Wednesday, January 11, 2006

See the forest, know the trees.

You know coming in that medical school is going to be difficult. What you likely do not know at the time, though, is that over the first two years of school (the "basic science" years), you are going to have innumerable details hammered into your tired little head over and over again until you hardly remember the overarching principles of medicine, let alone its scientific underpinnings. One of my friends summarized this feeling perfectly during a Neuroscience lecture this week with the phrase, "See the forest, know the trees". What he forgot to mention is that sometimes in can be difficult to see a forest through a microscope.

I haven't studied the history of medical education in any depth at all, so most of what follows is probably useless conjecture, but stick with me here. Are we as future physicians expected to believe that our daily lives in the clinic is going to rely on our intimate knowledge of the enzymes that carry out fatty acid beta-oxidation, or the molecules underlying the construction of our cell's cytoskeleton? I would confidently assert that these details will have no bearing on our job as a physician. So why spend any time on them at all? I can think of three reasons:

1). The classes are taught for the most part by PhDs conducting research at the college. Undoubtedly these are very intelligent people, and many are excellent teachers. However, the very process of basic scientific research as conducted by most professors entails exploring a very specific process in excruciating detail. Therefore teaching their subject of choice in such detail is a natural extension of the professional vernacular that they utilize every day. Through no fault of their own, they are left speaking a foreign language to what is often a disinterested audience.

2). Medical schools have an obligation to their students and to the residency programs in which their graduates will enroll to stratify the class, and thus must reflect the individual student's relative performance quantitatively. We're all familiar with this process in undergraduate classes or even high school, whether such grading is done on through percentage cut-offs or a class curve. What I was not prepared for entering my first year was the quantum leap that such partitioning must make to adequately separate students who on average have always found themselves scoring in the top 10% in academics. This leads to incredibly high class averages, and correspondingly high benchmarks for each grade. Ultimately, if you are at all competitive with yourself or your classmates (and who are we kidding, if you made it this far, you are) it will probably lead to many wasted nights in the library in search of those elusive two points on your next exam that could mean all the difference in your course grade. It seems unlikely, but I'm being serious here--most of my friends had at least one grade that would have changed one way or another if they had answered 1 or 2 questions differently over the course of the semester. That's pressure.

3). I really hope that this is the most important reason behind what seems right now to be a daily glut of minutiae--they are preparing us in personality and temperament to be a detail-oriented professional committed to working on a daily basis toward improving our mastery and knowledge of medicine. I find myself believing that much like undergrad the important lessons I learned during the first semester of my M1 year were outside of the classroom and not on any exam. I promptly forgot 98% of the material tested on my finals within a week of the classes finishing, but the strategies I used to tackle the challenges of the semester and the psychological cross-training that occurred will stick with me for a long time. Like any difficult challenge, I find myself amazed that we all made it through the other side relatively unscathed, and proud that my class stood up to the challenge. Hokey, I know, but future M1s will probably understand when they finish their first set of finals.

Anyways, that'll wrap up my take on the scope of medical school as I've experienced it thus far. I welcome any comments you may have, and would be more than willing to answer any questions about medical school, applying to medical school, or any other topic you can think of either on this site or via e-mail at Also, feel free to leave suggestions for topics you would like to see me address with an entry.