Wednesday, September 17, 2008

Lament Over Education; or, I'm Going Through a Little Blue Period of Sorts...

I have become convinced that (perhaps unbeknownst to itself) this country doesn't give a flying frigging rat's patooty about education.

Worse: I think a lot of people here actually see being educated as a negative - at best, an "elitist" goal; at worst, a useless endeavor; and somewhere in between, an embarrassing obligation.

Someone please tell me I am wrong and am just going through a little slump triggered by thoughts of being on call every other night at the end of next month. Please. Someone please reassure me that all the propaganda about reading to our children isn't just empty hypocrisy in light of how little we end up reading as adults.

Here's what's behind my momentary cynicism. American politics, for one thing. And for another, American pre-medical education. Both worlds, incidentally, highly competitive, centered around defeating opponents and making oneself appear irresistible despite the reality of one's qualifications. And both worlds ones in which a solid grounding in the humanities AS WELL AS the sciences - in other words, a well-rounded education - seems grossly undervalued.

Let's leave politics alone right now; there's no shortage of verbiage on it all across cyberspace. But what of becoming a doctor?  What of pre-medical education?  Why are we still wondering what that educational path should consist of, after discussing it, criticizing it, revamping it, defending it, and criticizing it yet again, for the last hundred years?

I believe all doctors should be well-educated people who appreciate the value of a truly liberal education. But a lot of doctors echo in spirit what one thoracic surgeon once said when the patient was surprised to learn she hadn't read an author that the patient had been discussing with me as I placed monitors before administering the anesthetic. The surgeon said to the patient, a little acridly, "No, I was busy reading things that would actually be helpful to you." I wanted to make a little sound of incredulous protest but I held my tongue. I was surprised, though, by the intensity of my own resentment of her remark. I felt personally affronted.

Let me tell you, my having had to learn organic chemistry has NOT been helpful to my patients, and I've forgotten it all. All of it. Hours of effort, sweat, and tears - gone. Calculus is NOT helpful to my patients either (though I did use some arithmetic once trying to calculate how much bicarb to give somebody in an extreme state of acidosis). The work in medical school is do-able for anyone who is reasonably intelligent, interested in the material, and willing to work very, very hard. It was certainly easier than organic chemistry for me, and more relevant...though a lot of what we learn in medical school never, ever comes up again in clinical practice (unless you're an anesthesiologist; then it comes up every day). Whatever you end up choosing, though, chances are having gotten an A in orgo was no more predictive of your being a good doctor than getting a B or a C, and getting a B or a C no less predictive than getting an A. 

Don't get me wrong; I believe a strong education in science is integral to medical study and of vital importance regardless of one's chosen profession.  But encouraging intense focus on hard sciences, for a secondary goal (admission to med school) rather than for the sake of science itself, to the exclusion of the humanities, selects for a very particular (competitive, self-interested, often arrogant, and at times, decidedly un-empathetic) type of student - often, for students who get really good at shutting themselves up in rooms with their noses in textbooks away from the rest of teeming, suffering humanity. 

Authors Jeffrey Gross, Corina Mommaerts, David Earl, and Raymond De Vries couldn't have painted a more accurate picture when they wrote in their paper for the journal Academic Medicine,

"The requirements established by medical school admission committees and the courses and tests used to weed out those who are not qualified to become physicians do more than lay the groundwork for the rigors of medical school - they also create a premedical student culture with a distinctive set of norms and values.  One does not have to believe in the existence of the premed syndrome - excessive concern with grades, extreme competitiveness, and lack of sociability - to acknowledge that during the premedical years, students learn more than information from their textbooks and teachers."

If medical students end up forging effective relationships with members of suffering humanity, understanding the ramifications of their patients' conditions, and negotiating the often complex journey from clinical evaluation to clinical decision, it's not only because of those hours of isolation spent memorizing facts that they won't be applying in the practice of their art anyway. It's because they learned, in the course of their journey into adulthood, how to participate in story and relationship - how to understand, evaluate, discern, and communicate. The ones that aren't afraid to touch their patients on the first day on the wards already have something that can't be taught - but that can be learned.

I'm with Lewis Thomas: let's stop encouraging the formation of stereotypical "pre-meds" (carbon-based life forms) and start going for real people (flesh and blood and, if we're lucky, soul). He wrote, "I have a suggestion, requiring for its implementation the following announcement from the deans of all the medical schools: henceforth, any applicant who is self-labeled as a premed, distinguishable by his course selection from his classmates, will have his dossier placed in a third stack of three. Membership in a premedical society will, by itself, be grounds for rejection."

Huzzah, I say. Let's do it. Then maybe after another hundred years there will have been enough talk and revamping of medical education that we'll actually be nurturing physicians-to-be who, instead of making "strategic" pre-med choices to project the best "image," will be making genuinely self-edifying choices to be the best human beings they can be - and thus the best doctors.


Anonymous said...

EEEK! So, erm, you want me to take English? And pass?

rlbates said...

Yes, and some literature, etc.

Elaine Fine said...

Unfortunately I have to agree with you on all counts. It is certainly possible for a person who has the desire to get a good education, and for a person who has a great deal of desire to get a great education, but I fear that the larger part of the population (at least in America) does not have that desire. There are so many "other" ways to communicate, that those old reading and writing ways don't seem to matter to a lot of people.

I fear that one of the biggest problems is that professors in the humanities (and particularly in community colleges) want their students to like them. They want their students to think that they are "just folks," and they try to hide their "elitism." They are afraid to actually call people on things that need to be fixed in their humanities-based courses (like their poor ability to write clearly or to punctuate properly)for fear of getting a bad evaluation (in college teaching) or for fear of parental, institional, or community pressure. This simply fuels the problem, and keeps it alive through "generations" of students who go on to become teachers. The ultimate prize is a totally polarized society.

Thank you for the "expose" on the use of math and chemistry for actual doctors. I have a friend who would have been great doctor, but she wasn't able to do the math required to even get into medical school.

Anonymous said...

Biggest Waste of Time in College were the Literature and History courses I took to broaden myself. Learned more from the Cliff's notes and old episodes of Bullwinkle. If Obama ever releases his College transcripts see how much Science or Math he took. Heres a hint, "ZERO", unless there was an astronomy or highschool math course somewhere. And its not a Liberal/Conservative thing, Bush is the same.

Anonymous said...

I'm afraid that you aren't wrong.

It is terribly sad that someone could be considered elitist simply because of their educatio... I could go one for hours, but I won't.

I think that the attitudes of many of our countrymen have devolved into "kill all the peoplpe with glasses"

Mary Ann said...

That's why Marcus Welby, MD was such a popular physician, albeit TV fiction. He was uber-intelligent YET he had a heart. And one might hope he read many things other than just medical tomes!...

There are elitist mentalities abounding everywhere you turn. Politics, Medicine, Literature. I like the common-man's term for it, myself. SNOBBERY. I'm all for the well rounded individual, but a snob is...just icky.

What the world needs now is _______ sweet _______. It's the only thing that there's just too little of.

Just have stumbled upon your blog by accident as I was researching the image of Polixina by Repin (now how snobby does THAT sound!? HAHA) You write with great humanity, humility, intelligence and a sense of wonderment. I already really enjoy this blogspot.

And what an intense job you have. An anethesiologist! Your discipline is right up there with neurosurgeons in my rankings.

Anonymous said...

I'm afraid that I have to report a conversation with a freshman pre-med student who has never, by his account, read a book. Why is he in pre-med? Because it lets you "work with your hands."

Anonymous said...

Amen. And I'm glad to hear an anesthesiologist and not just one of us touchy-feely doctors say it.

Anonymous said...

I don't disagree that a diverse group of pre-meds should be selected for admission.

I DO disagree that you don't use organic chem and calculus every day.

Much of your knowledge, as a physician in general and specifically as an anesthesiologist, is grounded in those fields. Acid-base? O2-hemoglobin dissociation curve? Doing dosage calculations in your head? Tell me those undergrad courses didn't help you with those.

T. said...

Though I might INDIRECTLY, through the fruits of brilliant people's labors, use organic chemistry and higher mathematics in medicine, I really, really cannot say that I personally use organic chem or calculus at ALL, ever. I don't remember the first thing about them and would therefore be unable to apply them even if I wanted to.

While I agree that college science classes are valuable for one's understanding of the theory behind a lot of pharmacology, physiology, and medicine - and give people a good foundation for a certain way of thinking about things - I think the multiplication I learned in grade school and the algebra I learned in high school are all I've been using to do dosage calculations in my head lately, especially since I can't even remember how to do integrals.

I do think the training one gets in science courses - understanding how mathematical equations, sometimes so elegantly, can express biologic truths or processes; what variables affect the distribution or behavior of fluids in certain compartments; how perturbations in biochemical pathways can cause upstream as well as downstream disturbances, etc. - provides crucial "thinking tools" for integrating the endless information and complex concepts we try to assimilate in medicine. In that sense, then, yes, we do use this stuff day-to-day...but in my own experience, much more commonly in a holistic way rather than in a way that demands recall of highly specific/discrete nuggets of knowledge.

Finally, I feel about humanities scholars who shy away from studying science much as I do about science enthusiasts who undervalue the humanities. I think each attitude is self-defeating and almost irresponsible. I think if we're able to learn, we should strive to learn, as completely as we can, in as many fields as we have the opportunity to explore.

Anonymous said...

Why do physicians have to learn O-chem?

Because Osler said so, more than 100 years ago. Of course, what was taught in o-chem then is high school chemistry now.

In addition to humanities, I think that physicians should also learn basic business and economic skills. Unfortunately the political environment on most campuses will prevent factual information being presented to them.

Thats OK, they'll learn - Evolution in action.

T. said...

Fidel, what a fantastic point! I totally agree. We all need a solid education in business and economics. Thanks for coming!