Premedical Education, the Long Way, Part 2

Yesterday I discussed pre-undergraduate and undergraduate educational experiences, today I dive into pre-medical requirements, medical school, and other educational experiences I've accumulated over the years.

6.  Premedical requirements:  You may have noticed, during the discussion of my undergraduate experiences, the notable absence of any premedical science classes.  That's because I never considered being a doctor until after I graduated from college.  I worked as a psychiatric research assistant for several years, doing work in psychoneuroendocrinology.  I was interested in mind-body connections in mood disorders, and as I read papers on the subject, I realized a scientific background was useful.  Without one, I only understood about 25% of what I read.  So my first thoughts about medical school arose from a curiosity, rather than a professional career choice.  While working days, I started taking chemistry courses at night, just to try my hand at the basic sciences.  I didn't think I'd do well in class, but I did, and curiously enough I discovered how interesting the sciences were, how much they were about mystery and wonder rather than plain, hard fact.  

I did all my premed requirements while I was working full-time, so it took me three years.  Juggling school and work taught me a lot about organization and self-discipline, more than I'd ever learned in college.

7.  Medical school:  Since I graduated, my medical school revamped its curriculum so things may have changed significantly--but, when I was in school, the preclinical years were highly programmed; most classes had a pre-printed syllabus which contained most of what we needed to master to do well in the course.  A few classes required an associated textbook (Robbins' Pathology, of course), but the breadth of reading for medical school was extremely limited.  I feel ambivalent about the syllabus-driven curriculum.  On the one hand, limiting the amount of reading we had to do made the avalanche of information manageable and made us focus upon fundamentals rather than esoterica.  On the other hand, by tunneling our attention we were given no opportunity to wander around a field of ideas.  I think we have to accept the preclinical years as a whirlwind designed to produce basic mastery rather than depth of understanding.  How else can you expect to fit anatomy, physiology, pathology, microbiology and pharmacology into two years?

During the clerkship years we received relatively few required readings but were encouraged to make presentations during rounds.  These are supposed to be off-the-cuff, 5-minute summaries about some clinical problem relevant to one of the patients on the service.  The usual approach is to find a review paper, read it closely, and distill its contents into a precis of the diagnosis and management of the question at hand.  These presentations caused a lot of anxiety for students because a successful presentation style--confident, thorough, efficient, articulate--was thought to enhance the chances of getting an honors grade in the rotation.  From the beginning I recognized these presentation as a mockery of real scholarship so I never put much effort into them, although I did my share when asked. 

If the education in medical school originated only from professors and preceptors, I might dismiss the entire experience as a a limited professional training, with little or no scholarship or creative discovery involved.  But this is not true, because patients taught us more than all the faculty combined.  It's a pity that we don't acknowledge their teaching role more formally, because it took years for me to realize how much I owed to the man or the woman lying on the hospital bed, who were good enough to tell me the story of their lives.

8.  Extracurricular studies:  I started medical school during a period of life change and reflection.  I was no longer motivated by hopes of developing expertise or success in my career; rather, I started tackling the "big" questions about life and death and what makes life so desperately valuable.  For a year before starting school and for the entire MS1 year I volunteered in a residential hospice.  I remember how liberating it was to do simple things like wash laundry or make soup at the hospice after I'd been beaten up in anatomy lab for a whole week. 

I also rediscovered my old dream of writing the year before I entered school.  Building on the discipline of attending night school, I enrolled in a UC Extension writing class, which was so easy after the overnight camp-out requirement at Stanford.  All I had to do was enroll on time and submit the registration fee.  I was lucky to have Lewis Buzbee as my writing instructor; his level-headed approach to writing fiction helped me lay a strong foundation to doing the work of being a writer.  I went on to work with Lewis in his private workshop, writing and attending class once a week for the preclinical years at school.

8.  Autodidacticism:  I mentioned the excellent foundation in self-learning my college experiences gave me.  Since undergraduate days, I've dabbled in a number of subjects with varying degrees of mastery, but in each case have taught myself what I needed to know.

• Handknitting
• Handspinning
• Handweaving, largely in small formats such as inkle and cardweaving
• Natural (plant-based) dyeing
• Organic, no-till gardening

Currently I'm adding to my autodidact subject list.  Shakespearean studies is one new subject, oral history methodology is another.  I could be accused of dilettantism but I like to think of these self-taught diversions as an ongoing exercise in self-education.  Others might disagree, but then I remember what I wished I'd said to the naysayers I encountered in college:  "Oh yeah?  Well f--- you!"

Such is the state of my education, both premedical and postgraduate.  One of the great things about being a doctor is the expectation that you will continue to be a learner for the duration of your career.  Even if institutions woud like to distill this ongoing process under the banner of Continuing Medical Education, I think the truth has a greater span.

Comments

[sara]

Haaaaaaaaa I always half-assed those presentations too. One of the best things that ever happened to me in medical school was when I was supposed to present The Efficacy of Various Treatments on RPGN and the guy before me ran over and they ran out of time.

[JD]

Great post. I'm a 2nd year medical student on the other side of the country, and jut wanted to say how much I'm really enjoying your blog.

Great breaks from neuropath. =)

[Robin]

You are an excellent journalist, too. I think you left that off.

I'm too tired to put my thoughts into an organized form, but would like to comment.

On the "learning from patients", you made me think of my IPSS experience at UCLA medical center. I flew from the east coast to the west coast for it because I trusted the doctor there. Prior to the procedure itself, I met umpteen dozen interns and residents. They informally introduced themselves. A couple of them were working with the doctor (Dr. B) who was overseeing my anesthesia. She was instructing as she went. One of the young squirts (he didn't look old enough to be in high school much less in med school) said my tests didn't seem that abnormal because serum cortisols of 10-26 were normal. Dr. B looked at me and said, "Why don't you explain?" And I did. He didn't have a clue that late-night serums should be close to zero nor had he taken the time to look at the time on those tests. I'm not sure why he focused on those and not the UFC's, etc. But, in the next 45" to an hour I conversed with several of them and explained my long journey toward diagnosis (20+ years), the research that was new and available for them and others but not in the textbooks, and why so many symptoms are overlooked. Dr. B told me later she wanted them to hear what hardships so many of us with Cushing's go through and the ignorance we face so often with medical professionals. I was impressed with her as well as her "gaggle". And I found their honesty and interest refreshing. I'm sure the versed helped and I'm not sure what I said after that was added to my mix.

I'm a huge advocate of continual learning for whatever avocation one chooses as well as outside of it. Learning should never stop. Thank you so much for sharing your journey thus far and I hope you'll share the fruits of your "dabbles" with us.

BTW, I started college way too young and naive (17) and wish that I had said "Oh yeah? Well f--- you!" a few times myself. I do quite well with that now, though. ;)

Warm regards,
Robin