January 28, 2012

THE test

     Right after we got back from Christmas vacation, we were required to attend a meeting with a couple of the deans, which needless to say is unusual.  She greeted us with, "welcome to one of your hardest semesters in your training."  In June, we take our first licensing exam known by the boring name of Step I.  Talk about the banality of evil.  Frankly, it's more than a little terrifying as it's a monster exam (8 hours) and pretty much determines one's eligibility for various residency programs.  And medicine keeps getting more and more complicated so there's more for us to know.  More diseases, more genetics, more molecular mechanisms, more drugs, more everything.  To illustrate that point, here's a few slides from a presentation recently given to us.

     The first one represents a question from someone taking the Step I in the 1980s.  It's easy.  It simply asks what drug do you give for thrush.  It gives the diagnosis to you right off the bat.  Yeah, patients do that all the time.  And it even uses the common term 'thrush' rather than the medicalese 'candidiasis'.  The answer is E. Nystatin (though, to be quite honest, the drug doesn't work that well, you have to take it 4 times a day by swishing it around in your mouth, and it tastes like crap - not exactly a wonder drug).

     Then in the 1990s, you are now required to first diagnosis the patient, and then figure out the therapy.  A bit harder as it's now a 2-step process but still not too difficult.

     Now fast forward to this decade.  Rather than a simple question and answer, it's now become a three step process.  First, you have to correctly diagnose the ailment.  Not too hard.  It's thrush.  Wait, what about the picture?  Is that really thrush?  Could it be a bacterium?  Nah, no bacterium looks like that.  Definitely a fungus.  But is it really a Candida species, or is it a different fungus which might alter therapy requirements?  Does Candida have a germ tube or was that whatsitsnamethatIcan'trecall?  They're trying to insert some fuzziness into the question.  But let's stick to our guns and say Candidiasis, aka thrush.  Second step.  What's the drug to give here?  It's still nystatin.  But that's not the question.  They want the mechanism of action of said drug.  So even if you know the mechanism of nystatin, you've first had to diagnose and identify the proper treatment before you can even get around to answering the question.  Or conversely, even if you know the first two but forgotten the mechanism, you're still boned.  It's now a three step process and you've got 60 seconds to answer the question or you start to fall behind.

     And I love this one.  Like before, you have to first identify the ailment of the patient.  It's alzheimer's.  And what goes wrong in alzheimer's?  Memory.  And what part of the brain is that?  Hippocampus.  All of those are relatively easy.  For me it gets substantially harder when I have to harken back to neuroanatomy and recall where the hippocampus is...on an MRI.  Now repeat this process all day long.  Oh, and you are to study for this while taking your regular classes.  Like I said, more than a little terrifying.

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