Medical Education Philosophy Rant

Forest or trees?
Looking back on the last exam block, it seems that there is something inherently wrong with the way that I am being educated. I get the joy of trying to cram 3-500 pages of material into my brain and regurgitating it in the form of trivia questions and little black circles. How many of those circles I bubble in correctly corresponds to my grade, which in the context of the performance of 200 of my peers determines a small portion of where I will be allowed to work in the future and what I will be allowed to specialize in. It's an asinine process where I'm not really retaining a whole lot of material that matters. Instead I'm focusing on memorizing which CD's are expressed in which developmental stages of which WBC cancers...and it will have VERY little to do with the rest of my career from here on out. I'd assume that the forest was more important than the trees, but apparently we're going to examine every cell of every tree in the forest.

Multiple guess/Alphabet soup
Loosely thrown into the mix is an attempt to get interaction from members of the class in small group sessions. Unfortunately, these sessions turn into more of a lecture than a discussion/problem solving exercize. My concern comes when I'm actually going to have to make diagnoses and see patients and interact with other physicians. Will I see the patterns, will I know what tests to order, will I even know what to look for when it's not presented in a multiple choice format. It's not as if people are going to present with the choice of ABCD or E with me able to bubble in the correct choice with only the price of my grade on the line. These will be people's lives, and I don't even know how to make a differential diagnosis work or even what should be listed together. But I can tell you the different markers on the different flavors of Non-hodgkins lymphoma...what is more important in your future physician: performance on a multiple-choice exam or knowing how to diagnose a patient??? I saw an article from AAMC that the Step 1 is being re-thought.

I think what has bothered me most about my very expensive education thus far is that I could have learned most of the material with about 6 books and a ticket to Body Worlds at the Museum of Science...


Edwin said...

I like your blog, my brother! It's a great way to explain to readers some of the realities of medical education in all its weird glory.

Looking back, and being reminded of it all as I read your post, I wonder just how we learn. It must be some kind of concentration gradient osmosis. Like, the more they put next to our brain, the more they hope will go in. However, I think there's a serious threshold.

We learn so much that's obscure, and that we'll never remember. I think back on how much of my education had to do with cancer cells, and how little (as an emergency physician) I use that sort of thing.

I know we need a wide scope of knowledge, but the thing is, most of what we use we learn in residency. Sometimes it seems that basic sciences in medical school are really a rite of passage rather than a time to learn lots of relevant stuff.

Having said that, there are those odd times when something will come back to me in the middle of a patient exam, some odd connection or obscure fact that is, unbelievably, relevant.

As for how you could have learned it with a few books and a trip to the museum, one of the smartest guys in my class never came to class for the first two years, but stayed at home reading Robbins Pathology text. He was, and I'm sure remains, brilliant.

Merry Christmas! And keep up the good work.

Edwin Leap

The Lone Coyote said...

I agree with you 100% on the flaws of medical education. Rest assured that if you are seeing the flaws, you are likely already able to think critically and you will be able to think on your feet once the time comes.

WebGuru said...

As a course designer for a medical school, I hear/read comments like these often.
What I don't hear are suggestions. Can you give me any?
Specifically - utilizing technology.