May 24th, 2005



Got in around 11 PM last night, O Best Beloved. Am apparently suffering from plane-related illnesses (all those people, 13 hours of recirced air) and am now up for a coughing break.
I will fill you in more later - it will be a busy busy few days, but I am home.
And I had a lovely time.
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Kendo mouse


It is the time of the year when medical students, O Best Beloved, are preparing to take the USMLE step 1.
I finished second year, took a week off, reviewed from four books for six to eight hours a day, five and a half days a week, for two weeks, and did a lot of practice questions. I focussed on pharmacology and got through the entire NMS medicine book. I read First Aid religiously. I pretty much gave embryo a miss.
I did fine. I ticked in just a smidge above the mean on Step 1. If I had done any organizing of my entries at all, I would know where that score was.

I am reading med_school and med_students and trying to comprehend a schedule such as they are proposing. A month or more of studying, hard, every day. Spending hundreds of dollars on review items just in case it'll help.
It's compulsive. We're a society of compulsive students - study this, memorize that, learn the other. Charts and timetables and every little edge you can get you must take. Because it's about becoming the doctor who gets the awards, the one who makes it in Derm. The Orthopaedic Surgeon. The anaesthesiology resident saying that $300,000 a year is a bare minimum salary.
M got an award for the highest score in the entire state on the Pathology final, way back after second year. I caught up with him at graduation and congratulated him. He looked at me with a half-smile. "It's just one test." And I knew what he meant.
We are at a new stage, O Best Beloved, in our education. We are at a point where it is chafing - galling - to be tested and examined like so many laboratory rats; we do not learn from these exams, we do not ever know more than such a percentage in thus an area. For the Clinical Skills step 2, I spent $900, drove to Chicago, stayed in a hotel room and lost $100 in plane ticket change fees. I spent eight hours in white coat and stethoscope moving from rigidly-defined room to rigidly-defined room, filling out forms on a computer that left no room for thought or expansion, mind racing over the questions I must ask and the time limit, barely seeing the patient himself. And I received a white sheet of 8x11 paper, folded in half, with the word "PASS" written in unfriendly block letters.
Tell me, O Best Beloved, tell me what possible contribution my thousand dollars and eight hours, my toil and trouble, tell me what they gave me? When does this painful process where we are subject to review without feedback end? How long are we expected to be both passive listeners - mindless drones who learn and regurgitate - and active learners who question the "accepted way" of things? How many times do we have to subject ourselves to an evaluation instrument that takes away our precious time and gives us nothing back?
O, Best Beloved, I am so tired of being a mouse in a white coat. I am twenty-six years old and I have invested two decades in the art of learning, only to be stonewalled at this final venture. There is a red tube in my bedroom, and in that red tube is a piece of paper conferring on me the degree of Doctor of Medicine and yet the test I had to pass to achieve that degree enriched me not at all.
This is not learning, O Best Beloved. This is not the way of learning, of doctoring, of medicine. There is a National Board who licenses us to become the very thing they have forgotten the definition of. I am a doctor, a physician, and so help me O Best Beloved, I am a teacher.

There must be a better way to get there.
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