Mexico Medical Student

Guadalaharvard

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Here I come full circle with this blog, posting once and for all about the conditions at my medical school. While this blog started before I got here, it did carry the hope of what I thought would be an education that, albeit academically lacking at times, would be made up for in other cultural, non-academic ways. *coughing* For all you people considering a foreign medical school, know this: you better be rock solid with your self esteem, your goals, and your ability to nod appreciatively while inside you may be thinking, “You bass-ackwards !@#@!” You need to find the silver lining in everything, and appreciate each good moment to its fullest extent because you don’t know when the next one will come (they do happen, just not often enough).

Here is the template: take a Mexican medical school, carve out a portion of the campus for international students (60% US students, 39% Puerto Rican, 1% Other) complete w/separate administrative offices and the like–a school within a school. The rest of the campus and students are Mexican nationals (the “Latino” program), choosing the private education here over the big, public Univ. de Guadalajara to study medicine. There are some dental and nursing students here as well, but you can’t tell by looking at them for the most part. Almost all of the Latino students start at 18, fresh out of high school. While they might have gone to a specialty/magnet school, they haven’t had university level calculus, organic chemistry, physics, etc. — all the things that make a pre-med education prepare you 100% to begin your training as a doctor (*laughing*). Imagine what you were like as an 18-year-old, then imagine you’re in a lecture hall with your friends and suddenly there is a 6 foot penis on the projector screen behind the professor as you begin to discuss male pelvic anatomy. Hilarity ensues. Repeat for female genitalia, breasts, and ano-rectal lectures.

I mention all this not because it has anything to do with us directly, but in spite of the international program having its own cadre of professors, they were brought up in the system–perhaps were teaching in it as recently as a few years ago or even currently. The average demographics of our program consists of an older student, perhaps choosing a 2nd or 3rd career or a college grad who took a little more time deciding what they wanted, 1-2 years older than the standard US “5th year” MS1. A lot higher proportion are therefore married and/or have children, were professionals in their own right–some with advanced degrees already, etc. Now imagine said professor laughing with the penis or breast slides like an immature child, because he’s so used to having to deal with teenagers. He doesn’t get the funny response he hoped for, so he extends the joke further. People walk out. He doesn’t really teach as much as point and explain the labels on what amounts to a Netter slide. Repeat most of the semester.

Said professor says, “This will/won’t be be on your exam,” only to find out when the exam comes, it’s 180 degrees different than what he told us in class. Why? He didn’t make the exam. He never had any input in the exam. The exam actually comes from a “bank” full of asinine questions that should have died 100 deaths the minute they first soiled the page with their ink. Professors long gone have deposited their detritus into this “bank” to be used by current professors who also deposit their questions but have no input on whether or not which questions get included on their exam. They get no ‘veto’ power for any given question to choose another (although they can throw it out come test-time, of course), but they also don’t have freedom to proofread it themselves. Why? Because the university doesn’t trust them, either. Too many exams have been sold by either corrupt professors or opportunistic secretaries. So not even the professors get to see the exam before its given.

Or so we’re told. Because no matter what semester, there is always at least one professor who seems to know exactly what will be on an exam. Why are they so special? But this is just the idiosyncrasies of my medical school and its never ending quest to exert micro-managerial control to a pathological level. The real crime are the professors who don’t even make their own exams or submit their own questions. They simply cut and paste from other universities web sites without warning. These public websites have questions for their own students and the Internet at large for educational purposes. But you can’t escape the fact that questions from any outside source exhibit a type of professor bias that is impossible to know if you weren’t in that class, such as specific incidence rates, a hyperspecific question that the prof really wanted you to know, etc. As an outsider, you scratch your head with a question like that and say, “Huh?”

Any monkey can cut and paste questions from a web page or copy straight out of a review book or use another (better) professor’s exam questions and rightfully point to them and say, “Those are good USMLE-style questions.” It’s not about whether the professors know the material they’re teaching, it’s whether or not the instruction and academic support sets us up to succeed at that level, whether they are actively helping us along, pointing out pitfalls and explaining difficult concepts or simply putting in their lecture time and that’s it.

But in class–and here is where the problem lies–classes are mostly not helpful, to be kind. We are in lecture 2 hours per class, often with 3 classes (with a lunch break) and sometimes a clinical course elsewhere. When you are in class–mandatorily because attendance will affect your grade outcome–for 6+ hours a day, sitting in a rinky-dink hard-as-a-board auditorium desk that isn’t big enough to effectively study if you wanted to do something else, etc. you are TIRED when you get home. You need to do something just to get the blood flowing again. There are no problem solving sessions, no academic labs, no case discussions, or anything that supplements the book/lecture/etc. The lectures consist of being read to by professors, many of whom have a barely working knowledge of English. Most literally read, word for word, from PowerPoint slides we already have. The slide will have something as ridiculously simple as “Blahblahvirus recognizes glycoprotein moeties in the host cell’s membrane,” but the test question will be “Host cell-Blahblahvirus attachment is mediated by a) virus encoded VP6, b) CD28 c) CD3 d) B7 ” or whatever–you get the picture. It’s an aereal view from a plane followed by a scanning electron microscope of specificity.

To add the icing to this bitter cake, many professors simply feel that you owe them an inordinate degree of respect, as if they were renowned physician-scientists from Harvard (hence the title of this post). In fact, they might be succesful doctors who come to teach a class or two, who are used to patients and secretaries fawning over them, then they get to a group of students from the US who have a slightly higher threshold of “absolute” respect, and then we get attitude back for being “ungrateful.” Of what? Why the fact that they deigned to take time out of their busy schedule to teach the likes of us, of course. One professor in particular started every lecture (late, which is important to explain later), with a diatribe about the people who were not there, on time or otherwise, that they complain they don’t understand something and he doesn’t have sympathy for them, that they are disgraceful students, an embarassment.

“Do you know what I tell a student or resident that comes into the OR five minutes late? ‘Buenos dias, que bien que levantaste. Ya, regresate a tu cama. Peridiste la oportunidad para operar con migo. Vete.’ [laughs, proud of himself] This is what I say. And it never happens again.” (translation: “Good morning, how nice of you to have finally gotten up. Go back to bed. You lost the chance to operate with me. Get out.”

Ok, this isn’t Michael DeBakey, this is just a run-of-the-mill GI surgeon. But he likes his little pedestal of power, and unforunately, this adversarial relationship pervades almost all of Mexican medical education. It is especially frustrating for someone like me who is older, wiser, and less tolerant of bullshit. There is another older student in the class in his 40s who was a PA for 20+ years. I can’t imagine his frustration, but then again, he’s probably seen it all in terms of abuse having worked for at least a few physicians who saw a PA as their whipping boy when a nurse wasn’t around. Assholes. I’d hate to say this is the attitude of the typical surgeons we get (including our surgery classes), but it’s true. Generalizations come from somewhere.

The whole useless lecture thing reminds me of the famous quote from Shakespeare’s Macbeth. I’ll let you substitute for your own analogies, but you’ll get the picture:

Life is but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

It’s all up to us and our textbooks in the end for these first two years. I wish I would have known sooner; it would have saved me a lot of frustration and disappointment over the last year+. You’d think that medical school, paying 20k a year for tuition, etc. you’d feel that you were shephereded along the enlightened path, not herded like cattle en masse. Oh well.

Moo.

Living in Mexico, Medical School | enrico | October 9, 2006 8:22 pm

By topher, October 10, 2006 @ 10:34 am

moo indeed
By Jess, October 10, 2006 @ 3:14 pm

At times I do feel like a barnyard animal. I think the term “self-taught doctor” is evident more than ever here at this school. I can only hope that our rotations next year yield something more than the rhinitis, hypertension, and headaches we normally see at the clinics. Viva Mexico y viva el medico perezoso!
By enrico, October 10, 2006 @ 4:55 pm

Jess: They will. The patients we see for each rotation in medicine (gastro, pulm, cardio, etc.) as well as other specialties are specific for that service, so while our cardio patient might have rhinitis, the stenotic valve is more our concern. By the way, the appropriate translation you were looking for is “eslacker.” hehe