My third week of my second year of medical school is coming to a close, marked by the first block exam: Inflammation. As one of our Mechanisms of Disease (Pathology and Pathophysiology) professors gleefully sang to us in his song “-Itis, -Oma, -Emia, the Big Three in Path-ol-og-y,” inflammatory diseases (”-itis”) are integrally involved in 80% of total morbidity of all diseases (including trauma), while vascular diseases (”-emia”) account for 60% of total mortality attributable to disease and neoplasias/cancers (”-oma”) account for 20% of total mortality attributable to disease. On that opening note, the second year represents a shift from the normal to the abnormal, the exploration of function to the identification of dysfunction, the passivity of being a bystander to the activity of being an intervener. Although we’re not responsible for patients yet, there is a subtle change underlying our shift in focus: just as Harry Potter finally learned after several books that he had no choice but to fight Lord Voldemort in mortal combat, we are beginning to learn the faces and MOs of our enemies, the diseases that we all must face at some point in our lives, whether in our own bodies or by the bedsides of our loved ones or our patients. (I couldn’t help but throw in an HP reference there.) Each year marks a significant step in our professional progression, and each change is arguably many fold greater in magnitude than the previous one. However, the feeling of “extended premed” education from the first year is gone: now, we are beginning to acknowledge our future opponents.
But enough of the overly dramatic prelude! Here are some impressions so far:
Pharmacology has been very appealing and interesting so far: instead of being intellectually passive observers in Problem-Based Learning sessions or in the clinic with only the power of detection, we are now learning the tools of the trade. That is, we are learning the thought processes by which to treat and manage the maladies of our patients, and also learning the ins and outs of the treatments themselves. The emphasis then is more on problem-solving than on discovery: we’re medical students because we want to solve problems, not just point them out.
Clinical Diagnosis provides the other half of the equation: the skills of identifying and differentiating between disease states. This course, taught by the Chief of Medicine, was described by him as being a “meta-course,” a course that helps us use all of the information we learn in the other courses. Knowing something is one thing, being able to use it is another. This course, with its excellent lecture sessions and hopefully useful and carefully tailored preceptorships, is definitely going to be this year’s gem.
Pathology is the monster course of the second year: that is, it is the course with the most information, and it may not always be presented in the most effective or engaging ways. I’m very thankful that my Gross Anatomy instruction was top-notch and enjoyable as it can be a miserable experience for many medical students, but I’m worried that Pathology might be less cohesive. Although an inherently interesting topic (i.e. these are the diseases we will be fighting), I’m bothered that the course is explicitly and repeatedly described as being “not a lecture course.” This makes some sense in that there is a lot of material and limited time to convey all of the information, but without strong course leadership and direction, there is substantially less incentive for professors to teach comprehensively. It seems that the course policy should be “This course requires out-of-class study, but in lecture, we will help you learn the methods and core principles of pathology.” Either way, it seems that I will be spending quality time with outside resources.
The Clinical Diagnosis course involves a preceptorship, not with a community preceptor (outside of the jurisdication of the university), but rather, with a preceptor at our medical school. Our Chief of Medicine seems to work closely with the preceptors, many of whom are his residents, and we’re supposed to have the opportunity to work by the bedside with the residents and clinical faculty in an academic hospital setting. Last year, my clinical experiences were almost “third world” in some respects, since I was often working with minimal equipment in free clinics and ERs. However, this year is likely to provide a much more solid and uniform clinical training on which we will tested during the spring semester with standardized patient examinations (focusing on both the patient-doctor interaction and clinical skills). It also will be nice working in a real academic hospital, rather than only being allowed to observe in community hospitals.
Despite having a heavy courseload this year, I also hope to spend some time at one of the free clinics that runs on a “medical home” model, and which received a multimillion dollar grant from Congress based on its success (one of a handful of clinics to be awarded such, and one of the few local institutions that has received any post-Katrina federal funding).
USMLE Step One
This test will certainly be the culmination of this year’s hard work and have an underlying influence on all of my activities this year, whether as a motivator or detractor. However, in some ways, I’m actually looking forward to it. It certainly won’t be fun studying all of the time, but herein lies an opportunity to prove my mettle and wrap up the first two years of my medical education with a significant challenge.
I think this is going to be a good year, albeit a challenging one. While the first year’s challenge was primarily one of transitioning to a new school setting and mode of learning, this year’s challenge will mainly be one of withstanding the mental duress. If no one was depressed last year, there certainly will be many signs of depression among my classmates and all second year students around the country this year. I’m bound to write about this topic with some frequency this year: I’ve managed to maintain composure and calm in light of the panic and stress of my classmates these past two weeks, but I plan to continue finding new ways and reinforcing old ways of keeping myself energetic and in high spirits. And yet, despite this, I think we’ll all make it through, perhaps not unscathed, but wiser and stronger.
1. NEJM – “White Coat, Mood Indigo – Depression in Medical School”