Tuesday, March 22, 2011

Step 1: It's not just rote memorization, it's also useless!

The National Board exam, Step 1 is a test all medical students have to take in which we are expected to solidify and deepen our knowledge of the basic sciences so we can appreciate just how much worthless and bullshit they are.

Part of the worthlessness is that even when something is clinical for this asinine exam, it is not particularly helpful.  For example, I may learn about acanthosis nigricans, a velvety skin lesion* that signifies either insulin resistance (diabetes) or an underlying malignancy (cancer).  Whenever we learn about it, they show us a picture of someone's underarm with this dark, velvety (whatever the fuck that means) discoloration and we immediately know what it is and pick the right answer.  In the explanation, they will say things like, "the most common location is the underarm or the crotch (I'm using the laymens terms here, we say things like "axilla" and "crotch"), but the palms and soles are also common".  It's that last part that is the problem.  If you showed me the darkest, velvetiest lesion in the world on someone's palms and told me this person resisted enough insulin to murder a cow, and has a cancer the size of an Oldsmobile on their face, I would have no idea what it is.  Acanthosis nigricans is a lesion of the underarm.  I've seen that question and picture 1000 times.  It's in the underarm.  You, Patient, may only present with a velvety underarm, as I've been taught, or you can leave and come back when you've figured out how to present like the textbook.

Even the National Board people know these are pointless questions with no clinical basis.  On Step 2, the next exam we have to take, all of the questions start, "A 53 year old male with a history of hypertension presents because of abdominal pain...".  The question stem implies a clinical situation.  The questions for Step 1 start, "Medical students wanted to quiz each other so they created the following diagram..." Another actual gem I came across, "A doctor was cleaning out their old files and found a case report of a rare disease..."  Even they know this stuff isn't real.  Why not just ask, "Do you know the following piece of useless information?"

*Note: A lesion is a term we use for a variety of  problems when we don't want to be so specific as to reveal ourself as a clueless jackass.  It's as generic as saying someone is from "Asia".

Wednesday, March 9, 2011

Thank goodness it's not the 90's anymore*

There is a guy who legitimately sat down at the book store to look at Magic Eye. I wonder if he wants to devil stick later, then watch TGIF?

*Note: I really wish it were the 90's again.

Long time, no poop joke

"My pooping schedule is way off." -Every med student that just started clinics.

Sunday, March 6, 2011

Starting over, again.

I just finished studying for the national board exam (way more to come on this, but first I have to drive all that bullshit knowledge out of my head. And get over my post-traumatic stress disorder) and went back to the clinics.  This was a bit of a shocker.  I left clinics 2.5 months ago feeling as confident as a med student can be.  I could walk blindly into a patient's room and come out 15 minutes later with the most complete history and physical this patient has ever received.  I'm talking full review of systems.  I'm talking recent pet exposures. I'm talking auscultation and palpation*.  My fellow students and I were armed with a complete set of medical knowledge (as defined by our ability to bullshit our way through pimping questions).  We could stand for 18 hours without even so much as an awkward shift.  We gave up the instinctual need to urinate.  Those things are for the weak.  We were medical students done with our clerkship year.  We were the strong.

Then we went on winter break.  Then we went on extended winter break.  Then we sat down and studied 12 hours a day for the board exam learning the most clinically useless information ever to be associated with medicine.  Then we went on another winter break.

Then we went back to clinics.

And guess what? We didn't know shit. Again.  As my one friend put it, "I forgot to do an assessment and plan.  I finished my presentation, presented the lab values and radiology studies and just stopped.  Everyone was just staring at me. I was like, 'That's it'.  Then a resident politely said, 'We were kind of waiting for your assessment and plan.  You know, what we should do with this patient now that we know about him'.  I just completely forgot we did that."  We are back to being worthless, awkward, stupid med students. Two months and we are already back to borderline lay people.

I think if you could find the end of a rainbow, you wouldn't find gold, you'd find all that shit you used to know.

*These are med school jokes. A review of systems is a review of asinine things completely unrelated to the patient's symptoms.  Pet exposures are very important if your patient is a walking board exam question.  Inspection and palpation are parts of a physical exam to be done on all general parts of the body and are therefore never done.  Ever.