rant: it's all about the tone....

i cannot speak for all medical schools (there were certainly things in the 101 list that do *not* apply to my program), but it seems that there's a general tone of animosity directed at the students, particularly by the science ph.d. professors. anatomists, in particular, seem to despise medical students. they think we're stupid (<--heard at many an anatomy lecture last year: "if you don't understand this, you're so dumb you should get up, leave, and go fill out a subway application")*. one of my study buddies had a conversation with a physician she shadowed before beginning medical school and he issued this caveat: "watch out for the ph.d.s. they're bitter because they didn't get in to med school." ouch. ordinarily i'd have thought this physician's hypothesis was off, but after what i've observed, i'm not so sure anymore.... at the very least, they hate teaching--that much is clear. since mwms is an odd place that runs on a pbl program, the school has made some very bassackwards curricular decisions. they're still trying to figure out the best way to "teach" and test our knowledge. while our anatomy class was a 10 week marathon of lectures, we're now deep into the pbl portion of our program. so far, the way we've been tested is in the form of "learning issues." basically, after our group finishes a case, we're supposed to pick learning issues, relevant to the case, on which we want to be tested. the powers that be try to act like these should be discrete packets of knowledge for the case at hand, but since that's impossible (the books, after all, aren't designed around our cases!), what ends up happening is that we pick chapters from our various books. so, for any given exam, there might be 40 or so learning issues, all derived from different chapters. all the groups choose their own issues and go at their own pace, with some direction given by the faculty facilitator. for the last pbl exam that the class of 2010 took, the majority of the pbl cases were based on neuroanatomy. by the time they were finished with the 8 cases for that block, most groups had picked nearly the entire neuroanatomy textbook. *gulp* it's simply not possible (in my opinion) to learn all of neuroanatomy on one's own by reading the textbook, particularly in 6 weeks when that's not the only class/book/bit of material one has to learn during that time. there are only 6 hours of pbl class per week, so discussing all the material in group is not really an option, either. basically, we're left to sink or swim on our own. many groups, as a result, have attempted to make the learning issues more manageable. in other words, while the group as a whole reads broadly during the case, learning issues are picked with what the group feels it needs to be tested on in particular. the thought is that if the group is specific about learning issues, there won't end up being 50+ learning issues on an exam. basically, pbl groups are trying to choose wisely so as to survive these horrid exams. as list 101 indicates, though, everyone in medical school is smart. there's nobody there who didn't have to do some amount of more-than-ordinary work to get accepted. everyone is self-motivated, if not exceptionally so. but are we treated as if that's a given? heck no. we're treated like incorrigible schoolchildren. lest you think i jest, consider the following email (only modified by changing names to protect privacy) sent by the professor in charge of compiling all the learning issues for the exams. i swear to you, it's all about the tone.

Dear class of 2010:

After compiling the exam topics sheet from the 1st 2 cases, I have noticed that most groups are choosing only a few topics from each case. These cases contain many more basic science topics than are being chosen at this time. For example, why are most groups avoiding gross anatomy? If you are deciding to avoid gross anatomy because you “already had that,” you are making a huge mistake. What you already had was a “survey” course, not a full anatomy course. As stated by I and Dr. Head Anatomist several times during anatomy, you MUST choose anatomy exam topics in PBL to learn this science well enough. You were also told by Dr. Head of PBL and I that in PBL you must review topics several times to fully understand them. Why are you not reviewing anatomy? Aren’t you discussing gross anatomy during the cases? If not, you should be!

Please be reminded that you are in medical college where you need to learn all the basic sciences in a PBL curriculum. In this curriculum, it is assumed that you take the responsibility of learning seriously and become adult learners where you are responsible for your own education. Most of you are achieving that goal, but others need to be reminded from time to time that this freedom in your education comes at a price. If you continue to minimalize exam topics as a strategy to score better on PBL exams, this strategy WILL backfire: you will not learn enough basic science information to score well on PBL exams, the COMLEX exam, or to be a knowledgeable physician.

Please let me remind you that the PBL exam will be comprised of 185 questions. If you choose too few exam topics, your exam will have 8 or more questions from each topic. As you might not be aware, deriving 6, 7, 8, or more questions from a topic requires that I examine you on very minute details: the kind of details in which you may need to memorize charts or graphs to answer. If you choose enough topics, say 4, 5, or 6 from each case, then I can attempt to make your exam from big picture topics that are most important clinically. Although not always reached, this is my goal.

In closing, let me make it perfectly clear that choosing very few exam topics from cases in not a good strategy: neither for the PBL exam, nor for your medical education.

Another Frustrated Anatomist, Ph.D.

*no offense to anyone working for subway; i guess the anatomists just have issues with those employees, too, even though they eat lunch there almost every day.....