I should’ve posted a few months ago, but I was busy with other tasks and was “procrastinating”, my apologies. I hope everybody has had a safe and happy Christmas (or another festival if you don’t celebrate Christmas) and New Year’s Day.
This is a relatively controversial post, certainly among the medical academic staff and students, but I can’t resist my thoughts any longer, and I refuse to shut up and be “politically correct” in this regards. I’ll type about less “bitchy” things later on.
I’m rather disdainful of the concept of “Self-Directed Learning” in Med School, as I personally find that for me, it is counterproductive and obstructive to my optimal acquisition of knowledge, and I get frustrated by it. Yes, there’s definitely an element of personal responsibility in studying and putting in the effort to visit patients, speaking to them, and writing your own notes, but I feel that the burden has been placed way too much on the student, with insufficient guidance from the main medical faculty.
To put it in simpler terms, the concept of “Self-Directed Learning” primarily involves med students planning out what topics to learn and to what detail, with less didactic education given by lecturers/tutors in past medical curriculi. While this may sound simple and practical, this is far from the truth for me (and possibly many other students). A major issue is that the field of Medicine is so broad, and that there are so many medical conditions to learn, and so many textbooks, websites, medical papers discussing them, it’s hard to gauge which medical conditions should be studied (besides the really obvious ones like stroke, diabetes, cardiovascular disease, epilepsy), and how much we should know. I do receive handbooks for each of my rotations, but from experience I’ve noticed that other “significant conditions” that get discussed by consultants are sometimes not mentioned in it, instead including more “rarer conditions” instead! Also the handbooks don’t give a generic idea on what boundaries we should learn up to, before it becomes excessive/overkill. There are a few objectives that are vaguely stated, but I find this to be insufficient, especially when they don’t even tell you the steps on how to do it.
As an Aspie medical student, I have a much stronger tendency to process information as details and have trouble seeing the big picture (not just medical academics, but in social situations and generic reading comprehension for fiction). I also have a strong tendency to want to know a lot of details about the particular aspects of a medical issue, because I feel uncomfortable simply memorizing facts and I want to know the deeper aetiology/physiology/cause. I was aware that you don’t need to know, eg, 10 pages of the genetics of Marfan’s Syndrome, but it’s very hard for me to modulate how much depth of each section to learn. I feel guilty and uncomfortable if I only learn a few sentences about one aspect, and I feel like I’ve wasted my time if I learn too much about something when it’s not going to be examined or used (in a pragmatic sense) in the clinical setting for a JMO (junior medical officer).
I get frustrated by how each block is “only” around 6 weeks long comprising of 2 - 4 medical specialties, eg Haematology, Gastroenterology, Cardiology, and yet we’re somehow meant to learn the major conditions for those specialties in that time limit, without them telling us which is more important and how much. IMO 6 weeks is barely enough for 1 specialty, let alone 2-4. It feels like a very strenuous task, and later in the Semester, I tended to spend more time in the library trying to type notes on a condition (that might be trivial but still mentioned in the exams from experience) when I personally would much rather spend more time on the wards trying to practice my Clinical Communication skills and Physical Examination techniques with patients. I feel that I’m eating, sleeping and shitting Medicine and studying inefficiently through insufficient guidance when I could’ve had more time to talk to patients or even spare time for myself. I was very tired, and may be really tired/burnt out again when I start my next Semester.
People have told me the following - “If you don’t like the course, then leave.”
- “This is how your Uni arranged the curriculum, just accept it. Who knows, in 50 years’ time, the curriculum will change again, and the med students then will have to accept it with their heart.”
- (even more insultingly) “Suck it up, you’re just not trying hard enough.”
- “Self directed learning is to prepare you for the workplace, where you’re not getting spoonfed anymore.” (this operates under the assumption that everyone has adequate insight into the clinical setting + medical issues, which isn’t necessarily the case)
It’s not just frustration for my own comfort at the moment, but also for my future vocationally-wise. I DON’T want to end up accidentally hurting a patient through negligence of certain information coz I was spending so much time learning more trivial minutiae in med school. WE'RE LOOKING AFTER PEOPLE’S HEALTH/LIVES. The generic purpose of the Medical course is to prepare medical students for Internship, where they start engaging in “paid” service-provision in the care of patients, under the supervision of more senior medical staff and working in cooperation with nurses and other allied health people. IMO I don’t think the current medical course (maximally) efficiently prepares students for internship given the lack of practical guidance, and there’s a risk that students may spend too much time studying topics and details just for the sake of passing the exams, as opposed to improving their functioning on the wards. Yes, the work is applied knowledge, and medical information gets updated all the time, and yes I don’t expect to be completely spoonfed, but I really think that at the stage of a medical student, the faculty should provide more clear-cut guidelines so everyone can learn the imperative basics before moving on and learning things independently as they become more senior medical staff. Now, it’s all a mish-mash, VERY wishy washy and nebulous.
There has been speculation that some medical faculties are emphasizing on “Self-Directed Learning”, and not breaking the medical subjects down into more specific categories (eg Anatomy. Physiology. Pharmacology.) and teaching it didactically coz they wanted to save money. I can’t comment on that, but if that was true, then I’d be very disappointed. However, there were a few studies, starting from Canada, which came up with findings that “Problem-Based Learning” with a weekly-based medical issue is somehow a superior way of learning medicine compared to previous didactic styles, but I’d like to digress as I don’t think it that alone sufficiently addresses the amount of information we need to know, a block having 6 X weekly medical issues when the handbook contains 40+ (and probably at least 10 more that aren’t listed), ie not a complete substitute. The studies may show it works, but in practice I don’t think it’s noticeably superior.
Ideally I would prefer to receive extra time for each medical specialty (at the expense of graduating later), and/or be told directly what the main issues are along with generic boundaries for med students in their clinical years.
Compensation strategies (outside of official sources) that I have used include:
- Limiting myself to 2 or 3 pages for each medical condition, (painfully) forcing myself to limit each section (eg Symptoms, Investigations, Treatment) to a specific textbox.
- Limiting myself to only 2 or 3 textbooks, a major one being “OXFORD HANDBOOK OF CLINICAL MEDICINE” which happens to summarize the information for me (so I don’t have to figure out how to summarize it).
- Speaking to patients a certain number of times each week (but have to moderate it, otherwise I’ll be “occupying” too many patients and not giving other classmates a chance).
- Asking a family friend (who’s a doctor) for help, he tells me what’s important and what conditions I should just leave til I’ve covered the others.
I hope these strategies work for now and the future, but I’m somewhat displeased with how things are going atm. Even then, me artificially restricting myself as a preventative measure to avoid learning too much about each aspect of the condition may prevent me from gaining sufficient knowledge of areas that might need to be learnt to a deeper depth. I feel like I’m going to become a super duper Jack-of-all-trades just to cope, the lowest of the low : (
We'll see what happens for this Semester...
