Monday, June 23, 2008

Are today's medical students wusses? Consider what's different now.

Lately I've heard more and more rants about how today's medical students need to "grow up" or that we are "wusses" for not wanting high-stress jobs or for asking what we need to know for the exam, or how today's senior physicians are "washed up and out of touch."

Don't get me wrong, I strongly agree with the fact that medical students should not be recording remains of body donors (as mentioned in here). This does NOT happen at my medical school; along with virtually all of my classmates, I am strongly in support of my faculty's oft-stated policy that bringing cameras into the lab is grounds for dismissal from the program. While you can be upset at the students for doing this, there's also a lot to be said for not giving the students the opportunity.

What I am referring to is the impression of some more senior doctors that today's medical students are wimps, and that medical students today recoil to comments like this by saying that old doctors have no idea what it's like now.

One retired MD in my faculty, extremely well-respected among nearly everyone who knows about him, made the entire first-year class an exception to this during a lecture by making comments to them that he thinks they never would have survived medical school back in his day.

This only generates division between the generations. "How can he say that?" they reply. "HE would never make it through OUR medical school class. There is SO much more known about medicine today... heck, DNA wasn't even INVENTED when he was a medical student!" Despite their exaggerated protests, they have a point. One example: a rheumatologist told us "The things you are learning in this week in your second year of medical school weren't taught to me until my fellowship."

And whereas most people respect him very highly for his accomplishments in the faculty, all the first-years I spoke to on this won't see him for that. In their words, they think he is a "tool."

In fact, that retired doctor is right in one regard - today's medical students wouldn't make it through medical school back in his day... but only because they wouldn't make it in to medical school back then. This goes both ways, though - he and many from his generation (as I've heard many M.D. interviewers from that generation say during interview weekend) would likely not make it past the admissions process to get into medical school if he submitted his application from 1950 to one of today's medical schools.

And that leads me to the point of this post. Admissions procedures, like so many things, are very, very different today from how they used to be. Comparing a medical school class of today to a medical school class of 20, 30 or 40 years ago is virtually impossible.

Some of the differences I can come up with:

1. How medical students are admitted.

---> Class of 1960: Chosen on the basis of GPA.
---> Class of 2000: Chosen for extracurriculars, personality, answer to the ... . These days, many people in medicine know someone with stellar MCAT marks and GPA who are not in medical school. Back in the day, they were the only ones in medical school.

As a result of the admissions, this leads to a difference in:

2. The type of medical students that are admitted.

---> Class of 1960: Students who put medicine first. Everything else second.
---> Class of 2010: Variety of extracurriculars and social supports (family, friends, etc.) Can't get in to medical school without demonstrating this.

The type of students that get in is related to:

3. How the students that get in approach a high volume of information.

---> Class of 1960: Medicine comes first, so I will learn it all.
---> Class of 2010: How much do I need to know to pass the tests, so I can still have time to enjoy time with my family, friends, and extracurriculars?

This impacts:

4. Types of specialties students choose

---> Class of 1960: Specialties that allow them to be doctors 24 hours per day, live at the hospital, and surround their lives around their career
--> Class of 2010: A documented increased interest in "Lifestyle specialties" (a term now recognized and used by the AAMC) such as the "R.O.A.D. to a good lifestyle" - Radiology, Ophthalmology, Anesthesiology, Dermatology. Or, working 4-day work weeks. As medschoolhell puts it, "Honestly, why work 60 hour weeks for $120,000 per year if you can work the same amount of time and pull in $300,000?" This way, they can spend time with their families and doing the things they love, with their career on the side. Apparently that is what makes us wusses.

Put both types of medical students in a high-stress situation, and that leads us to the fifth difference.

5. What happens when these medical students are subjected to extreme stress

---> Class of 1960: Learn the physiology, pathology, and stay awake until you know it all. This is not a problem because its what they did during undergrad, and medicine comes first so sleep is the only thing that needs to be sacrificed.

---> Class of 2010: Learn the physiology, pathology, and stay awake until you know it all. This is a major problem because during undergrad, these students relied on their many extracurriculars to help relieve stress... but now, the volume of information is much too great to have time for anything other than study. So, far too many students have outlets in other ways... drugs to help them get to sleep (both prescription ie. sleeping pills, and non-prescription ie. alcohol), full-on medically diagnosed anxiety attacks, many minor freak-out sessions.

Anatomy on the Beach has written on this as well, and mentions a number of other factors: dashed expectations, professors who could probably do a better job of explaining the relevance of some of the seemingly irrelevant, nitpicky details we're expected to memorize and regurgitate, and the reality and stress of medical school which can dampen the enthusiasm of learning.

Well, this is just my take on the situation - in my opinion, the Class of 1960 and Class of 2010 are too different to be compared to each other and call one group "wusses" in relation to the other. I would be very interested in hearing from people who have been around longer and therefore know about this situation a lot better than I do...or anyone who has thoughts or can think of other differences.

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Sunday, June 15, 2008

Top 10 List: Ten things I learned in second year med school

Keeping with the tradition, my classmate Jay wrote another list of things he learned. Again, used with permission.

1) Chest pain at rest can also be diagnostic of 3+ cups of coffee before 10am.

2) Being in med school, I achieve a high Woodcock-Johnson every morning.

3) After one week of teaching us about chronic pain, the take-home message is to not call our patients liars.

4) I get all teary-eyed in only 2 situations: watching the ending of the movie Rudy, and being bedside at a live birth.

5) It is possible to almost completely forget what you had known front-to-back the previous week... and do this over and over for 20 straight weeks.

6) Me, and possibly most of my friends, have this condition called Orbitofrontal syndrome.

7) Apparently, the local hospital administration is willing to disrupt/discontinue the medical education of hundreds of 2nd year medical students, because of food and drink inside a lecture hall... and that hundreds of 2nd year med students respond by shrugging and using that forget-what-just-happen-last-week ability.

8) Toxic megacolon is pretty much exactly what it sounds like.

9) Everything you do in med school is the next hardest thing you've ever done.

10) Oh my god... in 2 months, they're going to expect me to make real-life decisions about patient care... wtf, I'm PRETTY SURE that I'm not ready to do that.

If you enjoyed this, check out the top 10 things Jay learned in first year.

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Monday, June 09, 2008

What about those Canadians studying medicine overseas?

A medical school dean once told me, "Every year we turn away as many applicants as we admit, who would also make excellent doctors - our class size just isn't big enough to hold them all."

I've had the unique opportunity to spend time with a few Canadians who are attending medical school in Australia, and I've come to the conclusion that what that dean told me couldn't be more true.

The students here have all impressed me with their life experiences, their intelligence, their motivation, their accomplishments, and how friendly each and every one of them is.

In fact, if you had told me that they were students at my medical school, I would have believed you. I can't see any difference between the students here and the students in my class. They're by no means inferior, whatsoever. And while I'm basing this impression on only a limited amount of time with them, I have already spent a lot more time getting to know them than any admissions interview committee does.

I've also learned that just because a Canadian is studying medicine overseas, it doesn't necessarily mean they were denied from entering a Canadian medical school. Getting into medical school is a lengthy process, and if you don't get in on your first try, as was the case for up to half of the people in my class, the process to re-apply takes almost a year (apply in October to find out in May if you are in September's starting cohort). Rather than apply again, and sit out for another year, some of the students who learned they had been admitted in Australia considered it a logical choice to get on with their medical education right away.

In fact, in many ways I look up to the Canadian students studying here. Before I applied for medical school, I always told people my backup plan was, "If I don't get into medical school in Canada after my third time applying, I'll start applying overseas...Australia, Ireland, the Caribbean." But, to be honest, the thought of having to leave Canada to study scared me, and I wonder if I would have had the determination to apply yet again, let alone apply overseas.

The Canadians studying here, on the other hand, have given up proximity to their families, their friends, and everything familiar to them, to pursue their passion for helping people through medicine - many more sacrifices than we Canadian medical students are making.

And at the end of the road, that determination, that willingness to sacrifice, and that unbeatable passion for helping people - if that's what these students have in them, and if they put all that into how they serve their patients, well, you can't deny that's the type of doctor every patient prefers on the other end of the stethoscope.

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Sunday, June 08, 2008

Vitum experiences medicine down under!

I didn't expect to find myself seeing patients in Australia this week, but there I was, in a general practitioner's office, shadowing as a medical student, just hours after getting off the plane to Australia.

I have a buddy of mine to thank. I've always wanted to visit the Southern Hemisphere, and since he is one of the estimated 1500 Canadians studying medicine abroad (a quick tribute to the limitd number of medical school spaces in Canada) it worked out well to combine a trip here with a visit to an old friend.

Not only that, but his preceptor graciously agreed to let me tag along with him during his placement in her office this week, an opportunity that I was very interested in taking part. It was fascinating learning about the similarities and differences between medicine here and in Canada, identifying some rashes I had just learned about in our Dermatology unit, and actually feeling like I have learned something in the last two years as I was able to pass on some things to the first-year medical students.

Don't worry, I'm not spending my entire break doing medical'll find me laying on beaches and hugging kangaroos the rest of the time I'm here. But it was really neat to see what a doctor does halfway across the world.

What's different?

So, based on my afternoon in a GP's office here, how does medicine in Australia differ from that in Canada?

Well, the first difference that I noticed right away was the layout of the office. In Canada, GPs generally have an office with their desk where they do paperwork, but that is in a separate room from the rooms where they see patients. In Australia, however, the GPs have a large office, one half of which looks like a typical office with a desk and computer and bookshelves, and the other half - sometimes separated by a curtain - is the clinical area where they see patients, with a patient bed, sink, and various instruments hanging on the wall.

Another difference I noticed was the hints of the two-tier health system here. The public system, known as "bulk billing," works alongside the private system, funded by patients or their insurance companies. I've been told it isn't that profitable for a doctor to only see bulk billing patients, and for the most part those that do are more similar to what in Canada is a walk-in clinic - where patients go for minor issues after hours, or mostly to get prescription refills. GPs who have their own patients shake their head at the mention of a patient getting antibiotics from one of these bulk billing "medical centres"... just like GPs in Canada shake their head at the mention of a walk-in clinic. As well, driving through a smaller town in Australia, I saw a large public hospital... and right down the street from it, past the independent pathology labs that contract out to the hospital, was a private hospital - smaller, and much fancier.

Finally, a comment about the public health victories in Australia. Like in Canada, doctors here have had a major influence on smoking rates and seatbelt use - but before even coming to Australia, I had heard that the doctors here have had incredible success with the "slip, slap, slop" campaign - to get Australians to be "sun-wise" and significantly decrease their risk of sun-associated skin cancers by covering up with sunscreen and long-sleeved clothing. Based on their efforts, wearing hats and long-sleeved clothing to outdoor events has become a way of life in Australia.

What's the same?

Indeed, those differences aren't really that major, and I'll go so far as to admit that the thing that stunned me the most was that there are actually many, many similarities between medicine here and how I've seen it done in Canada.

Many of the things I heard the doctor mention - drug names, medical conditions, and investigations for medical conditions (such as a glucose tolerance test, nuclear studies, ultrasounds, biopsies, lab tests) - had the exact same name and terminology we use in Canada, much to my surprise. Even those rashes I had recently learned about in our Dermatology unit showed up, and are called the exact same things they are in Canada. I suppose I had the idea in my head that everything would all be called different things here.

Not only that, but a couple came in to talk about their plans to get pregnant - every single thing the doctor mentioned in the prenatal counselling, right down to the numbers ("you have a 20% chance of getting pregnant each month" and "if you don't get pregnant within 12 months, that's when we'll start looking into the reason for that") and advice ("take a folic acid supplement" and "don't drink any alcohol now that you are planning to become pregnant!!!!") were identical to what I had just learned in my reproduction block.


I'll admit that the rumours I've heard about how hard it is for Australian doctors, and international doctors in general, to come to Canada had always given me the idea that the doctors here are perhaps less competent than those in Canada, or that maybe Canada is keeping them out for the protection of our own people. However, having seen these docs in action first hand, this misconception of mine has been pretty much wiped out. From what I saw of the docs here, they're just as competent as any doctor I've worked with in Canada...if not more so than some.

All of the doctors in the office seemed very enthusiastic to have students, and took the time to try and teach me. It was also really interesting to go to class with my friend and meet many other Australian medical students, see that they are learning exactly the same things I am learning in class in Canada, and share perspectives with some more of the Canadians in his class who are all studying here for different reasons.

Many thanks to my friend's GP (and all the docs in the office) who were more than willing to make this unique experience a possibility for me.

One last random thing...

If you want just a normal, regular coffee in Australia, ask for "filtered coffee" - it's not the same as "percolated coffee" (ask for that and you'll get an espresso). That should save you the argument with the barista... which, based on my experience, ends up with them thinking you're crazy, you thinking they're crazy, and you settling for a "tall black" (their name for an Americano). Just a tip.

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