I caught up with the Dean of the Medicine recently to talk about the way our medical school is run.
Half MD: Thank you for agreeing to this interview
Dean: No problem. I know that pre-meds read your blog and will find this information useful.
Half MD: First question—why does our school put so much information on physicianship training, while ignoring other classes such as microbiology? Our university’s board scores are pretty mediocre, and I think it’s due to the curriculum.
Dean: We put so much emphasis on physicianship training because those are the real skills that you need to know to become a doctor. Learning the proper grip to use when holding a patient’s hand is far more important than memorizing a list bugs and drugs. Further, the only time we can ever teach you about bedside manner is during the first two years. As for all of that other trivial information such as microbiology and pharmacology, we figure that you’ll learn it on your own while studying for the boards.
Half MD: I’m currently on my surgery rotation. While there’s a lot of information to learn, why do surgeons have to be such assholes? Isn’t there a better method for teaching than negative reinforcement?
Dean: Surgeons are the playground bullies of the medical world. Any compassion and genuineness has been beaten out of them long ago. They’re so used to talking to others through screaming that their encounters with students and residents are rarely pleasant. That’s not to say that all surgeons are like that. Urologists and Ophthalmologists bring civility to the medical community.
Half MD: I’ve noticed that a lot of the “rules” are broken on the wards. For example, students have to come in a 5:00AM to pre-round on patients, despite being told by the clerkship director that students are not supposed to pre-round.
Dean: There’s a lot of that in the medical community. He told you not to pre-round simply because he’s required to. Yet look at his own students. They regularly arrive before 5 and will spend over 80 hours a week in the hospital. The residents goes through a similar process. Do you know of an intern who spends less than 30 continuous hours in the hospital?
Half MD: Is there any way to save my backs and legs during long procedures? I would love to bring a stool into the OR.
Dean: Mentioning that you’re tired will only make you seem weak. You can try hidden methods of relief. Compression stockings, shoes with high arch support, and regularly changing your socks will help a lot in the long run.
Half MD: Although I have no desire to become a surgeon, I’m still eager to learn. I’ve tried to get opportunities to do simple procedures such as starting I.V.’s and suturing patients, but no one wants to teach me. I even offered to insert a foley catheter on a patient in the OR. Our nurse said, “No, I don’t want you slowing us down.” Given that we were already an hour behind schedule, I don’t think taking 2 minutes to insert a catheter is going to make things worse. Why are the nurses so rude on our service?
Dean: They’re only rude to medical students because they know that’s the only time they have you by the balls. For the rest of their careers they’ll have to take orders from doctors. Sometimes, they’ll even have to fulfill those orders. Some of them have a pool to see how long they can ignore students who are asking, “Excuse me, can you help me find something?”
Half MD: I’m still not quite clear what my role is as a medical student. I finished general surgery last week and began the specialty service this week. Every week I learn of some new role such as getting X-rays from an unknown radiology location, changing the wound dressing according to the whims of a particular attending who uses methods that may or may not be evidence-based, or what information is supposed to written in the progress note. At times I feel like I’m in the movie Office Space. I have 8 bosses giving me orders at any one time.
Dean: The contradictory methods of leadership or the read-my-mind mentality that many attendings have comes with years of perfecting the art of frustrating students and residents.
Half MD: What’s up with pimping? I would guess that it’s supposed to be based on the Socratic method—using questions to lead a student towards discovering truth—but it’s really an embarrassing endeavor each morning when I can’t list 10 causes of a condition I’ve never heard of.
Dean: “Pimp” stands for “put me in my place.” Attendings can never be made to feel as if a student might be considered an equal in the eyes of others. Know the number 1 cause of a disease? I’ll ask you for the number 2 cause. If you know that information, I’ll ask you who authored the paper on the subject. If you’ve got that also, I’ll ask you the date that the article was published. I’ll keep asking you questions until you get something wrong and then smugly tell you that you need to study more. It’s all part of the learning process. Just wait until you’re an attending; you’ll get to treat students the same way.
Half MD: I keep getting the suspicion that many of the academic doctors aren’t cut out for private practice. Unfortunately, they aren’t cut out for teaching, either. If they’re so bad at teaching, why are they professors?
Dean: That’s a pretty harsh statement to make. The title of professor is reserved for anyone who holds a academic job. Some just haven’t learned that negative reinforcement is not a good learning tool.
Half MD: Any advice for surviving long on-call nights?
Dean: Try sleeping whenever you get a free moment. Empty conference rooms are perfect for catching an hour here or there. Don’t worry about sleeping through a page. The volume is intentionally loud enough so that you’ll wake up every time. It’s simple reminder that bad things happen to people at all hours of the night—and it’s your responsibility to fix it.