Blood from a Stone

Ever wonder what this idiom means? I mean, you can't really get anything from out of a stone, except maybe a bruise if you slam it up against your head. I'm thinking that maybe that's what I will call my book about medical school, not only because the process is difficult, but also because it's like beating your head against a hard rock. And yet, everyday I get up, and do it all over again. Here I am , on my spring break, and what am I doing? Not lounging in my bikini on a beach with a Mai Tai in my hands, but I am trying to get through a massive to do list that has grown over the last several months. Oh, I'll catch up on that over spring break I thought. So here I am, in the thick of catching up. 

I really don't mind having lots to do. In fact, I get irritable and bored when I have nothing to do. You could say that I need to relax, and learn how to meditate, learn how to not judge my competence on what I accomplish on a day to day basis, but that would be like trying to make a dog not be excited about chasing a ball. I love being busy; I love running around: and I love having things to get done. I am the Queen of productiveness. I have long let go of trying to meditate, or slow down, or zen out; it just makes my blood pressure rise, which is not the goal of meditation right?

I no longer feel any shame about liking to be busy, about enjoying challenge, about the love of competition. It's just the way I am wired. When the Goddess was giving out yogi personalities, I was obviously hiding behind the door. I WANT to DO. I WANT to EXPERIENCE, and I WANT to live life to the absolute fullest. And at this point in my life, what that means is hitting my head with the stone of medical school expectations.

So what I am banging my head against these days? Thankfully we have moved away from Neuroscience, which I have to say in retrospect was brutal but exciting at the same time. (I am such a masochist). Now we have moved to Hematology (the study of blood). We had heard through the medical student grapevine that blood was a much easier class, but you can't trust that information from an upper class that has a reputation for being gunners (more on that term later in case you are not familiar with it), as well as a class that has scored higher than ours on a lot of exams (as told to us from a course director who was trying to either motivate us to study harder, or shame us for our stupidity). Anyhow, for once, they were right. The first exam in Blood was the most straight forward (and easy) exam of medical school. It was like an exam in undergraduate classes - this is what we expect you to know, and every single question was related to those expectations. No curve balls, no "did you read the last line on page 155 of the book, nor any questions trying to trick us. It was such a relief, and at the same time, being used to the "abuse" of what exams are usually like, I left the room feeling a bit disappointed. I had WAY over studied, memorizing totally irrelevant details, statistics, and such, since during previous exams, you always had to be prepared for very very very detailed questions. I finished the exam thinking, WOW I think I can be a good doctor! I understand how to evaluate patients with blood abnormalities, and how to come up with a possible list of diseases.

Phew! Thank the gods and goddesses that this break has come at this time. Right at the time when students in my class are looking so ragged and are about ready to explode; we are not stones, and if we were to break we would spill our blood all over the lecture hall floor. But no need to rush us to the ER just yet. The course in Blood is straight forward and we can begin to concentrate on preparing for the boards.

So that's what I am doing, in part, during my week long vacation. Besides drinking some wine, reading a non-medical book (always wanted to read "Eat, Pray, Love"), and teaching my now sixteen year old to drive, I have been doing board study questions. I have been using a test bank that I purchased and so far have been getting 50-60% on the tests. When I told my husband how the practice tests were going, and what my scores were, he couldn't understand why I would be excited about a 50%. I guess he doesn't understand that 50% represents a successful trickle of blood from a stone. Cheers!

Cheating

Got your attention huh? You may think that all I ever do is study, sleep, and eat, but there actually is time to do a few other things in my life, and one of them is called the "Student Resource Committee." About three years ago there was an incidence here at OHSU where one less exam got turned back in at the end of the examination period. Let me clarify to you how it works - a wonderful person from the Teaching Services Office (TSO) (and they really are great - they make it smooth for the students, thank you!), wheel in a humongous stack of exams, 120 to be exact, all of which are about 20 pages long, with a big thick staple. We have those wonderful scantrons that you have to correctly fill in the little bubbles, on which we put the correct answers, which we leave at a table in the front of the room, and the 20 page thick exam, when we are finished. At the end of the exam, the TSO person counts to make sure all 120 exams are still in the room. So three years ago, some idiot student decided to take one of the exams home with him....and TSO discovered the missing exam....and all hell broke loose.

No one ever came forward with the missing exam, or information about who had taken it, although it did end up mysteriously underneath the door of the TSO office the next day. Whoever had grabbed the test decided it be best to return it to its rightful owners! You laugh about ownership, and yet in each syllabus and at the top of each test reads the ominous warning: "The content of an examination is confidential and distribution of the content in the public domain is prohibited when the examination bears the School of Medicine Public Domain Advisory. In this circumstance the reproduction or transcription of the content of the examination by any means is unauthorized. Possession and distribution of the examination or the content of this examination outside of the classroom setting or of the supervision of the course director or his/her designee is prohibited. Individual possessing or distributing exams or exam content that is not authorized to the public domain will be subject to academic disciplinary action for failure to meet professional standards."

Not only did this raise the issue of professionalism on the part of one individual student, but it also brought to light the pressure students feel to not rat each other out when cheating or a lack of professionalism is witnessed. Chances are very high that someone saw something, and knew who took, and then returned, that exam.

Well, they returned it right? Well maybe they copied it, and will distribute it to the next incoming class, which makes all 120 questions that the course director came up with completely obsolete. You may think it's not a big deal, but believe me, after going to many exam reviews, it's very difficult for a professor to come up with a good question that will withstand the pleading and arguing excuses of students who feel like the question is misleading or unclear. So directors have these test banks of questions that have upheld the high standards of student feedback, and are therefore, fair questions. In each exam period we have the opportunity to comment, on a separate query sheet of paper, our reasons for thinking a question is unfair, or that there is more than one valid answer etc. So you see, this exam question thing is a serious business, and I imagine the course director was VERY unhappy to get rid of those 120 questions out of the test bank.

So in the spirit of trying to encourage students to first of all, not cheat, and second of all, to report any unprofessional behavior, the Student Resource Committee was born. It took many years and countless hours of work to come up with a Statement of Principles for the student body to sign, as well as a charter outlining how the council will work on a day to day basis. I was not involved in the writing of these documents, but after the four classes passed the Statements of Principles with a 83% vote, I decided to put myself on the list to be considered as a representative of my class, and was subsequently voted in, along with two other of my classmates.

Now at this point you may be thinking, Medical Students Cheat? But why? They are so smart to begin with, and why would you want to cheat on something that you are eventually going to have to know anyway, and further more, on knowledge that is required to take care of patients! Well, I'm with you. I am totally naive, and had absolutely no idea how much cheating goes on. Here are the results of a 31 medical school survey, with a total of 2,459 students responding, done in 1996:
"RESULTS: Thirty-nine percent of the respondents reported witnessing some type of cheating among classmates during the first two years of medical education, while 66.5% reported having heard about such cheating. When reporting about themselves, 31.4% admitted cheating in junior high school, 40.5% in high school, 16.5% in college, and only 4.7% in medical school. Reports of cheating varied across medical schools, but no relationship was found between rates of cheating and medical school characteristics. Men were more likely to report having cheated than were women. The best predictor of whether someone was likely to cheat in medical school was whether they had cheated before, although the data strongly support the role of environmental factors. Medical school honor codes exercised some effect on cheating behavior, but the effect was not large.

CONCLUSION: About 5% of the medical students surveyed reported cheating during the first two years of medical school. The students appeared resigned to the fact that cheating is impossible to eliminate, but they lacked any clear consensus about how to proceed when they became aware of cheating by others. The guidance students appear to need concerns not so much their own ethical behaviors as how and when to intervene to address the ethical conduct of their peers" Baldwin DC Jr, Daugherty SR, Rowley BD, Schwarz MD, Acad Med. 1996 Mar;71(3):267-73

So, you see, cheating happens, and as the system is currently set up, the only option you have if you see someone cheating is to go to the Dean's office. Of course, not many students want to go to the Dean's office, even if it has nothing to do with them. The Dean's office is responsible for writing a letter of academic and professional performance that will accompany your applications for residency. The Dean's office has power. The Dean's office is, from the students point of view, not a place you want to go to. After talking to the Dean's office staff, in the process of trying to figure out what relationship will exist between the Dean's office and our Committee, if any at all, we have discovered that a lot of what the office does is quite benign. They try to recognize students that are struggling with school, whether it be for emotional, financial, or academic reasons, and lead them to appropriate resources. The Dean's office really wants students to succeed, for it will not look good if OHSU graduates students that are unprofessional, emotional unstable, or lacking in the required knowledge to be a caretaker of patients.

Nevertheless, the stigma of the Dean's office remains, and we are attempting to provide a place for students to come with any concerns about medical school, be they personal, interpersonal - with another student or a faculty member, or even an attending physician, as well as a place to discuss potential breaches in the schools Code of Conduct. Our hope is that by having a student run committee, that operates with confidentially and independence from the Dean's office, we can allow for a safer place for concerns to come to light. As it is, we have already had several issues come to us, which if we had not existed, would never have gone to the Dean's office, and therefore, would have never been addressed. It remains to see how effective our committee will be, and if we can, in the long run, change the culture of medical school so that students will accept responsibility for the behavior of their colleagues. For when we get to be physicians, there will be no Dean's office around to approach a physician who is behaving unprofessional. It will be up to us, as physicians and colleagues, to talk to our fellow physicians, and find out what is going on. I'll let you know how this committee progresses as the years go on, but if you want any details or names, you aren't going to get them, because it's confidential!! Cheers!

Cramming

When I was an undergraduate, I was never one to stay up all night before an exam and cram. I always wrote papers days or weeks before they were due, and I only used the time right before an exam for review. Well those days have certainly come to pass. I am now a crammer.

Last night I stayed up late studying for our final in neuroscience (thank the Gods this class is now over). I looked at all the flash cards I had made for the second or third time, then tried to go to sleep. My head was full of test anxiety though, and so I didn't sleep much at all. One of my dreams had me waking up in my hometown in Vermont, and driving around looking for OHSU. My mom was asking me where I needed to go for the exam, and I couldn't remember. I thought I would call one of my friends, and then I had a flash of insight, OH YA, it's at the University. At which time my mom looked at me funny, asked "What University" and I quickly realized I was in the wrong state! Why oh Why did I fly to Vermont the day before my final exam in neuroscience I thought to myself. I wondered if the director of the course would believe me that a family member had died and that I had to fly home right away.

Thankfully I woke up to my own house, right here in Oregon, and well before the alarm was supposed to go off. I got up and looked, once again, at the flash cards I had made. Ronando dropped me off at school, and I looked at the flash cards once again, hoping that the words would be singed onto my brain. After a very demanding test, (that once again contained not only irrelevant details, - like what are the names of the two enzymes that break down the APP protein involved with Alzheimer's - alpha-secretase, beta-secretase, or gamma-secretase - does that really matter?- but also some information that I had absolutely NO idea where it came from - like what is the mechanism of degeneration in the condition Chronic Pontine Myelinosis? - I had never even heard of the disease - did I miss that chapter?). As I was saying, after that demanding test, I realized that I did not study the RIGHT flash cards long enough. Or that I didn't even have any flash cards with the needed information. Sigh....oh well, I know that I passed, and I have to remember that C equals MD right?

So anyhow, I have happily become a crammer, right at the time in which we are preparing ourselves for the quintessential cramming session. Studying for the boards. There was a panel of third and fourth year students that were giving us all advice the other day about how to survive this period of our education. (If one more student tells me not to stress, or that it's going to be all right, I think I am going to throw something at them. I make a promise to myself that I will NEVER say that to students coming behind us. NEVER). You see, it's the stress and the fear that it won't be OK that keeps me motivated to keep studying, to do this insane thing called medical school. So why would I want the stress to go away? If the excess cortisol from my adrenal glands coursing through my arteries stopped their daily drip of drug into my blood, I would just curl up on the couch with a bottle of wine and about two years worth of TV series (the last two years that I have missed).

So about this board studying thing. Some students say don't worry, just study for 21 days after your last class ends, from 8 am until 11 pm every day. (Ya, right). Others say, start studying now, so that you can still spend 15 hours a day studying for the last three weeks, but only on the high yield subjects, and the things that you don't understand very well. Everyone has their advice, and although I so appreciate their willingness to take the time out of their schedules to come and give us advice, I would like to hear from the ten students who did NOT pass the boards, or the other 50 or so that were below average, or below what their goals were. (Of course the ones that tend to show up for these panels are the smart ones who did really well on the boards).

The one thing they all had in common, and did agree on, was that the this time in their medical school education was the worst (I'm there already), that we don't have to like it (just bear it, not even with a grin), and that it will be over eventually (like labor). So while I wish I could say I am feeling the relief of having finished the taxing Neuroscience, I have to be honest and say, that it's one more day to that three week cramming period that I am not looking forward to. I have already told my family that I will not be able to do the laundry, or grocery shop, or cook, for that three weeks. Well then, maybe it won't be that bad! Cheers!