Medical School: the curriculum

Patients rely on the knowledge and expertise of their doctors, yet they seem poorly informed regarding the process by which relatively normal human beings develop into the storied creatures known as physicians.  The following paragraphs describe the typical four year voyage through medical school–which, despite the striking similarities, should not be confused with a journey through Dante’s Inferno.

The first two years of medical school require students to learn the basic science concepts underlying clinical medicine.  Subjects necessary to master include anatomy, histology, physiology, caffeine consumption, biochemistry, pathology, pharmacology, prolonged sleep deprivation, behavioral science, neuroscience, immunology, disavowal of all social interactions, microbiology, and random advanced molecular theories related to professors’ research areas but unrelated in any respect to diagnosing and treating illnesses.  To complete this monumental task, students employ a number of time-tested learning strategies: watching prerecorded online lecture videos at home while wearing pajamas and eating Lucky Charms; rewatching said lectures online at Starbucks while wearing sweatpants and eating overpriced pastries; and, re-rewatching aforementioned lectures, on 2x speed, while wearing boxer briefs and softly sobbing one’s self to sleep.  Additional techniques include obtaining contraband copies of prior years’ examinations and shamelessly memorizing the answers; querying professors as to the exact lecture slides that contain likely test items; and largely avoiding any effort tantamount to genuine studying.

At the conclusion of their second year, med students take the USMLE Step 1 Exam, which is a nationally standardized test that involves regurgitating in the span of eight hours the contents of every Powerpoint lecture slide ever observed during the students’ previous two years of coursework.  Though having little relevance to one’s ability to practice clinical medicine, Step 1 scores largely dictate where and into which specialties med students will match for residency training after medical school.  Faced with this stress, most med students prepare for the exam by closeting themselves for 6-12 weeks in a musty garret; studying intently for at least 3 hours per day; cruising Facebook and Insta while pretending to study for another 12-15 hours per day; and foregoing all sunlight, human speech, and vestiges of personal hygiene.  Immediately after completing the Step 1 exam, students invariably feel certain that they failed and elect to drown their sorrows by means of a several-day-long binge of alcohol, psychotropic illicit substances, and/or prior seasons of “House.”

During the third year of school, med students enter into the clinical realm of the hospital, where on a daily basis they face ridicule and condescension from attending physicians, residents, nurses, ancillary personnel, patients, janitorial staff, and reasonably perspicacious neonates.  Typically, med students take at least four hours to collect a history and perform a physical assessment of a patient, receive thirteen seconds to present this information to the resident or attending physician before being interrupted, and then stand by quietly as the patient proceeds to give the resident or attending an entirely different account of his or her symptoms.  This scenario repeats itself across a range of required clinical rotations that include pediatrics (also commonly known as “make funny faces” month), internal medicine (“whatever you do, do it pensively” month), obstetrics/gynecology (“wish I could forget seeing that” month), psychiatry (“you thought your Uncle Chuck was crazy” month), neurology (“finally get to use the reflex hammer” month), family medicine (“refer to a specialist” month), and surgery (Lasciate ogni speranza, voi ch’entrate).

Shortly after third year ends, med students take USMLE Step 2, which has two parts.  Step 2 CS requires the examinee to role-play as a doctor and to treat simulated patients.  Speaking rudimentary pidgin English and correctly identifying where in the body the lungs are located are the only skills necessary to pass the exam.  Step 2 CK evaluates students’ clinical knowledge much as Step 1 assessed their basic science knowledge–except that CK has less impact on residency options and therefore elicits only scant studying efforts from most students, unless the student has a pathological addiction to standardized exams and/or wishes to match into a highly competitive specialty such as neurosurgery.

The fourth and final year of medical school stands as a sort of Elysium.  The grueling, mandatory clinical rotations of third year have come, gone, and left their psychological scars.  Students in the fourth year take electives geared towards their specialty of interest; they rediscover the sky, trees, and their university gym; they engage in “research” months that involve reading one or two review articles and thereafter trying to abstain from any other scholastic activity; and, they apply for residency positions.  For those who do not know, residency begins after graduation from medical school and consists of three to seven years of additional training as a resident, or supervised doctor, in a particular clinical specialty.  In the dead of winter and during the year’s worst possible travel season, students receive interview invitations from residency programs that liked the students’ applications or that are desperate for the cheap labor these students will provide as residents.  Either way, students gladly brave snow and ice storms and spend $3,000-$10,000 on airline tickets, hotel rooms, and other travel expenses to attend the various program interviews.  Throughout the interview season, a mafia-like organization known as the NRMP, which claims to be an independent philanthropic entity but which in truth exercises monopolistic hegemony over med students’ lives, serves as the self-appointed intercessor between students and residency programs.  On a spring day known simply as “Match Day,” the NRMP matches students to their “optimal” residency positions based on a patented computer algorithm that a third-grader could have designed but that nonetheless earned the organization a Nobel Prize.

At last, with four arduous years behind them, $250000 of student loan debt, moderate to severe PTSD, and residency positions assigned per dicta of the NRMP, med students reach graduation.  In addition to congratulation cards from relatives whom they’ve never met but who nonetheless are “proud to have a doc in the family,” graduation provides students the opportunity to take their final licensing exam, USMLE Step 3, which as long as it is passed has absolutely no impact on students’ future careers and for which the maximum level of preparation consists of identifying the correct testing facility on the evening before the exam.  Beyond graduation lies the vast Unknown of residency, non-negative monthly incomes, freedom from grades, and being “a doctor.”  Godspeed.


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Itinerant doctor | Intermittent blogger

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