Monday, March 3, 2014

Students With A Past (The Mythology of Medical School)

 
The things I remember. My childhood address, phone numbers for my dad's saddle shop, my aunt's for emergencies, the digits on my first driver's license. Considering my conflicted relationship with math, beginning with elementary school arithmetic and culminating in high school algebra, it's hilarious that I remember numbers so easily. Maybe it wasn't the numbers themselves, but their use that was a problem -- no pun intended.

I also remember a little sing-song ditty I made up during high school biology for the elements of taxonomy: Kingdom, Phylum, Class, Order, Family, Genus, Spee-sees (species). For someone who's mental hard drive has always seemed a few megabytes short of RAM, it's intriguing how bits and pieces of this and that are dredged up with ease.

It's encouraging, too, because I've never had a talent for memorizing. Spelling Bees were fun because I'd been taught the lost art of Phonics as an elementary student. Sounding out a word was as natural for me as mentally associating guitar chords with a song on the radio. It irritated other students because I spelled slowly and deliberately, rather than fire off the words from memory, but I frequently won. So, there. 

While memorization sometimes seems like my "Voldemort," learning has proven my magic wand. I'm mentioning this today because occasionally, someone who's contemplating medical school contacts me with concerns about their personal calender. Since it's turned over more often than other applicants', they're wondering how it might affect them or their performance. The doubts and fears that race through your imagination at times like this are so prolific it feels like you're possessed. The solution to possession is exorcism, but we don't need Richard Burton (The Exorcist, 1973) to banish our tormentors, instead, we need to re-tune our reality-testing skills to gain a different perspective.

There's a mythology associated with medical school, composed of assumptions, perceptions, and beliefs, some which are true, others partly true, and some downright false. Take, for instance, the notion of the "typical medical student." It's more accurate to say there is no such thing; there's only those who obtain admission and among them, you'll find so much variety you need a taxonomy to categorize it. Though still a minority "species," for several years nontraditional students have been the fastest growing one in the medical student populace. Women used to be the nontraditional applicant, now it's the student with a past.

Another assumption is medical students must be capable of memorizing vast quantities of material. I believed this once. There was also a time when I believed Viet Nam was a just war, so what does that tell you? It's true medical school does expose us to a great deal of information. That it all must be memorized is not true. Thanks to the demythologizing efforts of Dr. Francis, founder of the PASS Program in Champaign, Illinois, I came to realize how incorrect my beliefs about memorization had been. They were sincere, yes, but they were mistaken -- as mistaken as Linus, spending Halloween night in the pumpkin patch. Memorizing is important but it's not all-important. It's a useful tool but there are others that may be better.

The trouble with memorization is, it relies on short-term memory, which I called RAM (random access memory) earlier. Some students' short-term memory capabilities resemble the biological predisposition necessary for a runner to be a good sprinter. Distance runners don't sprint well because their muscles are built for endurance, not the short burst of speed. Many of us, particularly liberal arts majors, are "distance" rather than "sprint" learners. Our minds are more efficient at encoding material into long-term memory than an overloaded short-term memory. Dr. Francis taught me how to decipher the conceptual framework underlying medicine and use it to facilitate long-term memory storage. Learning 10, memorization zip. So, there.

A third popular false belief is medical students rarely sleep, nor do they have to, since they worship regularly at the Church of Starbucks. If you can't keep up with your bleary-eyed, robotic, hyper-active lab partner who gets perfect exam scores, you may as well forget it, or so goes this urban myth. Medical school is demanding, that's true, and sleep gets short-shrift now and then, but guess what? Who sleeps when they have babies waking them up every two hours? You get up, change and feed junior, then go to work. Students with a past are no strangers to the routine. 

The belief that medical students must be able to go on and on like the Energizer Bunny is a twist on a partial truth. Medical school is physically, as well as mentally, challenging. What the "bunny belief" doesn't tell you is how challenging it is for all students. By the end of each term and even before, everyone is weary. Younger, older, and those in-between. Those who graduate with their health intact generally eat (fairly) well, exercise (fairly) often, and do their best to get at least six hours a night -- the minimum for a full REM cycle, the key ingredient for effective learning. Energy is no more a gift than a silver spoon. It results from the desire to achieve and is maintained by common sense self-care. Students with a past can do this as well as anyone else.

Lastly, there is the assumption about flexibility. By this, I don't mean the fellow who crawls into a milk crate on Saturday afternoons on the Downtown Boulder Mall for dollar bills tossed into his tip jar. He's the only person I know who can do this and whatever he does the rest of the week, I'm sure it's not studying medicine. Flexibility as an urban myth concerns being set in one's ways and hints the less we've experienced, the more adaptable we are. Of course, that runs directly counter to nature's insistence that exposure is essential to adaptability. Exposure is how we develop an immune system. Exposure drives adaptation. Exposure motivates us to evolve.

Persons acclimate to rigid patterns of thinking and behaving in response to fear and uncertainty. Those who are resistant to new information are less likely to step outside their comfort zone and pursue medical school than those open to new ideas. Becoming entrenched is like psychopathology, it can happen to anybody under the right conditions. It's like falling back on memorization in a crunch. Students with a past may have to unlearn a few things, but that too, is part of being adaptable. Because you have a past doesn't mean you can't let it go.

There's more to medical school than its mythology in the same way there's more to us than appearances. Demythologizing is critical for evaluating one's potential realistically. Viewing yourself as capable is as important as envisioning the outcome as obtainable. Students with a past are as capable as their fellows. They just have to believe it. I'm living proof. 


(Creative Commons image by bfi Office Furniture via Flickr)
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