Last week I had dinner with two former classmates from that time. We had not seen each other in over a decade, and after catching up on personal news and reminiscing about gross anatomy lab and our first nights on call, one of them said quietly, “I hated med school. I wanted to quit.” The elephant in our collective memories had broken free.
With that elephant now running loose, and the three of us more comfortable with our own professional accomplishments, the conversation grew more honest. “If you look over my entire lifetime,” my other friend said, “those four years were the lowest point in terms of self esteem.” He held his hand out in the air, plotting an imaginary line that dropped precipitously to his knees.
It took nearly 20 years for the three of us to learn that we had each been miserable as medical students. It has taken even longer for researchers to discover the extent to which such feelings exist among American medical students.
Well, I’m a second year med student and while med school has had it’s difficult times I’m certainly not miserable. We’re actually a lot busier our second years (which I am now in) but at this point I have acquired a great group of friends which really makes the experience fun. Another important thing for me was finding a good church which I did in a small Anglican congregation which is under the authority of the Ugandan church.
MattJP [#1]: Any thoughts about the changes in medical education pioneered by Harvard over the past decade?
I loved medical school. People say that medical school is like taking a drink from a fire hydrant. There is no other place where very smart people are working very hard to get vast amounts of knowledge into you in a relatively short time. It is transformational. On graduation day one looks back four years prior to the first day of medical school when one was thrown into gross anatomy lab, etc., and one realizes on how much one has learned, and it is exhilarating.
There is an alarming trend in medicine. It used to be that after finishing four years of medical school one could hang your shingle and be an OK general practitioner. But then one had to do an intern year, then you could be an OK GP. Now the general practice route has disappeared. Previously medical students actually did something. And previously interns used to do something. Now, they walk around with their hands in their pockets getting book knowledge. Thus, to call some “Doctor” after finishing medical school is a bit of a joke. (Sorry, MattJP.) They are worthless. And the trend to becoming a real doctor is being delayed even further by residency work rules which have all sorts of requirements on how much a resident can work. One doesn’t want physicians learning on the job (of course they do to some extent but one should expect competency if not excellency at the end of residency).
The residency work rules came into effect my last year of residency so they didn’t affect my education. And I was a lot more aggressive than my peers at pushing the attending out of the way and telling them that I can do it myself. I am better surgeon than I was five years ago, but I was a pretty good one then.
When we need cardiac bypass surgery in 20 years, we need to be very worried.
And the cause of this trend? My very politically incorrect view is that females now constitute 50% of the medical students.
I read C. Everett Koop’s autobiography (highly recommended!) and what they went through versus the cushy life that we had, we have no cause to complain.
Is it true that medical professors look askance at students who ask questions?
Hi, This is a very interesting article indeed and I do remember going from periods of intense stress to ones of exhiliration. Bottom line is that I have always enjoyed what I do and would not change anything if I had to do it over again. I agree with alot of what robroy has written, although I do not regret for a minute the presence of women in medicine. The big issue that I see in the younger folk is a “shift work” mentality, and there is alot less of the “patient first” outlook in today’s medicine than there was when I trained. This article does suggest a tremendous opportunity for Christian outreach, as this is a group who might readily respond to a Theology of the Cross. I wonder whether postulants to ordained orders have ever been similarly studied and if so what were the findings?
Sorry, I also meant to respond to Irenaeus #4; this med school faculty member does not look askance at students who ask questions.
Hey Irenaeus, my school (Loma Linda) is currently in the process of changing to the Systems Based approach which I assume is the method pioneered by Harvard. We’re kind of on a hybrid model right now with separate classes like anatomy and pathology and so on but our studies in the different classes are focused on the same area at the same time so when we’re studying say the anatomy of the heart, we’ll also be looking at the cellular structures of the cardiovascular system in another class and the diseases of the heart in another class. I think it’s a good approach as you are looking at the same thing from a variety of angles.
No offense taken Robroy but I do have to say that one of my friends here, with whom I’m always competing with and comparing exam scores is a female and she had one of the top ranks in our class last year (above me and I do very well). So I have to disagree with the idea that females are dragging medicine down.
Okay, back to studying…
Irenaeus, my medical school profs almost uniformly loved questions. One of my favorites, would say to me, just before going into to see a patient together, “Your job is to ask a really good question when we finish with this patient.” I use this same line when teaching residents. Asking a good question shows understanding. It also opens the conversation up. It also well demonstrates the level of the student.
MattJP, I am not saying that women aren’t as talented or more. But I would agree with physician without health who decries the shift work mentality. It’s all about lifestyle. When I was applying for residency, ENT was the hardest specialty to get a residency slot, now it is dermatology. Similarly radiology is very popular because you can punch a clock.
I was an aggressive resident as I said. What’s wrong with being on call every other night? Answer: you miss half of the good cases. Now, with the residency work rules there are no every other night calls. I remember the neurosurgery chief residents would be on call EVERY night for 6 mos of their chief year. Talk about bitter. Our neurosurgery residents averaged slightly more than one divorce per residency (meaning that some divorced, remarried, and divorced again in the span of six years). Fortunately, I married a woman whose faith is near boundless and is good and caring and loving. But even with all her good qualities, our marriage was put through the wringer and only through God’s grace did it survive and was actually strengthened from the adversity.
I remember my first day of residency. I was on call that night. The M.D. degree indeed was worthless when the pages from the floor and ICU nurses started pouring in. But one quickly learns to “spread the blame” and check out problems with upper levels. If one discussed a problem patient with your upper level (and documented it!) and then something goes bad, it’s his butt that gets chewed.
I have to say that I really enjoyed med school, especially the first two years, which were basically college which I also enjoyed. But then I went to a six year BS/MD program, and my first two years of medical school I was more worried about how likely I was to make the NCAA fencing team then about passing (as I was still playing varsity – you get 4 years). The NCAA were three days before Part I of the medical boards, and I studied pathology between bouts. (Yes, I’m weird).
Junior year sucked for a lot of reasons. You stop being a college student. If you are an athlete (and I wasn’t the only one) that stops too. Instead of being a good student, you are now a useless worker, and many medical students first taste of the working world is junior year. My previous summer jobs had involved being a lab tech for an extremely kind medical scientist who taught me how to write research papers. In junior year, medical students get the introduction to the working world that probably their less studious age mates met at Burger King in high school. Previously protected they are introduced to the world of “yes, rounds begin at 6am you moron, and you should have rounded on your patients before you got here, what kind of a useless, lazy piece of shit are you any way?” You then find that everybody hates you because you are less use than tits on a bull and you just slow everybody who is senior to you down. And everybody knows this and thinks it is their job to “put you in your place” which you rapidly find is the portion of the totem pole that is embedded in the ground. Even the medical secretaries groan when a new pack of junior medical students come on service and the nurses are openly contemptuous and make a point of making your life miserable.
However, by senior year you are no longer a drag on the service, you can put in ivs, draw blood, put in foleys, run scut and are a modest asset instead of a complete waste of time. You have also (if you have any sense) learned a little humility and don’t get on the wrong side of the nurses. Or the interns. Or the medical secretaries. Or anybody else, because you are still on the portion of the totem pole that is embedded in the ground. Your just a notch higher than the juniors.
It is definately a transformational experience. I think West Point must have the same effect on folks. They simply have their “plebe year” as freshman instead of as juniors. Folks in either service can either be depressed and wash out or else leave a different person who has grown incredibly.
Part of the problem now is that the whole process is incredibly expensive. Thus, the folks who should be allowed to wash out and go be librarians or teachers or lawyers or whatever can’t do so, because they are already 150,000 in debt.
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Regarding questions, I think most faculty like students who ask questions, but most interns hate anything that slows down rounds. Also, a large part of the junior year experience consists of making sure that the junior understands his/her total worthlessness as a human being; thus folks who ask questions that are not pertinent are suspected of “showing off” or “brownnosing” the attending. Such folks tend to be dumped on by the more senior members of the team.
In my hospital neurology is a one on one mentorship with an attending neurologist and a medical student. Questions are encouraged, and the students (and teachers) love it. Part of the problem is the hospital ward team dynamics which involve a senior resident, several interns, several medical students and way too little time. A couple of medical students who don’t pull their weight in running scut, and spend on their time sucking up to the attending can really drag down a teams morale (and an unhappy team will take it out on the student).
“A large part of the junior year experience consists of making sure that the junior understands his/her total worthlessness as a human being” —Clueless [#10]
That’s reprehensible.
Hi Clueless, I also attended a six year program. Where di you attend? I attended Boston U and finished in 1982.
[blockquote] Part of the problem now is that the whole process is incredibly expensive. Thus, the folks who should be allowed to wash out and go be librarians or teachers or lawyers or whatever can’t do so, because they are already 150,000 in debt. [/blockquote]
This is a huge problem. The retention rate in medical school rate is high – less than ~5% drop out. Those that don’t make it are hosed. In comparison, the attrition rate for PhD students is ~50% but those that get weeded out aren’t usually left with huge debts. I saw both playing out.
[blockquote] “A large part of the junior year experience consists of making sure that the junior understands his/her total worthlessness as a human being†—Clueless [#10]
That’s reprehensible. [/blockquote]
It is amazing to me the number of physicians that suffer from malignant personality disorder. They are miserable people and try to spread their wealth. It is a wonderful profession, and one gets to work with some of the best people in the world. This includes some physicians but a lot of nurses and ancillary care workers.
robroy #13, absolutely. Agai9n to bring it back to the church, what a potential mission field that could have broad reaching impact!
“A large part of the junior year experience consists of making sure that the junior understands his/her total worthlessness as a human being†—Clueless [#10]
“That’s reprehensible”. Ireneaus
Oh I dunno. Is the West Point plebe system “reprehensible”? In point of fact if you can’t cut the mustard (make life and death decisions after 36 hours without sleep, and remember to put your patients needs in front of your own, maybe you don’t belong in medicine. They have made intern/resident years a WHOLE lot easier with their shift work and 80 hour limits but frankly the new generation of docs really aren’t as good. Or as dedicated. Further, they will be expected to work much harder than they do (currently) in residency once they become attendings, so I figure they should get used to the harness. That is what junior year teaches you.
The harness does chafe.
I doubt that the caliber of Army officers would be improved if West Point focussed on making sure that all their plebes had high self esteem. The public schools and civilian universities have been working that angle for decades now, and all I see are a bunch of spoiled whiny babies who need to live with their mommies well into their thirties because how else can they sustain the lifestyle comensurate with their importance?
As to the other question, I went to Northwestern University’s six year medical program. Great education. Great fun. Great fencing team – Big Ten Champs, Go Wildcats! The football team was lousy though. My freshman year we not only didn’t win a game, but we were shut out for 9 games in a row. Our cheer was “That’s alright, that’s okay, we’re gonna be your boss someday!”
I actually am quite kind to medical students and resident, and I pride myself on my popularity with the lot (Neurology is a very popular elective). However I disagree with Iraneus and the other folks that the Junior year humiliation process is all bad. Medical students tend to have big heads anyway, because they tend to be folks who have done brilliantly from an early age, and are used to thinking well of themselves. I think egos would be even worse if you let that lot out on an unsuspecting public without making clear their place in the universe of medicine.
Just my two cents.
There are a lot of folks with “malignant personality disorder” in medicine, however I don’t think it is the “plebe system” that does it. There are even more malignant types in finance and law. I think that medicine would be better if students had no tuition the first year, but were made to work as orderlies and nurses aides while studying. Then those with the malignant personalities would leave and go be investment bankers and malpractice attorneys.
“Is the West Point plebe system reprehensible?” —Clueless [#15]
Physicians are not called to the same sort of obedience as soldiers.
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“If you can’t cut the mustard (make life and death decisions after 36 hours without sleep, and remember to put your patients needs in front of your own, maybe you don’t belong in medicine”
That’s no justification for bullying or otherwise “making sure that the junior understands his/her total worthlessness as a human being.”
Bullying undermines judgment, teamwork, and morale. Those who indulge in it are hardly putting their patients’ needs first.
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“There are even more malignant types in . . . law”
Maybe so, but if you’re a law professor, you can’t belittle or bully your students as if you were Professor Kingsfield on a bad day. Law schools recruit students in a competitive market, and rude professors are not a draw.
You misunderstand Irenius. The professors stick up for the medical students. The students are bullied mostly by the nurses and the ward secretaries, and to a lesser extent by the interns, and to a lesser extent still by the residents. The profs are usually pretty benign.
Medical professors earn less than those in private practice. They teach because they like it, and are willing to earn less to do so.
And physicians are called to the same obedience (to a natural law regarding patients) as are soldiers. The analogy holds. You do not understand what is expected of physicians.
Everything that I’ve heard from brother and father, as well as friend, about residency and medical school is similar to RobRoy and Clueless’s description.
I think that the residency experience varies by field. Pediatrics was certainly stressful but much more humane than what my surgery colleagues went through. And I trained long before the limitation on hours worked. My “post call” days were my longest because I was least efficient.
Surgery has always been the most difficult residency (but then it is pyramidal. Only a handful of those who begin, complete). Neurology was reasonably humane. Call was every third – intern through 3rd year, and every day (second call only) for seniors.
It beats being an attending in private practice where I have been in practices where I was on every day 24/7 or more commonly every other day. Right now my practice is every third so I’m back to being on call no more frequently than I was in residency. I see about five times as many patients in clinic however.
Actually, I’m not sure how the folks leaving training now can possibly gear up to be as efficient and thorough as they will need to be when they are attendings. What I have seen of recent grads since the rules changes went through has not been encouraging.
But I think the biggest problem facing medical students is that they really don’t have a clue what medical practice is like until their third year and by then they have sunk a huge investment into being a doc and they feel trapped.
I will say I never felt trapped. There was a time that I toyed with leaving and being a scientist, and another when I toyed with leaving and being a science teacher. However then, I didn’t have the debt that kids have today.