Sunday, January 20, 2013

Analogy Overdose with no Narcan Shot to be Found

Inadvertently, I found myself listening to a presentation by a potential Academic Dean, who was presenting herself and her philosophies concerning the education of medical students -- in essence, an opening salve in what could eventually be a job interview. Often times, if there is no other pressing issues, I spend lunch in the lecture hall with my headphones on. It is nice to get some quiet time and get organized for the rest of the day. Despite having my nice headphones with me, I found myself actually paying attention. It didn't hurt that the presenter last (or is currently, perhaps) worked in Oregon, and briefly discussed the residency position situation, which is about as big of a hook for me as there is.

Most of the mechanisms she proposed to use for medical student education are things that I've heard before, nonetheless, they seem sound and logical. Whether or not this particular school is implementing all of these ideas or isn't, is a very difficult thing to assess. After all, if one jumps in to a fast flowing river, it is very difficult to know what the river was like the day prior, much less ten years before. When hitting every boulder when floating (hopefully) down the rapids, it is not easily detectable if the flow rate of the whole river is changing at that moment. My point is, it is hard enough to be a medical student and trying to understand the philosophies that shape the overall, grand course of the "river" takes energy that is not always available.

Once in awhile, however, it is nice (and valuable, I'm sure) to be able to take a step back and try and understand why and what we're doing -- especially during the first two years, which is full of rote memorization and processing of abstract jargon. One of the points this candidate made highlighted the difference in the volume of material that schools mandate be understood, and/or memorized and regurgitated on a test. In no way, shape or form was this an "old" person, either. I won't venture a guess as to her age, but I'm sure she is not more than a couple of decades outside of her medical school education. Her point was that there is no way that memorization of every drug, technique, disease and treatment can, nor should be done. She went on to highlight her overall model of medical education, with plenty of good things to say.

I kind of lost her at the issue of memorization, and the ever-increasing volume of material that should be memorized -- note, I say should because, there is plenty of things that a physician does need to have stored in their heads. Of course, finding that balance is, admittedly, very tough. Unfortunately, since I'm the one doing the heavy lifting with the memorization, I wish there was an easier way. There may not be. But, no matter where that balance is, even if it is the best balance possible, there will still be more to memorize.

So, what does this mean? I think that medical schools should do a much better job of teaching students how to learn. First semester rolls around, and all the students are still feeling good about just getting in and then they're hit with the curriculum. Perhaps some of the students have a method of studying that allows them to organize, process and then comprehensively understand and then regurgitate the testable material. Most don't. I didn't. I thought that since I had a demanding undergraduate education, coupled with fluctuating, but at times heavy employment hours and plenty of extracurricular activities. I figured, that taking a 30 hour/week job while enrolled full time in school, and then coming to med school and having nothing else to focus on other than med school would make things easy. Perhaps this put the workload of medical school curriculum demands in perspective, but I had so much more time during my undergraduate years. What this means is that even though I thought I had good organizational skills, and a solid ability to enforce my discipline needs, I didn't have the means with which to immediately tackle the requirements of med school. Of course, like most other med students, it doesn't take all that long to acclimate to the accelerated pace and increased pressure but the acclimatory stage is not easy. However, the steep learning curve is necessary, as I believe that being comfortable with the overall level of work that being a physician demands starts with med school.

My argument is not that we need to be cauddled, nor that memorization is no longer needed. What I want from my medical training is guidance in how to most efficiently learn (in general), find information and then integrate it into my ongoing education and eventual practice (not that education ends, but I'm referring to formal training.) Nearly all med students show up on day one with motivation and willingness to work hard, and I want that raw energy to be morphed into tools and not wasted on rote memorization that surely will fade into obscurity, over time.

When I was a young teenager, and was newly obsessed with all things skateboarding, my friends and I would pour over all available magazines and the few company produced skateboard videos that were available. We would watch skateboard videos (VHS, of course) to tape failure, often to the point where I would have anywhere from 20 minutes to over an hour of footage memorized to the point where I not only knew what trick was being done at every moment of the video, but where it was being done. For the most part, I could give a brief profile on each skater being featured. Where they were from, if they were pro or not, what companies they rode for, and what their (if they were pro) board graphics looked like.

Of course, this was during an era where videos were, almost exclusively, produced and released by companies. Some companies released more than others, of course, but in general, it was a few years between major productions. Magazines were released on a monthly basis. There has always been Thrasher and Trasnworld, and for a few years there was Big Brother (oh how I miss you!) and a handful of transient, short-lived publications. I would read each monthly offering as if it were scripture -- I would have each page memorized, I would read, and re-read over and over, and then I would tack the best photos to my wall.

These days, there are more companies (I'm not actually sure about this, but one thing is for sure, the industry as a whole is much larger than it was 20 years ago), more riders, more publications, more company produced videos. Perhaps most importantly (in significance and magnitude) there is more individually disseminated content. Youtube alone (again, I'm pulling these numbers out of my nether regions, but my point still stands) probably has as much skateboarding related content uploaded every month as I was exposed to during all of my teenage years combined! Of course, much of this content isn't quality, but the very fact that mediocre and "beginning" levels of skateboarding are readily available make it easier for other new riders.

The analogy being made here is one that can be applied to just about any other field, hobby or industry in the world. Information dissemination has, and continues to grow at incredible rates. I'm not judging the quality, but that is really not the point. If I (and I shudder at the thought) were a 13 year old boy right now, who just fell in love with all things skateboarding, I would have no problem finding skateboarding related material. I would most likely not watch videos over and over (at least to the extent that I did with those old cassette tapes) and re-read magazines over and over. I might, however still tack photos to my wall, but they would probably be printed on a photo-printer and might be of myself and friends and not some pro in California (I know, I know, I now live in California...) that I've never met. However, what I would be is much, much more selective about where I found my sources of skateboarding data. Contrast to the 13 year old version of me in the '90's, where I was a voracious "hoovering" vacuum for any skateboarding related morsel I could find. The modern day "little-shit" me would have certain websites, channels and blogs that I would pay attention to and this would still be more than I could memorize. New content comes too fast, trends come and go, with local variances and riders are motivated (mostly by larger financial incentives, but also from a larger limelight, and all the trim that comes with being "skater famous") to constantly push the boundaries and baseline of trick capabilities, in that keeping up with all the newly released material is impossible.

It is important to note that while in this analogy, skateboarding has become more popular in the last 20 years, this same dynamic would still be at play even if the greater popularity was stagnant or had even declined. There would still be more information available, despite less participants overall.

Of course, in the medical world, I would be hard pressed to state whether or not there is more research being done today versus 20 years ago, but that is not the issue at hand. Especially for medical students. The issue is that the overall pool of data that we are expected to master continues to grow. Along with this is the increasing bounty of study tools, whether it be for actual school content integration (think digital flashcard programs, anatomical guides, etc) to full blown board-prep tutorials. These are all good things, but weeding through the voluminous variety is difficult and something a med student can't waste a lot of time on -- of course, each one has different points of value for each individual, who has different strengths and weaknesses, and, of course, different mechanisms that allow for the most efficient manner of comprehension, retention and regurgitation.

I'm okay with memorizing, and I recognize the need (despite the pain involved) for it. I'm not sure how this could be done, or what this would look like manifested, tangible and integrated into a medical school's curriculum, but I would like more instruction and guidance concerning how to best learn. Perhaps this isn't a problem, and I'll eventually get to a point where I know myself so well and I'll have my techniques down to such a sharp point, that the continued integration of new data (especially data that contradicts that which has guided my treatment algorithms!), techniques, philosophies and ideas will be second nature. Perhaps some day it will be like this, but just like being able to mentally walk through all 20-some minutes of Blind's "Video Days" or every minute of 411 VM's #3 is not of much value (other than nostalgic, which is not with out value intrinsically) to me now, even if I was still involved in the skateboarding world (business world, that is), so is memorizing lab values that will change over time. I don't want my knowledge base to be filled with unnecessary Video Days and 411 VM's 20 years from now, and that is what I want out of my medical education (yes, among a few other things), to be able to increase my plasticity potential and ongoing ability. Oh, and the other main thing I want from med school? More big, important sounding words with which to wow the blogosphere with; that right there is worth $45 a year!

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