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I'm a Medic -- Get Me Out of Here!

Aaronsingh72x721Aaron Singh -- Making the decision to become a doctor is easy. It probably happens one lazy afternoon, when you're sitting in front of the television watching one of those hunks or supermodels playing doctors on TV burst through double doors, white coats billowing behind them in slow motion as the theme music plays. You see them save patient after patient whilst having time to form lasting relationships, sleep with one another, get into and out of prickly situations, and still show up on time for work the next morning. And you think to yourself, "Hey, that looks like something I'd like to spend my life doing." It is one of life's great sadnesses that at that moment, an angel does not appear in a glow of heavenly light and smack you on the head with a mallet to bring you back to your senses and make you choose a different career.

In my case, this particular tale took a surprising turn. After going through all the years and years of school, after sitting through all the exams they could throw at me (and there were quite a few, as Cambridge makes you endure quite a drawn-out application process), and after burning enough midnight oil to single-handedly raise the global temperature a few degrees, I found myself finally in university. After the senior medics had taken us wide-eyed eager beaver freshers on a tour of the medical school, I realised something was wrong and piped up.

"Um, excuse me, but -- when do we get to the hospital?"

A blank look. "What hospital?"

"Well, we're medics, aren't we? Where's our teaching hospital?"

They looked at me and blinked. Then the sniggers started. "Hospital? Riiiiiiight." Full-blown chuckling now.

See, my university is one of the last bastions of a purely traditional medical course. This means that while other universities hold lectures in hospitals and their students get patient contact in the first few weeks, we spend our first three years sitting in lecture theatres having obscene amounts of scientific detail shoveled down our throats. In fact, we enter the local hospital a grand total of about two times a year (barring any serious accidents, of course, and there are few serious accidents associated with lugging around huge textbooks from room to library and back again). I knew I was giving up some clinical contact when I applied here but I didn't appreciate the full extent of the sacrifice.

A few weeks ago, I was on first-aid duty at a sports carnival at Nottingham University. I was the only first-aider there not from Nottingham. I received my first hint that it was going to be an interesting day when I dabbed a bloodied gauze into my bottle of antiseptic. "What the heck do you think you're doing?!" came a shrill cry from the senior first-aider next to me. "Don't they teach you sterility where you come from?!" A very basic mistake, and one that, in retrospect, makes me cringe, but one that I simply hadn't been taught about.

For a while after that I felt sorry for myself. I felt as if I wasn't getting out of medical school what I'd gone into it for. Then came a chance meeting with one of those passionate genius book-toting medics that we all want to kill at some point in our careers. She was in the year below mine but knew stuff I was still learning in my lectures. In the midst of pummeling my self-esteem into the ground, she told me why she chose to come to Cambridge to read medicine; to her, the traditional system was a safeguard, a way of ensuring that when she came into contact with patients, she really knew her stuff. Everyone who enters the medical profession has some desire for excellence and hard work, and to her this meant knowing her stuff inside out, even if it also meant she'd know needlessly obscure molecular details about how the drugs she was dispensing were acting.

It made sense. It didn't immediately solve my crisis of confidence, but it helped. The University Prospectus warns you that there are many ways to learn medicine and that "by choosing Cambridge you have declared your choice." Personally, I'd like a little more blood on my shield before I go out into the arena that is the medical profession, but hey, every method of learning medicine has its pros and cons, and I get some reassurance that at the end of the day we'll all be on even keel. Even those of us from PBL (Problem-Based Learning) universities.

Theoretically, at least.

December 3, 2006 | Permalink


First I would like to say, "Welcome." I look forward to hearing how things go for you.

I am looking at going to Oregon and Health Science University. One of the main draws for me is the fact that you have contact, though limited, with patients starting in your first year. It would drive me crazy to have to wait as long as you have to.

Having said that know that I wish you the very best.
Sarah Hobbs

Posted by: sarah hobbs | Dec 5, 2006 6:35:39 PM

I feel your pain, Aaron. I am now on my first clinical year in a big teaching hospital after 3 interminable pre-clinical years at St. Andrews. During those years of memorizing minutiae, I began to question if a career in medicine was right for me.

My lifesaver came in the form of a family friend offering to let me shadow him in A&E over the summers. I finally got a taste of the human interactions that drew me into medicine in the first place. I realized that as much as I despised my pre-clinical years in the ivory tower, they were a means to an end that I was going to love.

Now that my task is to hit the wards instead of the books, I feel a little more charity towards a traditional pre-clinical program. Whereas my PBL-trained colleagues are very practiced at introducing themselves to patients, I can hazard a reasonable guess as to a diagnosis or differential list without having to retreat to the toilets with the Oxford Handbook first.

You've already grasped a key truth regarding your time at Cambridge. It seems to be the clinical students who refuse to acknowledge that their early training had both pros and cons, who struggle. They think slickness in talking to patients excuses them from knowing the pathophysiology of a disease, or vice versa.

Best of luck to you! I'm looking forward to getting a UK medic's perspective on The Differential.

Posted by: Jenny Page | Dec 6, 2006 5:57:35 AM

Hi Aaron,
I totally understand what you're going through. I study at the University of Suriname (South-America) at the faculty of medicine for about seven years right now. We got the classical style of medicine school, 4 pre-clinical years, almost no PBL, just plough through textbooks like Robbins Pathology and more, after that 3 years on the ward. But you know, although we almost don’t get patient contact for those years it feels very rewarding when we get at the ward. It feels like a new life starts after many years of dry textbooks and sacrifice of your social life.
I discovered that though our communicative techniques aren’t well developed yet, this is not an insurmountable problem. You’ll learn it, just like thinking the other way (from symptoms tot a diagnosis).
In our Academic Hospital we also get medical students from the Netherlands, from PBL universities. And we always looked up to those European Universities like better and of higher standards, but if we meet the Dutch students, it is just like Jenny wrote. You’ll experience that it is much easier for you to get a differential diagnosis and because you are trained to think from a patho-physiological point you understand the diseases and the problems of your patients better.
I hope you’ll feel better with the knowledge that med-students all over the world go through similar phases.
Keep it on Aaron, I bet you’ll be a good doctor with a broad theoretical base!
Amar Punwasi

Posted by: Amar Punwasi | Dec 6, 2006 3:21:17 PM

Hi Aaron,

Wow, that’s tough. There seems to be a popular trend in the states now to dump med students into clinical situations as soon as possible - or even to compress down the 'scientific' years as much as possible, to include earlier clinical or research exposure.

I am rounding out my 2nd year (In January, go figure) and am in the clinic for 2-3 half days a week. Some of it is essentially shadowing whereas at other clinics I'm doing full histories, exams, etc. on my own, and then following up with a preceptor. Its tough to do with time constraints, but I always leave pretty satisfied that I am in the right career.

Hope things get better for you!


Posted by: Robert D. | Dec 6, 2006 3:48:37 PM

Hi Aaron!I am currently in my final year of medical school and I come from a PBL based teaching.

Although it was nice to have patient contact very early on in the course which kept my motivation levels high, whathelped me the most in terms of differential diagnosis is still thinking about the pathophysiology basis of diseases. Medicine cannot be learnt in isolation by "problem based" or "system based". Physiology and pathology is continous. I believe it is only by having a firm foundation in the basic sciences, can we than have problem based learning to consolidate this knowledge. Problem based learning should only be introduced in the clinical years in conjunction with seeing patients instead of sacrificing didactic teachings in the clinical sciences in the pre-clinical years!

I sincerely wish you the best in your course and honestly, I envy students who come from such a strong background of clinical basic sciences. I believe thats the best way to learn medicine-clinical skills based on a strong foundation of the basic sciences =)having realised this only in my 3rd yr of medical school , i have been trying to patch up my deficits in my knowledge in the basic sciences..Hope you do well! All the best!

Posted by: Adel | Dec 6, 2006 5:51:23 PM

Hello Aron,
Don't give up..Med school is a battle,its fun and yes you tend to burn all the candles , in the long run its wort it...Here in Fl , our Hospitals help students.. E-mail me and I would give you more info in finding a hospital to do your internship..

Good luck!! Its not all that bad !! You have reached this far, hang in there buddy..


Posted by: Minty Singh | Dec 6, 2006 7:55:10 PM

Hello Aaron.I'm in 4th year of study. My university has more or less the same system as yours.By the way I'm a Malaysian studying in Volgograd, Russia ( I got a scholarship from the Malaysian Government).

Our full medical course is 6 years: 3 pre-clinical and 3 clinical.I think as a medic we must have a strong fundamental knowledge about physiology and pathology. As a matter of fact here in Volgograd we have two separate departments for Pathology- Pathophysiology and Pathoanatomy. I believe that in other med schools all around the world there's only the subject of Pathology.
Believe me, after I managed to pass all 3 demanding years, it's rewarding to finally to be able to apply my knowledge in the 4th year in the wards.And I agree with Amar Punwasi, it's better to grasp the basic clinical sciences, and then CORELLATE them with the problems faced by the patients.
Good luck!

Posted by: Hafidzudin Zainal | Dec 7, 2006 2:47:11 PM

Be thankful you got into Cambridge, dude. Many others like myself would never get the chance. In any case, having tasted both the trad and PBL way of teaching, I believe there has to be a balance. PBL makes life interesting but disorganised. Trad makes you memorise lots of theoretical things but it's boring cos you don't apply. Oh well, at the end of the day, it boils down to yourself. Good luck.

Posted by: Dah | Dec 12, 2006 6:49:47 AM

oh this is strange. all this while in med school i thought that our method is not the traditional one. we have PBL's and we learned basic medical sciences for 2.5 years, then we go to clinical school/ teaching hospital for 2.5 years.. now i'm in semester 6 and by the time i got into clinical school, i already forgot 3/4 of what i learned. shame on me. anyway good luck to u ^^

Posted by: anemociti | Dec 13, 2006 3:36:35 AM

just a few words about pbs and trad. In my university İstanbul Marmara University ,we take lectures in a integrated program such as cardiovascular system and disorders subject committee and clinic and basic scinces integrated and we discuss on a specific subject which is a big morbidity or mortality cause in the country (i.e atherosclerosis ,risk factors and prevention )from the committee in small groups where we use pbs system, which is infact a good way in learning as long as your moderator and your friends are in a good communication.I can't imagine a system only with pbs, trad is amust in medicine.
And it is a pity that we don'thave access to clinic practice in hospital before 4th year. But I try to go and see some procedures such as endoscopy or attend some meetings which i interest in,such as child psychiatry. But it is a pity our hospital and basic sciences(first medical school of Ottoman empire,we look to Bosphorus when we get bored:) ) are far away from each other.
Nevertheless if i had a chance to go back in the time,i am afraid i would do the same "foolish thing" according to many dr. i encountered and I would choose the same way of life being a dr. Lectures modules(pbs meetings) labs ... nothing make you dr. You learn as much as you want...

Posted by: Dem@ | Dec 14, 2006 5:25:49 PM

I am a 6th year med student from Romania, Europe. In my country we study medicine the traditional way. The first 3 years of study were the pre-clinical years and we had no contact with the patients back then.
However, from the 4th year, things changed and since then, our activities have been only in the hospital and we got the chance to establish the contact with patients, so communicating with the patient is not a problem anymore.
Unfortunately, most of our teachers still teach us the traditional way and we could sure use PBL from time to time because it is the only way that could make us think quick and draw up the correct diagnosis.
As a conclusion, i think that even if they teach us medicine either traditional or PBL way, in any case we should combine both ways in our medical practice.

Posted by: Oana | Dec 19, 2006 5:25:40 AM

Hello Aron,

do not be panic .the things u think as a great problem is no thing ..this basic clinical data you will know later . we all passed through this feeling .iam in the six year and i know that good .study hard to have a residance to develope ur clinical ability more and more............keep fighting.......good luck.

Med. Stuud. Alazhar Univ. Egypt

Posted by: M.Kamal | Dec 20, 2006 2:15:24 PM

in our country we enter clinics after the 11/2 years..but still has to learn pathology pharmacology and all the nonclinical sciences side by side its tough and our clinical learning suffers...its good to leave these things behind as they tend to consume time and wits..so u can concentrate in clinics once the postings start..maybe its good india

Posted by: shaan | Jan 15, 2007 11:03:29 PM

If you don't like the system in Cambridge, why did you apply to a traditional course?

Posted by: Fran | Feb 1, 2007 12:58:32 AM

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