Learning vs. Studying

Are learning and studying the same?

Most people that are in medical school have probably had a conversation that goes something like this.

Non-Medical Student: "You're in medical school! You must love school, I could never put up with four more years of it"

You (or Me): "Well I don't know, I don't really think that I love schooling all that much..."

If you are anything like me, you probably find it really hard to give someone a satisfying answer to that question. I've thought about my own motivations a lot, and this is what I've been able to come up with.

I love learning. I love finding out something new that I think is applicable to my life (or to my future life). I love when I finally understand something, when I spend time trying to wrap my mind around something and then I finally "get it."

I hate studying. I hate being told to read 200 pages of notes and commit it to memory. I hate sitting down in a lecture hall for 5 hours of lectures followed by 3 hours of lab. For me at least, there is nothing fun about that.

I'd love to learn another language, or how to play a musical instrument--or even another sport--but the medical school curiculum is so constrained that there is no time for that. So what you end up with is a bunch of people who are (on some levels) miserable for the better part of two years with one test after another hanging over their heads.

I agree that much of the information learned in medical school is very valuable, but I think that there are much more efficient (and less costly) ways of training our future doctors.

So how would I change medical school to make it better.

The biggest change I would make is to switch to a 3 year preceptorship, broken down like this:

First year: anatomy, histology, physiology (6 months) pathology, pharmacology, microbiology (6 months)

Second-Third Year: 6 months of family practice at 2 different sites, 4 months of internal medicine, 4 months of general surgery. 1 month of Emergency Medicine, OB/GYN, Psychiatry, etc.

Fourth year: 8 months of required electives, 4 months for interviewing etc.

In this system you would have to expand the "shelf" tests to account for longer periods in each rotation, but I feel like this would be a better situation for everyone.

Current doctors can feel like they are having a greater influence on future doctors. Medical students will absorb much more information when facts are associated with real life situations. Patients will have better trained doctors, and hospitals can hire a few less MAs and save some money. In my mind, it seems like medical education is stuck in the dark ages--where medical students are still being taught to memorize side effects for 100s of drugs, even though that information is now only a PDA click away.

Wouldn't that time be better served learning how to be a better doctor instead of a fact-spitter-outer. How many times have you heard from doctors that many of their colleagues in medical school who were great students have made terrible doctors--isn't that a sign that something needs fixing?

Is There a Doctor in the House?

Recently I read something about the new program that has begun in nursing where a nurse practicioner has the opportunity to become a doctor.

What? A nurse who is also a doctor? How could this be?

I'll tell you. Nurse Practicioners in some areas now have the opportunity to pursue a degree known as a Doctor of Nurse Practicioning.

Maybe some of you are thinking: This is great! Another possible option for nurses to pursue. No longer are they forced to adhere to the constraints of what it means to be a traditional nurse, e.g. being involved in every aspect of patient care.

I'm not of that opinion. And here's why:

Here's a blurb from the University of Tennesse, Memphis:

"The DNP curriculum is Web-mediated including opportunities for synchronous and asynchronous learning. Students are only required to be on campus 4 times a year (July, December, January, & April) for 5 to 7 days each session. With faculty approval, clinical courses can be completed in the student's state of residence."

What is this, the University of Phoenix? Other reports I've heard have stated that nurses need only complete 1000 hours in order to complete the program. It's absolutely ridiculous on a number of fronts.

First, the amount of experience that a medical doctor gets is at least ten-fold higher the experience that a DNP candidate would have to gain.

Second, what does it mean to be a nurse anyway. What is so wrong about being called a nurse. Personally I think that nursing is one of the most selfless, noble professions that one can pursue. Why is it suddenly necessary that we need nurses proscribing medications and being addressed as doctors.

Third, there was such a righteous fervor over the inventer of the artificial heart (Jarvik) who is a Ph.D "doctor" that was supporting a certain medication on the internet. Where is the fervor now. We're going to see a day where someone with 1000 hours of experience is seeing a patient that has no idea about the difference between a DNP and an MD "doctor." It's disgusting, and I think the biggest reason is because the current doctors of America couldn't care less.

Where were the doctors when malpractice lawsuits have got out of control? Where were doctors when people saw the subtle signs that medicine in the US was going downhill? Where are the doctors now when an exer increasing number of "physician extenders" encroach on what it means to be a doctor? Sadly, the pay is still good, the hours aren't terrible--so the majority of doctors could care less what state the health care system is in when it is handed off to the next generation.

Instead they'd rather complain about duty-hour restrictions, and how medical student today "just aren't as driven as they used to be."

Edmund Burke once said, "The only thing necessary for the triumph [of evil] is for good men to do nothing."

Is what is going on in the medical system evil? I don't think so. But the only thing necessary for it to continue in its downhill trend is for enough of today's doctors to do nothing.

The debate over the validity of having Doctors of Nurse Practicion is sadly going to become a debate over whether the still male dominated doctors are just trying to keep the female dominated nurses down. And at its root I think many people will view it as a gender equality issue. But it isn't. The question is not whether a nurse could be as knowledgeable/valuable as an MD doctor, because I can tell you right now, there are some nurses that are smarter/more adept than some doctors. The question is what would be best for patients

The root of the question is this: What does it mean to be a doctor, and what does it mean to be a nurse? Are there roles that a doctor should fill that a someone trained as a nurse shouldn't be filling? In the same token, are there roles that are better filled by a nurse? I think that the answer to the last two questions are both yes. But if the DNP program (among others) continues, we'll continue to dilute the respect that the average person has for someone who is known as a "doctor" until we're all just "health professionals," despite our vastly different training.

4/48/04 Update: Today in class we had a family of acondroplastic dwarfs come and speak to our class as part of a genetics patient panel. Here is a phrase that the father used, I'll try to reproduce it verbatim.

"When we were at this conference in Dearborn one of the nurse practicioners / doctors got up to tell everyone a story..."

The person he was referencing turned out to be a nurse practicioner and not a doctor. I don't for one second think that John Smith patient has any idea what the difference between a nurse practicioner and a doctor is, and I think they would know even less about what the difference between someone who has NP-C and MD on their coat (if they even looked).

It's misleading to patients and those who keep pushing to expand the role of nurses are exploiting it.

Where Do We Get Off

Where do we get off. When did medical students start thinking that they run the show? Has disrespectful behavior always been a problem at schools of graduate education? Is it because we all have a bachelor's degree in something and we think that qualifies us to complain nonstop?


One of the most disturbing trends that I have witnessed while at medical school is the drastic increase in the amount of complaining and improper conduct towards professors. During the class time, a student once raised his hand to ask a professor a question, here's how it went:



Student: Doesn't that enzyme do the opposite in the presence of insulin

Professor: Well, I don't think that is correct

Student: No, that is correct



Since when is this considered acceptable behavior? Since when have we decided that that is appropriate for future professionals?

I think it goes back to how many in my generation were raised. A lot of people have mentioned that our generation was the first "you can do anything!" generation. What I mean by that is that most of my generation had parents that told them they could do anything. Never mind that they have no singing ability, you are the worst parent in the world if you don't make them feel like they are the next Pavaratti.

I've always thought my parents did it well. When I was a kid, I wanted to play professional basketball. Rather than just say, "Sure you will someday, you can do anything you set your mind to," he was very pragmatic about it. He said things like, "If that is something that you want to do, than you will have to make big sacrifices to get better at the sport." And I did, for awhile--but then my friends wanted to play with GI Joes, or there was a new movie out at the theater, and I gradually realized that professional basketball wasn't in my future.

I think the best thing that parents can do is encourage their children that many things in life are attainable through hard work, but without having certain innante physical or mental gifts, not everything is possible. If I am 4'7" I'm probably not going to play center for the Piston's someday. If I don't have anything resembling a singing voice, I probably won't be a world famous singer. This doesn't mean that I shouldn't work hard, but I should have parents who can see the gifts that I have and steer me in the right direction.

Another reason that I think that there is so much trouble with respect and discipline is the Political Correctness wave of the 90s-2000s. Don't get me wrong, there are aspects of PC that seem reasonable, such as eliminating the terminology of phrases such as "you people," e.g. "you people are all the same... But one of the downsides of the PC movement is the idea that there is nothing that is right or wrong.

Heaven forbid a teacher uses red ink to grade a paper! Who knows what might result from that! The child's fragile psyche could be forever damaged as a result from the 70% that they got on a test. It's pure ridiculousness and I think that it has contributed to the mentality that many of my peers have that they are always right. Not to mention the fact that they are probably angered that medical school grades are on a strict curve, and that 2/3rds of the students don't get scores above 90% anymore.

In summary, it's very frustrating to be surrounded with so many smart yet rude medical students, especially when the few obnoxiously vocal will be thought of as representative of the entire class.

Cheers for Fears

Hey med students, please stop signing off letters with "cheers," we're not from England and were not in a 90s sitcom. And last time I checked, I don't have a glass of anything in my hand.