Sacrilege! Med students not wanting to use microscopes!!

[yaah]

http://www.studentdoctor.net/diary/display.asp?ID=2025 the 8/19 entry...

An excerpt: In my opinion, microscopy is a dead art. While I understand the importance of studying the microscopic components of organs in order to learn how structure correlates with function, I think that using a microscope to do this is rather outdated. If microscopy exercises were eliminated from the curriculum at medical schools, we would save time and money. This would allow students to have more free time in their schedule for independent study or electives. It would also save students a considerable amount of money, because they would not be required to purchase microscopes.

And another: I find that the time spent looking at slides in histology lab is wasted time. Images of cells are included in the histology lecture, found on the histology website, and are available in the histology texts. These media allow professors to point out the key features of particular images to everyone simultaneously. Given the fact that we observe microscopic images through means other than microscopes, it seems wasteful for us to spend time in the laboratory looking through tiny lenses, focusing microscopes, and trying to assess what portion of a slide displays the image on which we should focus.



Because, as we all know, every slide that diagnoses are made on comes handily equipped with arrows and/or text messages that say: KEY PATHOLOGIC CHANGES HERE. And clearly, every slide only has one diagnosis on it, and it's always obvious as long as you know the key features. And clearly, it is useless to have to learn how the diagnosis of a certain cancer or disease is made. You just have to learn the name of it and what medicine to give, or, if you're really advanced, how to cut it out or order a scan to evaluate it further.

Yet another example of the way the short-attention span is overtaking our world and the education of our next generation. Why spend time actually learning about disease and how it is diagnosed when you can get THE ANSWER in much less time? Because as we all know, the answer is the most important thing, not the process, because the answer is on the ****ing test!! Hyaline membranes? What's a hyaline membrane look like? What's it made of? What other features are around it? I don't care because I know hyaline membranes=ARDS! Why don't treatments for it work? I don't know and I don't care! Oh well, I guess if I ever get a patient with this I won't be able to do much. I'll just tell them they have ARDS and then I'll read about it in my "INTENSIVE CARE MEDICINE FOR DUMMIES" book that will no doubt be published in the next 3 years.

I guess I don't blame this girl though - I hear this a lot. She's just expressing what many people think. Unfortunately, part of it is that they probably don't have great teachers. They have people who either by desire or convenience are short changing their education by teaching them only what they need to pass the test and nothing more.

I learned a ton during my second year path course. I learned how to look at microscopy. I learned how to appreciate cellular changes. I learned how things interact at a cellular level. It taught me WHY certain diseases cause the symptoms and signs that they do. And because of that, it has stuck in my mind and it isn't something that I learned for the damn test and then promptly forgot about 3 days later so I could get back to learning the important stuff like why people with fibromyalgia need to be "listened to." No ****? Listen to the patient? Wow, I never would have thought of that. And you're telling me that if someone is a different ethnicity than me they can still have the same disease yet can have a different perception of it and its treatments? Wow! What a concept! Thank you for not wasting my time with teaching me about cellular inflammation and letting me learn about how treatments of it work, etc, so that we can spend more vital (and expensive) time on learning how to interview a patient through a translator. That didn't waste my time at all!

Did any of you learn anything from a physical diagnosis class? How to palpate the liver? Great. Very helpful. It's big. But why is cirrhosis such a terrible disease, and why is it irreversible? Well, spending time looking at the microscopy might help. Fibrosis, scarring, regeneration. What a concept!


Grrrrrr..........

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[smellycat]

Starting next year, at my school the path program is creating a high-tech lab where everything will be on computer...
Takes the whole fun out of everything if you ask me. The only plus is that you don't have to "rent" a microscope for a 100 bucks.

 

[yaah]

High tech, sheesh.

Whatever happened to good old fashioned intellectual curiosity? Is everyone simply satisfied with having people tell them the correct answers instead of actually understanding why the answer is correct?

When I hit retirement age, I want my doctor to
1) Know who Virchow was
2) Know what inflammation looks like on a slide
3) Be able to ask questions appropriately of consultants AND me.
and 4) Have a brain of their own, gosh darnit!

I don't give two ****s if they can palpate my liver or appreciate my ethnic background.

 

[b&ierstiefel]

Yaah is back and is angrier than ever!

Oh well, there ARE a lot of students who think that histology lab is a waste of time since many images are on computer. The same applies to students at U of Michigan. Personally I love microscopy and I think it's the bomb! But I can understand why students don't want anything to do with microscopy...they just wanna hit the wards and be involved in direct patient care!

We profess our dislike for clinical medicine; they profess their distaste for microscopy and anything basic sciency. It goes both ways. I wonder what else those freaks are saying about mutants like us

 

[yaah]

It's a bit of a difference though. I certainly appreciate clinical medicine and those who practice it well. I just dislike many parts of it and think it has gotten away from being a science and an art and is now somewhat of a political realm. And I learned a lot, despite my many criticisms, during my clinical months. I learned how diseases present, how they affect patients, the various levels of illness, how doctors can be fooled. Many people spend their clinical months trying to learn paperwork or writing notes, I spent most of mine learning about disease.

I would never think of having to go through medicine without learning how to take a history, how to properly examine the heart (even if it is sort of a waste of time), scrub in in the OR, or learn how chemotherapy drugs attack the target. Just the same though, I would never think of having to go into medicine without learning what cancer looks like on a slide, how to find the area of abnormality and distinguish it from normal on a slide, learn about how a lab test measures what it pertains to measure and why that result is significant. Would someone want to go through med school without anatomy lab? Without learning basic biochemistry? Genetics? Multiculturalism? (So no one gets angry, I am obviously not adverse to learning about multiculturalism. I just think that lectures on the topic are wasteful and uninformative. Appreciation of multiculturalism is gained through life experience).

I guess there are lots of things that are important to understand and that vie for our attention. But microscopy teaches you about the body at its most fundamental level, the cellular one. Every patient is made up of billions of cells, all of which have their own important function. And the fact that if just one of these cells attains a mutation and loses its normal relationships with others can kill a patient? I need to know why this is.

I guess I'm old fashioned. If I was an internist I would want to have an understanding of all these things, not just the damn answer.

 

[b&ierstiefel]

Face it yaah,

med school unfortunately isn't about understanding stuff these days. it's all about taking tests well, pattern recognition, and conditioned responses to pimp questions. god forbid we talk about mechanisms and pathophysiology.

 

[Howard Roark]

good luck

 

[yaah]

Microscopes suck. Get rid of them. Give me images on a computer! Hopefully will never have to look in another microscope again!!
.

And hopefully in the future all of our patients will come with instruction manuals and pre-printed forms. And all diagnoses will be clear and obvious.

Stethoscopes are the pointless things.

 

[b&ierstiefel]

And hopefully in the future all of our patients will come with instruction manuals and pre-printed forms. And all diagnoses will be clear and obvious.

Stethoscopes are the pointless things.

If the microscope is outdated, one could make the point (to an extent) that the physical exam is outdated too. I mean you don't see TOO many situations where a physical exam finding leads to impressive changes in inpatient management. Of course, some physical exam findings are important like decreased breath sounds/hyperresonanace (pneumothorax), carotid bruits (order a carotid u/s STAT), and blue testicle (torsion). Physical exam gives way to more TESTS.

Anyway, the microscope is not totally be needed. Cytological studies of pap smear specimens to state an obvious example.

Plus, most of medicine is being done in cookbook fashion...it's called evidence-based medicine. The art of medicine is fading...but I never cared about the art of medicine anyway :0

 

[Logos']

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[Smitty]

Yeah, histology was taught by Dept. of Anatomy at my school. It was OK, but our scopes did suck. We had pathology case conferences, which used vignettes with radiological and pathological images, which seems like an OK idea, but I really did not get a chance to learn even the most basic stuff regarding how to approach a path slide or even simple tissue changes! I've pretty much had to learn on my own, which brings me to my question. To Yaah and anyone else who wants to answer, what is a good resource for learning basic histopath? I've got Wheater's Basic Histopath and I've looked at some of the stuff on PathDoc (Virtual Slidebox, etc.), but I'd really like something like a kit of actual slides with explanations, arrows, marked outlines. By the way, did any of you guys buy your own microscope? I'm assuming that anything of any quality would be really expensive, but I haven't checked yet.


______________________________________________________________
"If there's one thing Dr. Atkins taught us, it's that we're all gonna die!"
Ruby Ann Boxcar-"Ruby Ann's Down Home Trailer Park Cookbook"

 

[deschutes]

Sacrilege! Med students not wanting to use microscopes!!

yaah is strongly back.

Aside from all that has already been said above by various posters, I would add the following:

Caveat #1: Med students cannot know what is important for them to know.

Patronizing, but true.

The first med school I went to taught some basic histology and general path in lectures, before progressing to systems-based path. The second never taught histology ? students are thrown right into the systems without an understanding of general principles of cancer and inflammation. Heck, the students can?t tell normal from abnormal ? like anyone you pick off the street, they really do see only a blur of pink and purple when you show them a photomicrograph.

Powerpoint images: focussed, cropped, and nicely arrowed ? that is their concept of pathology. I don?t think they have ever thought about what goes on in the lapse between taking a sample and the image on the computer.

With that sort of background, it took me a while to realize the huge chasm between asterisked pictures in textbooks and trying to find the same on an actual patient?s slide.

With that sort of background, any wonder that scarcely any graduates go into path?

Where I am, we have a very "student-oriented", "clinical" curriculum.
What this means is that curriculum reform cannot be driven by departments (basic science or otherwise) but rather by student support. Going to a more discipline-oriented mode of instruction versus the current systems-based approach would be seen by most people as a ?step backwards?.

But systems can work too ? if there is enough time for exposure and organization.

Then we run into the issue of the 3-year curriculum. Limited teaching time, limited elective time.

With my leverage in the path dept I tried to work on this, set up shadowing timeslots to improve students? chances of clinical exposure to pathology.

Then clerkships came along and my own survival was called into question? so that grand plan for reform went out the window.

I don?t know the names to most parts of microscope, and only after 4 years of med school have I heard the words "Kohler illumination" for the first time ? in a hotel.

It sounds rather hopeless, doesn?t it. Whichever path residency program is willing to take me, will have to start from scratch.

 

[Stinger86]

On one of my path exams last year, we were given a case involving an older patient with a headache and then an image of the histopathology involved. The question asked for the diagnosis. I found this to be an awesome question because the case history was non-specific and the histology looked like nothing at all (either the magnification was too great, or the field was heavily cropped-- don't really remember). The key to the whole problem was actually *gasp* LOOKING AROUND THE SLIDE and examining the whole field, which revealed a single multinucleated giant cell in the very bottom-right corner of the image (not easily seen without a closer look). Upon seeing this finding, the answer (given the other choices) was obvious: temporal arteritis.

Something like 80% of my class missed the question, and it was appealed relentlessly. Too bad the appeals were denied That's what happens when you try to play "connect the buzzwords"

 

[Stinger86]

Because, as we all know, every slide that diagnoses are made on comes handily equipped with arrows and/or text messages that say: KEY PATHOLOGIC CHANGES HERE. And clearly, every slide only has one diagnosis on it, and it's always obvious as long as you know the key features.

This is so true. Most of my professors (even the career pathologists, unfortunately) would show us a clearly labeled slide in class, and then just repost it on the exam and have us recall the label from memory. Don't worry about understanding the diagnosis, just memorize these ten pictures. Because all images of this particular disease will look exactly like this, always, without fail. Sigh.

We had a zoology professor in college who would show us slides in class and lab, but then give us brand new slides we'd never seen before on the practicals. Why? Because he wanted us to understand what we were looking at, why this thing looks this way, etc. Not exactly a novel concept, but given the current trend ("traditional" is probably more accurate than "current") in education, it could probably stand to be put a little more into practice.

It's a shame more students don't complain about this. Educationally speaking, it's their loss.

 

[chameleonknight]

Holy crap. Pathologists are crazy. I always suspected, but now I know.

 

[monopolova]

I'm an undergrad who took histo with dental students last year. I loved it. They didn't. I suspect they didn't because some people who claim to be interested in the medical sciences really aren't; they don't know what such knowledge entails. They're lazy as hell, and God only knows why they're in these schools to begin with. They couldn't stand the time it took to know microstructures inside and out; we had to show structures on our slides to instructors who asked us for them. Of course, it took hours in lab to look through all our slides to know them well enough to identify a proximal tubule or that damn osteoclast when asked for it. Anyone who loves medicine or dentistry will realize that microanatomy is an essential part of both; after all, most pathology begins and ends in the microscopic if not at the molecular level. I'm not sure if someone who doesn't appreciate that fact should be given the privelage of practicing the science.

 

[deschutes]

Holy crap. Pathologists are crazy. I always suspected, but now I know.

I guess we are a little crazy. The funnest people I have known always were.

Britney Spears is probably a little crazy too.

I suspect she may be a closet pathologist.

 

[yaah]

I'm an undergrad who took histo with dental students last year. I loved it. They didn't. I suspect they didn't because some people who claim to be interested in the medical sciences really aren't; they don't know what such knowledge entails. They're lazy as hell, and God only knows why they're in these schools to begin with. They couldn't stand the time it took to know microstructures inside and out; we had to show structures on our slides to instructors who asked us for them. Of course, it took hours in lab to look through all our slides to know them well enough to identify a proximal tubule or that damn osteoclast when asked for it. Anyone who loves medicine or dentistry will realize that microanatomy is an essential part of both; after all, most pathology begins and ends in the microscopic if not at the molecular level. I'm not sure if someone who doesn't appreciate that fact should be given the privelage of practicing the science.

I am not so sure if it is all about laziness though - but that is part of it. A lot of students seem to feel entitled these days. Entitled to good grades, entitled to time off, entitled to getting answers for the test, entitled to NOT showing up on time for lectures, if at all, while at the same time being annoyed if lecturers were late, entitled to NOT having to learn things on their own. I always felt bad for people who would show up to a class, give a great lecture, and the first question at the end would either be whether something was on the test or if there was a handout for the class.

It's all about "me" these days. People don't seem to think it's important to better themselves unless there is some tangible benefit, like a higher salary or chances of a certain residency. Learning about cirrhosis is fascinating - well, how much of it is on the test because that's all I'm going to learn. I understand that med school is an unending assault to the senses with so many things to learn, and many things must frankly be memorized, but that doesn't mean you can't still be excited by the knowledge and figure things out for yourself.

Stinger we had a similar question on one of our tests - there was a glass slide section of the exam (the GU block) and the slide was of a TCC in the renal pelvis, invading into the kidney. The questions that were asked were, frankly, simple questions. Like "describe what you see" and "name 3 things that suggest malignancy" and "what part of the body is this." And still people complained because we hadn't seen a slide like this before.

Independent thought! Independent thought!!

 

[pathdr2b]

The way I figure it, if microscopes aren't used anyomore in medical school that will be OK by me. I've got my own to use at home!

 

[b&ierstiefel]

Holy crap. Pathologists are crazy. I always suspected, but now I know.

Yep, doctors have told me that I am crazy. Fortunately, I have insight into my illness which makes me less likely to be psychotic.

 

[chameleonknight]

Yep, doctors have told me that I am crazy. Fortunately, I have insight into my illness which makes me less likely to be psychotic.

works for me.

 

[b&ierstiefel]

I am not so sure if it is all about laziness though - but that is part of it. A lot of students seem to feel entitled these days. Entitled to good grades, entitled to time off, entitled to getting answers for the test, entitled to NOT showing up on time for lectures, if at all, while at the same time being annoyed if lecturers were late, entitled to NOT having to learn things on their own. I always felt bad for people who would show up to a class, give a great lecture, and the first question at the end would either be whether something was on the test or if there was a handout for the class.

It's all about "me" these days. People don't seem to think it's important to better themselves unless there is some tangible benefit, like a higher salary or chances of a certain residency.

Wo wo waitaminute...you mean to tell me that there are medical students like this OUTSIDE of Michigan? I only say this because, being a student at Michigan, I see this in so many people at my school.

During second year med school (the first year where we actually get honors, high pass, pass, fail grades as opposed to pass/fail grades), we have a Query System online for each of the sequence exams. Basically it's a medium through which students can express dissatisfaction with exam questions/answers. However, it frequently gets abused as many people will do ANYTHING to get credit for a question they clearly got wrong just so that they can get above 94% and get that Honors grade. You even see people whipping out the Harrison's card: "On page 1536 of Harrisons, it states that that Crohn's disease first manifests as headaches [in 1% of patients with Crohns] hence I believe that I should be given credit for picking headaches. I believe that this was an ambiguous question and thus can you make this a drop/bonus question?" Of course, the professors have a say in this too and they can post responses such as, "Honestly, did you read page 1536 of Harrison's BEFORE the test or afterwards?"

I always thought that querying was a waste of time when used only as a mechanism to further one's own grade. Now if there's a legitimate issue with a question or answer, the appropriate interventions will unfold. But I was wrong. See, the classmates that I started out med school with graduated in 2002. 7 of them made AOA after second year...they were very very smart people. And amongst those names was a certain individual who was NOTORIOUS for frivolous posts on the Query page. I guess I was wrong...she ended up getting her way and getting what she wanted

I think though that medical students are like this for a reason. Medical schools are enriched with some of the brightest people who are used to doing so well all throughout their lives. Then when they realize that they're not the best anymore, they freak out and regress to childish and selfish tendencies. A few get really super-pissed and flip out ninja-style.

 

[yaah]

Then when they realize that they're not the best anymore, they freak out and regress to childish and selfish tendencies. A few get really super-pissed and flip out ninja-style.

I saw a few flip out broadway style. Turned towards the open end of the room and broke into song in which they reveal much of their inner monologue. That test, for me, was really tough; But Curtis B says it was all fluff. If I fail this test I just might die; Not being a dermatologist makes me cry. Med school! Med school! Fighting to stay in the deep end of the pool! Med school! Med school! Who knew it would be such a duel??

Then, of course, in true dramatic style, the protagonist challenges the evil bookworm to a duel of the fates.