Learning vs. Reality

Regularly we attempt to learn content that is constantly in flux and subject to change, even before we learn it. This phenomenon is built into the system of education that is medical school. There is a built in delay from reality, to national board testing that almost requires that we learn "old" information in the first two years so we can "pass" a board exam that was effectively written, validated and released during the past 2 years. Confused? When I sit for my Part 1 USMLE board exam in early 2010, that information being tested will have been "current" in 2007-08...it's just how the system works to write, review, validate, test, store and assemble questions and exams.

Flash to now...I'm learning content that is both text based (in itself 2-3 years old via publishing standards) and trying to integrate that with my current knowledge and new knowledge about patient care that we read about everyday (about the only reason I'm sorry for the Internet). So as we learn about the disease of ovarian cancer, the data is in continuous flux. Today I read....

Investigators disagree about value of combination screening to detect early-stage ovarian cancer. (3/20) reported that researchers in the UK, who are conducting "the largest randomized controlled trial of ovarian cancer screening to date," are saying that, used together, "both the cancer antigen 125 (CA125) blood test and trans-vaginal ultrasound might be capable of detecting early-stage ovarian cancers." But, researchers at the University of Alabama-Birmingham maintain that the screening regimen "fails to discover the cancer in its early stages and often results in unnecessary surgery," HealthDay (3/20) pointed out.

The question is what will be current knowledge on my board exam in 2010 when I am taking the most important test of my life to get to the next stage of my medical education...rotations? This guessing game of sorts, and preparing for an exam is understandable, but a bit bizarre and more about the test than anything else. I'll learn how to be a practitioner later.

The next Bozo instructor that tells me he or she is not teaching to the test should be fired right on the spot. It's ALL about the test! I can't move to the next phase of this educational process without passing that exam. I'll learn about current ways of thinking after Step 1 (and then unlearn it a few years when I have to take Step 2). I'll learn about doctoring in my residency. In the meantime, focusing on the massive amounts of "old" content is enough. If you give me one more cutting edge study or minutiae point of information that has nothing to do with anything but showing me how much you know (or test me on it, God forbid) in this part of my education, I'll SCREAM!

Crunch

The week before exams, people change. Beyond the nervousness of the exams and content, this time there is an air of "I've got no clue how this prof tests". The field of medicine is so huge, even within the course disciplines and testing shouldn't be a guessing game. This exam, for many of us in all the terms, it is. So beyond the content, which isn't hard, is the unknown of new teachers and methods (changed mid-term). Students are more isolated, and pensive this block and frankly I don't blame them. It's crunch time...with an edge.

But I went swimming in the Caribbean today and saw my first octopus...a big Caribbean Reef Octopus. Beyond the exercise and getting the "stress" out of my shoulders and working out, the thrill of the animal was amazing. I actually spotted him when a stingray (a common sight where I was) cruised by him and they scared each other. The ballistic movement of both  threw up some sand and caught my eye. It was cool and got my mind off "crunch", even for a moment.

It Doesn't Fix Easily

I try. I really try. Every day it's a new start and an effort to work with what God gave me. Psalm 118:24 says, "THIS IS THE DAY THE LORD HAS MADE". I try to maximize all that is provided and cerebrally know that it's a blessing to have this opportunity and focus. But this system is broke and it won't fix today, tomorrow or for many, many months to come. By then I'll be gone.

Valuing Teaching

An outstanding article appeared recently in the "New Physician" journal from the American Medical Association. It sort of summarizes my frustration with the education I've witnessed here and heard about for years. But here at a "teaching" institution with minimal research, and publication pressures on faculty, I expected different. But what I realize is that school administrators and instructors who are not now, and have never been educated in "teaching" don't even know where to start. The classroom in medical school IS the "last frontier" in need of change.

MEDICAL EDUCATION VS. MEDICAL EDUCATORS

After 100 years of bold strokes, improving the training of medicine’s teachers still requires investment
The New Physician, January-February 2009  by Pete Thomson - Volume 58, Issue 1

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“Revolutionary would be if a medical school succeeded in truly valuing the teaching mission.” -Dr. Kenneth Ludmerer

**"...one element of medical education only recently began to change, and it may not change much more without support from medical schools themselves and an attitudinal shift in physician culture. That element is the recognition and promotion of teaching skill in the medical school classroom."

**“What would be revolutionary would be if a medical school succeeded in truly valuing the teaching mission.”

**"Generations of medical school faculty and administrators have held to the idea that teaching as an art is a waste..."

**"...the delusion that knowledge of subject matter automatically makes a good teacher...At the higher-education level, very few faculty are really taught how to teach."

**"...we have an obligation and responsibility to prepare our teachers to teach.”

**"...medical students are medical school consumers and, as such, are entitled to demand great teachers and great teaching. But excellence in medical teaching matters the most to the ultimate consumer: the patient population."

**"...medical education has a lot to learn about teaching..."

Nuff said...just nice to hear someone else say it.

Long Time

I know it's been a long time since my last post. Lots of stuff has happened and I've been very busy with school, but I hope that regularity will now follow.

Teachers continue to come and go. Classes are unpredictable and sometime unintelligible. School is reorganizing with new administration punctuated by school functions and events. Island life never really changes but offers peace in the form of diving and hiking for me. Looks  like we are open in Summer, but beyond that is anyone's guess.

I think it's time for some Buddhist balance and perspective.

"If we use our human life to accomplish spiritual realizations, it becomes increasingly meaningful.  Thus by using our human life for gaining spiritual realizations we can solve all our human problems and fulfill all our own and others' wishes. What could be more meaningful than this?"- Spiritually I'm still in the "right" place and finishing the basic science years is still the "realization".

"The real source of happiness is inner peace. If our mind is peaceful, we will be happy all of the time, regardless of external conditions, but if it is disturbed or troubled in anyway, we will never be happy, no matter how good our external conditions may be." - I'm not quite there yet. I still have expectations that are not fulfilled, but I'm getting better at realizing that school can never provide everything we need. How close they come is a matter or daily gradations.

"If we respond to difficulties with a positive or peaceful mind, they would not be problems for us. Eventually we might even regard them as challenges or opportunities for growth and development. Problems arise only if we respond to situations with a negative state of mind. Therefore if we want to transform our life and be free of problems, we must learn to transform our mind." - Sound so easy, but the exam we take at the end of this process is make or break, and all important. It is hard not to hang that success or failure on what happens now, but "positive and peaceful" is clearly the goal. That school can provide everything we need is a delusion, a bad mental habit, and that habit can be broken.

"Delusions are just bad mental habits, and like all habits they can be broken. With no delusions remaining in our mind, there is nothing that can disturb our inner peace and joy."  - Gyatso