Second year...

I'm not sure if this is how things are at every school, but second year has been a farcical experience to date. Here's you're syllabus, here's the extremely shallow intro lecture that doesn't even scratch the surface of the topics you need for the exam, here's the summary lecture that basically recapitulates the intro lecture, here's the clinical correlations group discussion problems that are far too in depth for you to possibly glean from the reading and thanks for that $40k in tuition.

I know, I know...first I whine that there's too much class, now I'm whining that there's not enough. You're missing my point...effective lecture beats the pathetic excuse that we're asked to sit through any day. What I have a problem with is that the LCME is making all of medicine "self taught" to make us "life-long learners". Wonderful. How is paying an exorbitant amount of money to sit around reading, highlighting, memorizing and rereading hundreds of pages of Robbins going to make me a life long learner? I could buy myself a Kaczynski style hut in the woods of Montana and hole up there with my Robbins, my Lippencot pharm, my Parham immuno and my Clinical micro made rediculously simple books, 500 highlighters and the syllabi and get just as much done without the bothersome distractions of food, electricity or human interaction. I understand that medicine is progressing at an amazingly fast rate, so instead of updating your lecture series, I get the JOY of teaching myself the molecular nuances of every pathological condition that have all been illucidated in the last 10 years. But I digress...

Ok, so I'm expected to teach myself all of pathology, micro and pharm...cool. I've accepted that. So why am I still giving the school $40k for tuition? Well, they need me to come and discuss the readings, facilitated via a case study format, with my classmates. Sounds wonderful in theory, right? In practice, it is basically 20 of us sitting in a room going through a list of questions with either, a) a path resident who covers WAYYYYYYYYYY too much detail or b) a pathologist that they pulled back from the brink of death to moderate our small group. Kind of like the Crypt Keeper from Tale from the Crypt, but better groomed.

The other students in my group just sit there with blank stares hurriedly taking notes on everything that is said and not contributing to the discussion at all because they're afraid to answer a question incorrectly. We sit around for 2 hours, with the better part of an hour consumed by silence...it drives me up a wall. I throw out wrong answer after wrong answer and in the lovely Socratic method, the doctor just keeps telling me I'm wrong and waiting for someone else to answer correctly.

My favorite example: Young lady presenting with granulomatous lesions in her hilar and mediastinal nodes, SOB, the whole 9 yards infering sarcoidosis...what's the differential?

Lets see, you have to rule out EVERYTHING ELSE before you can call it sarcoidosis...so I start listing things and getting shut down. Silence. Something else, shot down. Silence. Look around at one of the girls that I know studies alot and is way up on her stuff and try to drag the answer out of her brain with Jedi mind control power...silence. IT IS DRIVING ME INSANE. One more try...shot down. Meek voice from the smart girl says "Sarcoidosis...?"CORRECT DING, DING, DING, praise showered on her. Excuse me if I am mistaken, but isn't a differential diagnosis a COMPREHENSIVE LIST OF EVERYTHING THAT MIGHT BE WRONG WITH THE PATIENT. Yet I get shot down at everything I mention...it just makes me feel stupid...better get used to it, because third year isn't much better from the stories that I hear.

Anyway I'll bring this tirade to a close with the following thought:
Dearest LCME,
If you want me to become a life long learner, aren't you responsible for building up my strong foundation now so that I can actually pass your classes, get through school and get to the point of having to educate myself??? I'm paying for an education, not to be tossed a 1500 page book to memorize minutae from while I flounder in your mandatory group sessions. Thanks for your consideration, and I look foward to your reply
~Bostonian