Medical School 2020, Year 1, Week 8

From our anonymous insider…

Exams begin next week. Type-A Anita is particularly nervous. Beginning last week she has refused to learn anything that is more in-depth than the NBME questions: “only high-yield.” She interrupts class once per day to complain when a professor gives more detail than the Step 1 exam books do. She also requests clarification about the number of questions per exam topic. She dropped her sweet Midwestern demeanor and submitted a formal complaint to the administration when an older physician said males have to work more to learn patient interviewing because women are more naturally caring.

Lectures focused on glycolysis and summarizing metabolic pathways.  A rather plump gastroenterologist in his 50s gave an “energy” synopsis about different states of metabolism. These lectures were paired with our patient case, a young anorexic teenager. Anorexia fits with the metabolism unit because it forces the body to break down protein to use for gluconeogenesis. We heard from her doctor that the patient is on antidepressants and receiving psychotherapy, but didn’t get to meet the patient.  

We finished dissecting the upper extremity with the elbow, forearm and the bewildering hand, whose muscles and vessels entail hours of dissection. I share my cadaver with three other students. Yet, with three hours of dissection time, we had explored only about 10 percent of the hand. Fortunately, the instructors convinced a chief surgery resident to spend his evenings dissecting a demo cadaver and then come in at 10:00 am to give us a guided tour of a perfectly dissected hand. We were doubly appreciative of his efforts after we heard about his 24-hour hospital shifts.

One of our most passionate and funny doctors spoke about using ultrasound to investigate the shoulder and upper arm.  Ultrasound sends high frequency sound waves into the body and relies on differences in the ways that tissues reflect or absorb the sound. We broke up into groups of six, each provided with a donated battery-powered 10 lb. ultrasound machine. The expert (attending) arrived at each workstation to help us diagnose each other. We were able to see torn muscles, ligament damage, tendinitis, and bursitis. As with Week 6, a high percentage of our classmates were able to supply examples of musculoskeletal damage. I contributed a torn supraspinatous (rotator cuff) muscle torn in the college weight room.

In an after-workshop discussion, our professor described his frustration that the medical school accrediting body, Liaison Committee on Medical Education (LCME), limits the number of “formal instruction” hours.  “I’m not exactly sure, but it is only about 25 hours per week,” he said. He recounted stories from his professors’ education in the 1920s.  For example, a instructor asked a first year class if anyone was uncircumcised.  Two students raised their hands.  They were instructed to drop their trousers, and in the pursuit of education, were circumcised in front of the entire class, including the two female students. His own 1950s education did not include any in-class circumcisions, but they were at school for 12 hours each day, with some mandatory Saturday sessions.  Anatomy lab dissection was 4 hours per day compared to our 4 hours per week. Our professor noted that passing the NBME exams requires more knowledge than for comparable tests in years past. Thus today’s medical student faces greater pressure to study independently.

Statistics for the week… Study: 35 hours (about 5 hours after class each weekday plus more on the Sunday); Sleep: 7 hours/night; Fun: 1 hiking excursion with Jane.

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10 thoughts on “Medical School 2020, Year 1, Week 8

  1. Good lord. The idea of a resident cutting and sewing my body at 22 hours into his workday fills me with horror. I thought they were easing up on the resident-hazing.

  2. superMike-
    In 2003 new rules stated residents could work no more than 80 hours a week and no longer than 30 hours straight. I assume that this is part of the easing up you are about.

    Before that it was common for surgery residents to work between 100 and 120 hours a week. (As a medical student on my first day of surgery rotation I did not leave the hospital for 39 hours and didn’t see the sun other than out the occasional window for a week.)

  3. What’s the theory behind that? If I programmed some code that screwed up some part of your life at the tail end of a marathon 2-day programming session, you wouldn’t say I was being a good engineer. (And it’s usually very simple to go back and fix bad code after the fact) Pilots and train conductors can’t pull 24 hour shifts. Don’t patients deserve a surgeon’s best work?

  4. Just guessing, but apart from ushering out the unsuitables, it could also be to make sure you have the stamina and, later on, the experience to handle extreme situations like a big disaster or a battle or something, where you may have to work for long times under pressure. And do a good job.

  5. Sam: it is not just surgical residents. It happens on almost all specialities, from family medicine to psych.

    SuperMike: the theory is that because all previous generations of doctors have suffered through that, newcomers must also go through the same pains. Otherwise, of course, they’d have it really easy and not be real doctors.

    Tom: the residence is after med school and after the internship. So the “unsuitables” you speak of have already successfully completed their university education and survived being an intern for more than a year. If they managed that, should we really get rid of them because they can’t work 48h shifts? (Not to mention that they’d be unemployed and with a huge debt.) Also people don’t realise that residents are paid almost nothing for life-saving work (ie, in between $40-50k), and the programmes are so competitive that many applicants have to move interstate (ie, no support network).

  6. Sure, but how can you weed them out in this way before they know even remotely what to do?

    We have problems similar in spirit with research scientists and their endless underpaid and overworked postdocs and assistant professors. There too, it would be far more kind to not let most of them begin their doomed path in the first place, right? It goes on for quite a while too.

    (I’m not sure about the tenure rate of assistant professors these days, though I get the impression it’s more humane than it used to be.)

  7. The hazing probably has the useful effect in today’s world of limiting the number of husband hunting women going into the field. Loads of competitive education tracks are a third filled with women who graduate and then permanently end their careers, or switch to part time, in less than nine years.

  8. Seriously, this “Anita” is the kind of oversensitive supposed adult US professors have to deal with these days?! Guess I have to get out before it spreads worldwide. She should probably stay in kindergarden. Is it weird I hope she drops out before she does any real damage?

  9. Why doesn’t my local chain pharmacy have an ultrasound station? I’d pay some nominal fee ($10 – $30) to have it instruct me on how to scan my shoulder/elbow/neck/knee/ankle and then have the “app in the cloud” interpret the results and email me a link on what was found and how best (and second and third best) to treat it. Either hire real doctors in India to interpret or (more fun) have machine learning figure it out. If it can tag me in photos against my wishes, I’d imagine interpreting ultrasound is within its grasp. Perhaps it could be subsidized by local surgeons & physical therapists. It shouldn’t be that hard to develop (yes I glossed over a lot of detail, but nothing insurmountable IMO).

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