The real first day of medical school... a moment six years in the making.

I told a group of first-year pre-med students today, "The moment I'm at right now is where you want to be."

True, they all want to become doctors, so technically the moment they really want is med school graduation.

But what I'm talking about is that the learning I'll be doing this year - on the wards, seeing patients, learning medicine - that's the learning they wish they were doing this year.

Unfortunately for them, they are a long, long way away from this moment, and the learning they have to go through now is very different.

For them, they have to take courses in intro biology, biochemistry, organic chem, physics, a whole degree's worth of courses... the MCAT... the application process including interviews and admissions...and then two years of medical school which are fun and exciting and horrible and challenging and gruesome and interesting all at the same time.

All in all, at least a six-year process...one that many of them might not make it through... and yet all they really want to be doing is learning how to take care of sick people in the hospital.

I know that it will only be a couple of months before I'm burned out from the day shifts, the night call, and the studying in every spare moment around those shifts, but right now, I'm so excited to start.

I had to keep myself from showing up to shadow at the emergency department tonight, after the doc orienting us this morning told us we could drop in anytime. Maybe I should wait until orientation week is over, I told myself.

Finally, we get to do what I signed up for.

Finally, there is a light at the end of the tunnel... only two years until I graduate.

Finally, it's starting to feel for real.

And talking to people who are six years of hard work away from this moment reminded me of what it took to get here, and made me appreciate it so much more.

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Job Title: Medical Student / "Health Remedy Engineer"

Job duration: Full time (approx. 168 hours/week, some additional overtime required)
Job location: Local university and all hospitals in a 3-hour radius, including some national travel in Year 4 (not compensated)
Advancement potential: significant
Experience: Will train
Required equipment (Textbooks, etc.): Supplied by employee (not compensated).
Term length: 4 years

Duties & Responsibilities:

• Learn all common diseases and conditions and how to diagnose and treat them
• Work well with people pushed to their extremes (and become one yourself)
• Successfully pass frequent extensive examinations
• Deal with life-threatening emergencies with a calm, cool head

Qualifications:

• Must have university degree (or nearly completed one), preferably a Ph.D. or M.Sc.
• Excellent GPA
• Vast array of extracurricular activities
• Olympic medals and superhuman powers helpful but not necessary
• Sense of humour is the common denominator noted among survivors of this position

Skills and Abilities:

• Ability to stay awake for days on end
• Ability to be on call (sample schedule of a night on call)
• Ability to memorize large volumes of data
• Ability to take verbal abuse and harassment in stride
• Ability to deal with human remains in a respectful fashion
• Be familiar with the following computer applications: MDConsult.com, UpToDate.com, CMA website, provincial medical association website, patient care database, X-ray viewer software, university website, course websites, patient logging websites, PDA software such as Epocrates, Archimedes, Merck Manual, Microsoft Word, Microsoft Excel, university tuition payment website, Solitaire

Compensation:
Hourly Wage: Starting at -$10,000, increasing to -$55,000, dependent on campus of emploment (no raises, and yes, that's correct, you pay us).
Benefits: 10% "student discount" at local pizzeria upon surrender of employee ID card. No dental, health or other benefits.
Scholarships: Some, available only to the people who are smarter than you

Application procedure:

Applications due date: September
Notification: May
CV: Include all details of employment and extracurriculars, being sure to account for every moment of your waking life. As well, include a contact person for all items on your CV that we can phone to ensure you are not making these things up.

Please note this is a very competitive position and that only successful applicants will be contacted. We thank you for your interest and hope you are insane enough to apply.

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Medicine still amazes me...and still lets me down

As I learn all the physiology, pathology and pharmacology that medical school has to offer, sometimes there are unique things I see during my medical training that really, really impress me.

Whether it's the capabilities of a 3D reconstruction of a CT scan of a bone or the heart, or watching a patient's debilitating tremor disappear instantly at the press of a button activating a microelectrode in their brain, or re-starting the still heart of a dead person inside the chest of someone else, I occasionally find myself with my jaw on the floor when I learn things that medical practitioners are able to do and see that, only a few years ago, were an impossibility.

Then again, judging by something that happened earlier this month, perhaps I'm just easily impressed.


The doctor I'm working with was called from his office to go see Catherine, a pregnant woman in the hospital. She is early in her third trimester, but started having contractions. Of course, he explained, calls like this come right at the end of the lunch shift to provide the maximum inconvenience to him and the patients waiting in his office. He also explained that disruptions to the office like this are a part of the reason many other family practitioners don't do obstetrics anymore.

We're taught that a lot of information from a patient can be gained from the first part of the physical exam - from "five feet away," or the first glance of the patient at the foot of the bed. This patient was a great example of this. We had barely entered her room, and right away, we knew that Cathy was not doing well.

More than anything, Cathy was incredibly anxious, and for good reason. On the drive over, the doctor had explained to me that Cathy had never been pregnant, and it had been her dream to have a child. She and her husband Dale had been trying for years. No reason for her and her husband's infertility could be found, and finally, after several tries of drug-assisted and then subsequently in-vitro fertilization attempts at a high financial and emotional expense, this woman was now pregnant. And at 41 years old, Cathy knew just as well as we did that if something went wrong with this pregnancy, there likely wouldn't be another chance.


The doctor did a quick exam, and was convinced that the cervix had not begun to dilate. The baby's heart was still beating normally, and monitoring of the uterine muscle contractions revealed uterine muscle activity, but it wasn't clear if this was due to actual contractions or more minor uterine irritability.

Just a few years ago, Cathy would likely be admitted for observation, at a cost of a couple thousand dollars a day. She might not end up being in labour, and might not end up delivering for weeks... meaning a long, expensive stay in the hospital, with an expensive air ambulance transfer to a big-city hospital, with little benefit. On the other hand, she could be sent home, then suddenly go into full-blown labour, and deliver a premature infant away from the hospital after being sent home. How do you spell "lawsuit" again?

I was surprised to hear that this dilemma is not faced nearly as often thanks to an expensive but convenient lab test looking for fetal fibronectin. This protein, made by the fetus, is found in the mother's cervical secretions only if the mother is likely to deliver within the next four weeks. By taking this swab, and getting the results from the lab a mere twenty minutes later, we were able to conclude with resonable certainty (the lab test is correct 15 out of 16 times, according to the packaging) that Cathy was not going to have a premature delivery, and that she could safely go home.


Despite the things I learn that amaze me, large or small, there still times that I am disappointed by the failures of modern medicine. So many diseases cannot be cured, and many can barely have symptomatic relief.

Earlier this week, I had to look into the eyes of a 83-year-old woman in a wheelchair who was begging me to fix her legs. She could no longer walk, and she desperately wanted to be able to. After she had left, my supervising doctor told me that she lost the use of her limbs because of a progressive neurodegenerative disease for which there is no cure, and she often forgets that this happened years ago because of her long-standing dementia. She has two diseases that, despite all of the advances in medicine these days, it still seems as though we can't do much more for her, and the millions with similar conditions, than apply a band-aid.


I'm told that throughout my medical career the advances in medical technology are expected to be staggering. Who knows what clinical decisions will be made much easier because of medical advances, or which devestating diseases will soon become relics of the past. Waiting to hear what the future will bring, and the chance to put these discoveries into action to change peoples' lives, is yet another exciting part of living a life of medicine.

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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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