Mexico Medical Student |

Regarding going to school here, it seems that the more I study and learn from textbooks, the more I seem to get further away from what actually gets tested. Today’s pharmacology exam was a classic example. I did relatively well, so this isn’t a sour grapes post, but with each exam, particularly this semester, I am feeling more and more like I’m on Jeopardy being asked trivia questions than proving my knowledge of [insert class]. I messed up a few things today to be sure, and that’s my fault, but I know for a fact that certain drugs that are given high importance in this class aren’t in active clinical use (sometimes even stated in class notes, “almost never used due to toxic effects”). Whatever we learn from “older” drugs is often still useful to understand new ones, so I’m not complaining about having to know them (although nit-picky questions about side effects about drugs that aren’t used is a bit ridiculous). However, to say, “When a patient presents with X, always use Y,” when you know “Y” is neither a commonly prescribed drug nor “absolute” for monotherapy, it’s tough to hold back the frustration of a golden opportunity lost to provide relevant clinical information. This isn’t necessarily the norm in this particular class, but it is for our schooling overall. You betcha.

It’s no consolation, unfortunately, that the USMLE Step 1 is no less a minefield. The only difference between questions on 2nd year classes here and USMLE is the how airtight and solid the question is (exactly one right answer, clearly worded, etc). Due to language issues and no proper vetting system, bad questions linger around through the years in a way that would never happen on USMLE. However, the idea that you’ll be tested over the outlying fringe material disproportionately, is something I’m reluctantly beginning to accept as a way of life (at least until I’m holding that score report from the USMLE saying I passed and can put a lot of this shit behind me).

You know what I’d love on exams? Essay questions. Obviously, I’m at no loss for words in general but the ability to crystallize divergent information into a reasonably concise answer (for time, if not for space on the page) with lucidity and relevance graded second behind the correctness of the information — now THAT, mis amigos, would be exam bliss for me. Because even if I just have to accept the fact that I can’t answer the question, you’d bet your ass I’d go home and look it up, learn it FOR GOOD, ready to be pimped on that question for life. You lay the nakedness of the holes in your knowledge bare when you’re looking at a blank piece of paper, not knowing how to formulate the answer, but in doing so, there’d be a drive to pick up the pieces and move on, do better, to understand rather than regurgitate. When I walk out of a 70-100+ question multiple-choice test, I can’t even remember what all the questions were that I had issues with much less what the answer choices to choose from were. What better mental preparation for one’s clinical years can there be than essay questions? You’re utilizing the same parts of the brain–higher-level association, memory recall, language centers, etc.–as you would when doing a differential diagnosis or explaining pros/cons of treatment options with a patient. Patients want their doctors to be able to think like doctors, leveraging their vast knowledge/resources, but relate to them as people, not fellow doctors, putting things in clear terms.

Everyone tells me things get better when I get to my clinical years. I just wonder what more sacrifices of time and sanity need to be made until then just to learn how to play the game and dance like a little monkey when the cruel organ grinder begins his melancholy tune.