2nd year is OVER!!

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WOOHOO! I am finally free of the shackles of the slow torture called “the basic science curriculum,” AKA “Pre-Clinical Years.” I now move on to the hospital, but down here, unfortunately, it’s not quite like it is the States with that. We still have quite a bit of classroom/didactic learning. Too much, in my opinion. We are only let loose on the wards, totally, for a precious few weeks out of the semester, at least at first. The rest of the time isn’t all lecture hall like the first two years, but rather small problem-based learning groups (you know, the progressive learning that many US schools have been doing for a long time, in the first two years, but I’m not bitter…) that do revolve around actual, current patient cases. I can only surmise that this spoon-feeding of procedures, techniques, diagnostic analysis, is to ensure we get the proper clinical training by design, rather than hope it gets through in “on the job” training. I wish we’d be given more credit, but that’s the way it’s done. Many people have told me that just the fact that you are doing relevant clinical learning by knowledgeable professors (as opposed to those lecturing from 10-year-old yellowed transparencies) more than makes up for whatever shortcomings exist.

If all goes the way I plan [insert raucous laughter here], I would have taken Step 1 by the time July 16th rolls around. Yes, I only have 6 weeks of vacation (if you can call it that this time), and yes, we start insanely early, and no, taking/passing Step 1 is not mandatory for int’l students to progress to 3rd year, since we aren’t in the US. However, you’d have to have a serious screw loose not to take it ASAP, and I really don’t relish having to take the exam while actually enrolled in classes. If, due to scheduling conflicts or something coming up life-wise at the last minute I must postpone into late July/early August, then that’s the way the cookie crumbles; I’ll deal.

The only downside I can see from here–and this is somewhat petty, but it is a real issue–is that for the next two years, we have to wear our “whites” every day to class. No exceptions, even if we aren’t doing rotations. I’ve written about this before, but the reality of all white–while serving the logistical purpose of showing you aren’t going around with others’ bodily fluids while you see a patient–is just beyond impractical. More to my personal point, NOBODY I know looks better in all white. I’m not fashion-conscious at all, but c’mon–white isn’t flattering, except for the lucky few. I makes you look bigger, it’s semi-tranlucent, underclothes-wise, impossible to keep clean, etc. It wouldn’t be so bad if I looked like this, but unfortunately, it’s more like this. Oh well. I better get over it, fast.

So Claudia and baby are coming tomorrow for a week-long visit. Yay! Basically, this is a final family hurrah before I take my exam–from here on out, I’m electively staying here alone so I can maximize studying. Also, Claudia wants to take inventory of things, organize, plan, etc. regarding household/baby times for when they come back for good in July having finished her PT later this month. But for now, I must de-bachelorize the house, do 6 loads of piled up laundry, remove traces of weeks of single-living debauchery (I’m *SO* kidding–I have no life, really), and just in general, relax knowing that although I’m busy as ever, at least it will NOT extend to have to sit in a lecture hall anymore for hours on end. It’s about damn time!

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  By AMiB, June 10, 2007 @ 11:16 pm

  “However, you’d have to have a serious screw loose not to take it ASAP”

  At our school (in the UK), we had a couple of girls who took the Falcon Review course in Texas. They sat the exam, and both failed. They came back, saying how ‘clinical’ the exam was, and recommended to the entire school that they wait until their clinical years are over to sit the Step 1. The fact is that they were on an older, medical science-based curriculum, and everyone at the school is now on a integrated, systems-based curriculum (where we have lectures as well as patient-centered PBL style sessions). Our exam questions were presented in a clinical fashion, and theirs weren’t. So essentially, they just weren’t used to it. But now everyone at my school has it in their mind that the Step 1 is some huge clinical exam, where they’re going to have to know everything about every single lab test and clinical outcome and treatment ever (which we actually DO learn, on our new curriculum, and the old system didn’t). No matter how hard I try, I just can’t seem to convince them that maybe they should actually look at some practice questions first without taking these girls’ lecture blindly. Granted, it was a good intro for them all, but it just sort of bothers me when they try and convince me that I should wait a few more years….(so that, y’know, I can forget all the biochemistry and things you don’t actually use in clinical practice).

  sorry, bit of a comment rant, but oh well. maybe one day i’ll write a post about it…
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  By enrico, June 11, 2007 @ 11:51 am

  AMiB: While Step 1 does ask questions by way of clinical vignettes, the expectation for your understanding of them is that of a completed 2nd year med student. The questions are written knowing this. Too many people study isolated facts, data, etc. in a vacuum, and Step 1 strives to ensure that one doesn’t lose the larger clinical picture. However, Step 1 still tests you on the totality of basic sciences, so waiting until 4+ year is shooting yourself in the foot, since, as you said, you don’t use biochemistry or genetics or embryology at that level of detail anymore.

  Another way of looking at it is this: Step 1 will ask, given all the lab data, some aspect of the disease, requiring you to diagnose what the real problem is (it will never ask, “What does this patient have,”–it assumes you’ve reached that point and will continue to ask something more “hidden”) in arriving at the problem. But you have all the lab/exam/pt data you need to answer the question.

  Step 2 will ask, “What is the next step in the management of this patient?” The lab data is often not given; it’s your job not only to know what the dx/ddx is, but which lab tests are pertinent and what the expected results will/won’t be for each to rule out/confirm each ddx. That is when the true “clincal” questions are asked. To retain this information PLUS all the crap from Step 1 is, again, asking for trouble IMO.
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  By Kim, June 18, 2007 @ 3:46 pm

  Congratulations on the end of a second year!!!!!!!!

  And you’ll have the entire family with you after the exam??? Fantastic!!!!

  I don’t look good in white, by the way.

  I used to. Now it makes ME look gray…….

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