When I started medical school, I was most excited to start learning again. Having spent the last couple years as a teacher in a classroom, I sorely missed the experience of being the student. Reflecting on my college days, I missed the intellectual conversations generated in our seminars, hours poring over literature under dimly lit alcoves of Sanborn Library, even the far-too-frequent all-nighters spent hashing through complex biochemical pathways with my study group. Despite the stress, and the, at times, esoteric nature of our material, I loved learning. I loved to think deeply, to challenge myself. I loved when organized study groups would unravel into theoretical debates. I missed this — the learning — tremendously in the years leading up to medical school.
But what I found — perhaps a rude awakening for most medical students — is that medical school learning is not at all like undergraduate learning. During the first two years, most of the material is disseminated in lecture and textbook form, with significantly less curricular time devoted to seminars or discussions. Tests are multiple choice, with always one right answer — despite the fact that we are told, over and over again, about the grayness often encountered in clinical practice. Studying means cramming as much information as you possibly can and hoping to remember at least half of it come test day. The proverb that medical school is like “drinking from a firehose” couldn’t be more accurate. The information is so incredibly vast, you can never possibly know everything.
The human body is a miraculous and infinitely complex thing, and the opportunity to study its intricacies has been an enormous privilege. Yet, I found getting lost in its mysterious labyrinths, asking too many questions, meant I wasn’t asking the right ones. In the strictly regimented curriculum of a medical student, there is little time for exploring, and those who wander tend to get lost.
Throughout the preclinical years, I found myself missing the creativity, the deeper Socratic nature of my undergraduate education. But, as most medical students do, I endured through the two years of rote memorization with the promise to myself that it would get better. Once they let us into the hospital during clinical years, I thought, then the real learning would begin. Then, we’d have time to discuss, think, talk to patients and really begin to understand the human condition, beyond the confines of biochemical pathways and anatomical structures.
Then third year came along, and I was so excited to finally be done with the books and lectures and actually get to do the real doctoring stuff. But as it turned out, third year of medical school was a lot more memorization, algorithms and multiple choice tests. “Pimping — the act by which an attending will fire off a series of questions at medical students — encourages rote memorization at the expense of curiosity, creativity or, as Dr. Dhruv Khullar argues in a recent New York Times article even — uncertainty. And as Dr. Khullar points out, uncertainty is an important attribute when it comes to learning.
What’s even more disheartening is that the vast reservoir of medical information we spent the last two years memorizing doesn’t seem very useful in practice. Residents spend much of their days making phone calls and completing administrative work. And, what about all of those facts that they spent years memorizing in medical school? They can (and do) look them up in the click of a button.
So why do we continue along on such an inefficient pathway? Why, in the past century, has there been little change in the way that our doctors are trained?
Perhaps we, the students, are to blame for a health care system that is falling behind. As medical students, we are good at following rules. We are given hoops to jump through, and obediently, we jump. Four years of premed courses, the MCAT, Step 1, Step 2 and Step 3. We never stop to question whether all the preparation will be useful one day. As a total clutz in the operating room with no future in surgery, it’s hard for me to rationalize the hours I spend in the OR, given that I have no formal courses on health care economics, on navigating insurance policy, on palliative care or even empathy. But, I dutifully put on my scrubs at 4 a.m., retract and suction and retract, and hope I won’t get yelled at for breaking sterile field (again). I do these things because that’s what I’m supposed to do. And while I’m a terrible surgeon, at least I’m good at following rules.
Looking around at my peers, I’ve been so impressed with the potential “brain power” among other medical students. There is so much opportunity for innovation and progress. But, rather than brainstorming solutions to health care’s most challenging problems, we spend most of our training buried in textbooks, algorithms and Scantrons. And then, as residents, we are buried in phone calls and paperwork. We accept the idea that we can’t change an entire system — we can’t move mountains. We settle. The questioning, the philosophizing, the healthy dose of skepticism, that I assume most of us arrived here with, all of these things were left along the wayside somewhere during M1 year.
Let me be clear about one thing — I’m a fourth-year medical student. The only thing I really know at this point is that I know next to nothing. But, even as a fledgling doctor-in-training, I can still see the glaring inefficiencies in how doctors are trained. I don’t have a solution, but I do think our curriculum must evolve in order to keep pace with the lightening speed pace at which health care technology progresses and the landslides in health care reform. I think it’s time we put less emphasis on micro-issues, and have more structured curricular time devoted to the macro-issues: health care policy, preventive care and the burden of disease on a global scale. It’s time we ask: is there a faster or more efficient way to do things?