busy during the week.
The class runs the entirety of the first two years of medical school. We undergo everything: clinical skills training, diversity training, ethics, professionalism, geriatrics, and evidence-based medicine every Tuesday and Thursday afternoon during M1 and M2. Physicianship is the bane of my existence. I’ve already mentioned my experiences with complementary and alternative medicine. The two biggest evils of this course come in the forms of geriatrics and evidence-based medicine.
As part of geriatrics training, we have to adopt an elder member of the community and then interview that person throughout the year. My first elder buddy got cancer after our first interview and had to drop out of the program. My second partner also got cancer and had to leave the state. My dean was so worried that I might kill someone that he told me to make up the results of my third interview. To make matters worse, I didn’t get the cuddly Wal-Mart greeter type of geriatric friend. Instead, I managed to adopt the senile, hates young people type of elder person who spent the whole time criticizing doctors.
Another component of Physicianship Training involves the cult of science known as evidenced-based medicine (EBM). Every month I have to do a directed search on PubMed, the government’s storage house of medical literature. Keep in mind that PubMed is a boolean search engine and works the same way as Google; but for some reason, my university has librarians descend upon us monthly so that we get to learn new ways of using AND/OR/NOT to find journal articles. What really surprises me is that whole books have been written about evidenced-based medicine. Never mind that using the principles of EBM will not lead to better clinical answers. The school just needs to keep the students busy so that we don’t go off and try to study for class or the boards.
While the stated goal of Physicianship Training is to prepare us to become doctors—to teach us the soft skills needed to practice medicine—I don’t know how coddling dinosaurs and sitting through presentations on using the Internet is supposed to make us better prepared to diagnose and treat diseases. Probably the biggest farce to come out of the Physicianship class is professionalism. According to this principle, our interactions with patients and colleagues should be strictly professional. The down side is that one of the instructors routinely hits on female medical students, telling one that she “has nice breasts and skin.”
In the spirit of soft skills, I leave you with this haiku on professionalism:
Do as I say, not I do—
The bane of med school.
My biggest complaint of medical school so far is all of the busy work. I’ve had to write three reports within the past three days on everything from my feelings on alternative and complementary medicine, a presentation on obesity as I would give it to a lay audience for preventive health week, and a patient write-up for preparation for 3rd year—as if I won’t get enough opportunities to do patient write-ups in the near future. Add to these assignments never ending PowerPoint presentations for my PBL class and today’s surprise assignment of writing an essay on sex in media, and you’ll soon see why I’m constantly frustrated with school. I should be studying for boards right now, not doing reaction papers as if I’m in elementary school. Then an epiphany hit me: medical school is a lot like elementary school.
The author of medschoolhell has already mentioned the busy work that happens in med school: go yonder and stand here, and at this time go there and hold these retractors. What’s next, writing 100 times, “I will not talk in class?” From my point of view, if we’re going to be treated like small children, we should at least have the perks. I demand 20 minutes of recess every day so that I can climb on the monkey bars. I also want nap time in the afternoon.
As part of the complementary and alternative medicine (CAM) health fair, we were given patient scenarios and asked how we would use CAM to help the patient. My case dealt with an older gentleman with chronic leg pain. After visiting the Scenar booth, I wrote the following real report:
According to the “doctors” touting this device, the Scenar uses electrical pulses to activate the C fibers, thereby forcing the brain to respond to that area. According to one website, the Scenar is “cheap and effective against almost any condition, from treat sports injuries, strokes, angina, acute infections, back pains and irritable bowel disease (as well as pre-menstrual tension and post-surgical complications) and even defibrillating hearts!” I tested the device for myself for my chronic shoulder pain. While I did feel electrical pulses—and I’m sure that it could relieve pain acutely—my pain returned the next day. I could not get the presenter to give a substantial explanation for how the devices works. He mucked up the description of electronics, could not point to any published reports, and would not even give me a cost for each treatment.
I did a PubMed search and found only two published reports have ever been written on the device. Unfortunately, both of the papers were in Russian. I found Scenars for sell on eBay, ranging in price from $500-$2,000, depending on the features. Overall, I would call the device a scam.
I would recommend electrical pulse therapy to this patient if he were willing to give it a try. However, given the chronicity of his pain, he may have to go on a Neurontin regiment to take care of his aches. If nothing else, I have a Taser that the patient could use. It has electrical impulses, too. I’ve shocked myself before and, after the initial sting, my shoulder felt pretty good afterward.
One trend in medical education is to force students into a learning style called problem-based learning. You and your team are given a fictitious patient with a variety of symptoms and laboratory values with the goal of figuring out what’s going on. You’re never given the answers outright, and have only limited information to work with. The idea behind PBL is that when you are forced to look up information about a particular disease and then present it to your classmates, you’ll better learn the material and gain the important skill of working through a differential diagnosis.
At first, PBL sounds like a great idea. It gets you out of the classroom and allows you to think for yourself. If you take a quick look through SDN’s pre-med forums, you’ll see lots of college students creaming their pants at the hopes of joining a PBL school. My guess is that they’re sick of lecture halls and want a more intimate teaching environment.
PBL sounds like playing a grand master in chess who will lead you through the game, while he teaches you new moves on the board based upon your successes and failures. In reality, PBL is like playing a five-year-old where the child constantly changes the rules and then kicks you in the testicles to make sure that you won’t ever have a chance of winning. As the semester drags on, your group mates will get sick of making presentations and will eventually bail out of putting together any useful information in hopes that they can skate by with the just the bare minimum. Then, they’ll kick you in the nuts and go back to studying for the USMLE.
Case-based learning is not all bad. When there is an intended end and the preceptor is experienced in the subject, the material can indeed be learned quite readily. Lately, however, I feel as if I’m languishing through the module with the desire to put a bag of ice on my crotch, all the while saying, “I’m taking my toys home and never playing with you again.” Consider today’s case: the patient had tons of blood work, an endoscopy, a colonoscopy, a full-body CT scan, an abdominal ultrasound, and an MRI of the head. From all of these expensive tests we still don’t know the diagnosis. What he really needs is a biopsy and a physician to tell him to stop drinking so much. Or maybe someone to practice NOT my problem-based learning.
In honor of Women’s History Month, my university has been teaching us about women’s health and reproductive issues. In preparation for the final exam, I’ll post a short study guide so that viewers can be better prepared to answer any questions regarding the subject.
So as not to be considered sexist, I’ll also include the stats for men.