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".

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