I've talked with the MS-2s at length about this. They all know who I am. The prevailing sentiment is - "That Dr. RustedFox is one crazy fella; but when he talks, I learn - not because he's an animated character, but because he teaches me 'mad doctor skills'.
When the MS-2s leave some crusty old fellas physiology lecture, they think:
"Gee, I just listened to 52 minutes of ion channels, proteins, gradients, and... whatever... I tuned that **** out 18 minutes in to the lecture... because its more of the same that I choked down in undergrad. I learned NOTHING about how to take care of a patient... and that's why I thought I fought so hard to get into medical school... to learn how to take care of patients."
When the MS-2s leave one of my lectures, they think:
"Whoa ! I know what to do when I see crazy-as$ electrolyte abnormalities ! Look out, wards !- Not only can I now do that (because any idiot can memorize *what* to do in a given situation)... I know why I'm slinging calcium gluconate... this is what separates me from nursemonkeys that just follow protocols !"
Think about it like this: each and EVERY lecture should teach you some sort of useful skill FIRST... then... get into the dirt behind it. If it can't be supported clinically that well, then it most likely falls towards the "useless" end of the spectrum (obscure biochem, embryo, etc.), and should be eschewed in favor of more useful curriculum.
Be honest with yourself: do YOU remember lipid metabolism on the spot? No? Me neither. But I bet you can fix hypoglycemia in the short term while you pull it up on the web and get the appropriate "fellowship-caliber education necessary" consult.
Give the student a palpable, immediate, useful objective. Then give them the next one. Watch them suck it down and learn, and learn fast. They won't be satisfied with knowing just 'what' to do, but they'll figure out 'why' they're doing it.
Another thing to think about: I never want to hear the argument of "well, that's the way its been done for years and years." Screw that. I frequently listen to some old fossil attending squeak about how things were better done "back in his day". Bollocks to that. Twenty-five years ago, science understood a pittance about the immune system, didn't have a good handle on even the pathophys of HIV/AIDS, and (ready for this?) they used to treat MIs with aspirin and lidocaine. No cath lab. No lytics. Reperfusion? Pffft...Here... bite on this stick. I'm being liberal with my examples (before anyone looks up when tPA/angioplasty came into vogue and calls me a liar), but you get my point. Right now, the "ICE protocol" is all the rage. We're cooling people after their ischemic events and watching as it works on the small-scale. In 25 more years, the whole paradigm will shift again. We're going to say things like - "I can't believe that orthopods used to put metal replacement knee joints into people.... can you imagine life before regenerative cartilage gene therapy? Pathetic."
Its 2012. In the time it takes you to fart, GenVeers can check his e-mail on his smartphone. Things were "done better" back in your day? I think not. Things change. Science advances. Education needs to change along with it.
If you want to teach every single pathway and every single step and every single cofactor... then medical school is going to be twelve years long pretty soon.... and that's after undergrad... and that doesn't count residency.
Nobody is going to spring for that. Not the student. Not the loan companies. Not the government. Not even (gasp) the lawyers.
Thus, you need to streamline education. Period.
Let me expound:
People can be as rose-glassed and idealistic as they want to be, and say things like - "I think that the purpose of medical school should be to offer you a well-rounded educat...".... Nope. Sorry.
Practically speaking... you can make the argument that undergrad should be the time to "offer you a well-rounded educat... " Nope... sorry... not at $20+K a year (if you're paying it), and certainly not at the cost of developing some serious, market-ready job skills. After all, those loans that you took out to study "Russian Fairy-Tales", "Latin American Today", and the "History of Jazz" (I took all of those classes) have to be paid back. Sharpish. Got a job ? Many of my buddies who farted around, and wound up with a communications or psychology major are now jobless, penniless, and in some serious debt. Sucks to be them. Really does.
This whole notion of "you can study anything you like forever and be fulfilled and productive and... whatever..." is bogus. At the end of the day, the bill comes due. If it wasn't you that paid the bill... maybe it was your parents... maybe a scholarship (also, not you)... then you're lucky, but you probably also don't appreciate the value of time or money. I admit: I had a partial academic scholarship from my university. Saved me a bunch of cash on tuition. My dad kicked in a little bit. Saved me some cash on books... but I still recognized that the money came from SOMEWHERE. It was earned by someone. It didn't just appear so I could fart it away.
Education needs to change. You can't just hand out B.S. degrees to everyone "just for trying". You can't keep a medical student studying cofactors forever. You can't have PGY-15s still trying to chase around someone's renal function.
At the end of the day... $hit needs to get done. And it can't all get done in one day.
What are you gonna do today ?
