A Med School Memoir

So, when I was a pre-med, I thought that the best med school for me would be one where I got lots of clinical experience in the first two years. See, in the US, the traditional medical school curriculum has very few chances for clinical exposure during the first two years. Typically, the first two years are composed of basic science classes–and lots of them. Nowadays, however, there is a movement to get medical students out of the classroom onto the wards to provide them with clinical experiences ASAP. I think there are several assumptions at play here that explain why the powers that be are foisting largely unknowledgeable and inexperienced med students on the patient populations at academic medical centers across the country.

1. Clinical exposures early in med school will create more compassionate physicians.
2. Clinical experiences reinforce material learned in the first two years of medical school.
3. The first two years of med school are skewed heavily toward the basic sciences, during which time the students lose sight of the importance of clinical acumen.

There are probably a handful of other reasons why they send us out on the ward before we get to our third year, but for now I’ll just address these three reasons, because they seem to be the ones that I hear bandied about the most.

1.  Clinical exposures early in med school will create more compassionate physicians.

I think I understand the thinking behind this, and honestly, there was a time when I probably believed this myself.  The thinking here is not unlike the rationale behind WWII-era propaganda campaigns–if you can gain access to the hearts and minds of the young and impressionable (1st and 2nd year med students certainly qualify as this), then you can more easily mold their thoughts and actions to fit your whims.  It’s almost as if the powers that be realize that they’re gonna be sick someday, and that my generation is will be their doctors.  They  must think that if they can scoot us onto the wards and show us a couple heart-wrenching clinical cases devoid of the muck and grime associated with real clinical practice (getting pooped on and yelled at by belligerent veterans, etc.), then perhaps they can fool us into thinking that medicine is all daffodils and unicorn poots.

2. Clinical experiences reinforce material learned in the first two years of medical school.

This is true.  Duh.  But for it to actually work, it would make sense to put the clinical experiences AFTER you learn it (in order for it to be reinforced.)  Face it, the first year of med school has almost nothing to do with sick people.  So why do they send us out on the wards to see sick people?  Unless they have one of those incredibly rare metabolic disorders that they teach about in biochemistry,  we likely don’t understand what’s wrong.  And we most certainly wouldn’t know what to do to treat the problem.  So what exactly are they reinforcing?  (More like pre-inforcing, amirite?)  There’s a very good reason why med students traditionally haven’t seen a lot of patients until third year.  It’s because we’re functionally retarded until then.  The less time we spend on the wards to embarrass ourselves and your fine medical institutions, the better off we’ll all be.  (And that counts DOUBLE for the patients.)

3.  The first two years of med school are skewed heavily toward the basic sciences, during which time the students lose sight of the importance of clinical acumen.

Now here’s a line of thinking I can get behind.  It’s SUPER easy during first and second year to forget why we’re actually here.  We’re here because hopefully we want to be good at our jobs.  And our jobs (unless you go into Pathology–and no offense towards the budding Pathologists out there, because I think Pathology is pretty cool) will be to deal with patients.  Our jobs will NOT be reading tons of books, attending lectures, and thinking about the most trivial minutiae of gene translocations, metabolic pathways, and the like.  Our jobs will be about dealing with people, learning from THEM why and how they’re sick, and hopefully helping them to get better.  The point about compassion above should be a given regardless of when you get your clinical experiences.  If you are not a compassionate person before you get to medical school, there is no way in hell that you’re going to magically sprout compassion glands and secrete newfangled compassion juices in the middle of your pre-clinical years when you are constantly stressed out about tests and grades and all that jazz.  Clinical experiences won’t help you there.  But they will help you to remember why you came here in the first place.  Maybe.  If you’re lucky.

But for the most part, these clinical experiences are just a pain in the ass.  I’m sorry, but it’s true.  I’m super excited to start 3rd year and finally get to act like a doctor.  But right now, as my second year is wrapping up, I am looking at weeks and weeks of tests followed by prep for the biggest test yet of my life–STEP 1 (more on that to come soon), and on top of all that I’m expected to go into the hospital and do H&Ps on people every week until the end of the year.  I feel like I’ve been pretty good about being gracious and not complaining about “OMG LIFE IS SO HARD AS A MED STUDENT” because usually it’s not really that bad, and honestly, it beats the hell out of a lot of other options.  But right now I’m pretty stressed out and I really don’t want to go talk to some dude about why he shit his pants the other day.  I’ll be happy to have that discussion, along with any imaginable other scenario come July when it’s time to hit the wards, but for now, please, medical school, let’s just do one thing at a time.  For now, please just let me study.