The Dialect of Medicine; Postgrad vs Undergrad
Saturday, July 11, 2009
This week at AMSA I've met with students from all around Australia and New Zealand, and a continuing theme for discussion is whether medical school should be post-graduate or under-graduate. There's presently a mix across the two countries, but I would suggest that the actual trend is more towards post-graduate courses, and certainly that's how it is in the USA.
I'm an advocate for post-graduate medical schools, for several reasons. Clearly, my bias is that I'm at a post-grad school. There's the potential for some very young doctors to be out there, particularly in Queensland. At shortest, a five year medical degree after finishing highschool at 17 means that, aged 22, you're a Doctor. That's pretty young, sure, but I don't think that age is the defining factor.
I've also heard an argument that an important aspect is about the 'entry process'. The post-grad entry process takes, from signing up for the GAMSAT, sitting it, getting through the interview, a few weeks of waiting by the mailbox, a fantastic letter and showing up for O-week, all takes about fourteen months. Not exactly the blink of an eye, you might say. That time certainly allows for some lengthy deliberation between "I think I'd like to do Medicine." and;
"Wow, I'm gonna become a Doctor... I guess that means several years of super-intense study, being chained to a hospital for 70 hours a week for at least five years, neglecting the majority of my existing social relationships, earning good money and, most importantly, shouldering the responsibility of caring for society."
Sometimes I get the vibe that application to undergrad medicine in Australia happens more along the lines of;
"I'm top of my school. I like helping people. I think I'll study medicine.", and the person ticks the box.
New Zealand has an entry year, so instead of slogging one's self in the final year of highschool, a set Health Sciences First Year provides the barriers to entry. I think that this provides some sort of medium between a protracted post-graduate entrance program and a somewhat impulsive high-school entrance program.
The key point I'm pushing here is that there needs to be time for prosepective doctors to really, and I mean really think about why they're doing medicine. Importantly, candidates should be able to have a good concept of functioning in the adult world, and essentially what it is to communicate with people who are not close family, highschool friends, uni mates and colleagues.
A good way to think about it is languages. I'm sure you've noticed that highschool kids have their own way of communicating, be it the absence of vowels in text messages or the use of 'like' every third word, there's just a certain style to it.
University students, at least undegrads, also have a somewhat more developed form of specific language, with their own wee evolving dictionary of slang and popular terms.
Medicine, indeed, has an entire language of its own. The innumerable acronyms and abbreviations, clinical terms and anatomica. An entire sector of clinicans who can appreciate the difference between aortic stenosis and aortic sclerosis, and the prognosis attached to each.
As exemplified by Guy Ritchie's Lock, Stock and Two Smoking Barrels, which provides subtitles to translate cockney rhyming slang, it's a lot easier to converse in a language you can understand. The best method of understanding regular, non-tertiary educated lay-people is talking to them. That way, terms like 'knock up' (dyspnoea), and 'chroming' (huffing paint fumes) don't sound like a foreign language.
My point is, that before someone breezes from the highschool to undergrad to medical dialects, it's pretty essential to be able to talk to everyone else. Sure, medical school has several classes in which these aspects of communication are taught from a theoretical perspective, but they just don't compensate for real life experience. Post-graduate medical students not only have more years under their belts, but they're probably more likely to have a job. The job might even involve talking to people! Frankly, the more you live, the more you talk, the more you see, the more you understand.
I'm an advocate for post-graduate medical schools, for several reasons. Clearly, my bias is that I'm at a post-grad school. There's the potential for some very young doctors to be out there, particularly in Queensland. At shortest, a five year medical degree after finishing highschool at 17 means that, aged 22, you're a Doctor. That's pretty young, sure, but I don't think that age is the defining factor.
I've also heard an argument that an important aspect is about the 'entry process'. The post-grad entry process takes, from signing up for the GAMSAT, sitting it, getting through the interview, a few weeks of waiting by the mailbox, a fantastic letter and showing up for O-week, all takes about fourteen months. Not exactly the blink of an eye, you might say. That time certainly allows for some lengthy deliberation between "I think I'd like to do Medicine." and;
"Wow, I'm gonna become a Doctor... I guess that means several years of super-intense study, being chained to a hospital for 70 hours a week for at least five years, neglecting the majority of my existing social relationships, earning good money and, most importantly, shouldering the responsibility of caring for society."
Sometimes I get the vibe that application to undergrad medicine in Australia happens more along the lines of;
"I'm top of my school. I like helping people. I think I'll study medicine.", and the person ticks the box.
New Zealand has an entry year, so instead of slogging one's self in the final year of highschool, a set Health Sciences First Year provides the barriers to entry. I think that this provides some sort of medium between a protracted post-graduate entrance program and a somewhat impulsive high-school entrance program.
The key point I'm pushing here is that there needs to be time for prosepective doctors to really, and I mean really think about why they're doing medicine. Importantly, candidates should be able to have a good concept of functioning in the adult world, and essentially what it is to communicate with people who are not close family, highschool friends, uni mates and colleagues.
A good way to think about it is languages. I'm sure you've noticed that highschool kids have their own way of communicating, be it the absence of vowels in text messages or the use of 'like' every third word, there's just a certain style to it.
University students, at least undegrads, also have a somewhat more developed form of specific language, with their own wee evolving dictionary of slang and popular terms.
Medicine, indeed, has an entire language of its own. The innumerable acronyms and abbreviations, clinical terms and anatomica. An entire sector of clinicans who can appreciate the difference between aortic stenosis and aortic sclerosis, and the prognosis attached to each.
As exemplified by Guy Ritchie's Lock, Stock and Two Smoking Barrels, which provides subtitles to translate cockney rhyming slang, it's a lot easier to converse in a language you can understand. The best method of understanding regular, non-tertiary educated lay-people is talking to them. That way, terms like 'knock up' (dyspnoea), and 'chroming' (huffing paint fumes) don't sound like a foreign language.
My point is, that before someone breezes from the highschool to undergrad to medical dialects, it's pretty essential to be able to talk to everyone else. Sure, medical school has several classes in which these aspects of communication are taught from a theoretical perspective, but they just don't compensate for real life experience. Post-graduate medical students not only have more years under their belts, but they're probably more likely to have a job. The job might even involve talking to people! Frankly, the more you live, the more you talk, the more you see, the more you understand.
There is definitely a trend towards postgrad. Undergrad courses are changing over from didactic to PBL/CBL and (I think) the new undergrad courses tend to be 1) outnumbered by new postgrad courses and 2)5 year PBL/CBL types.
And there are definitely people graduating medicine who weren't ever really sure in the first place, and still aren't convinced, and have done it for all sorts of other reasons. Not all drop out to pursue what they really want to do. Some are still there, decades later, telling medical students that they should have gone to business school instead.
I'm a fan of the graduate route, mainly because of the life experience such a route offers before commencing med.
Too often I notice that undergrad entrants have a higher inclination to be slightly condescending towards others. Seems like whatever communication lessons they are taught go in one ear and out the other.
Yet, even with the postgraduate route, in QLD I'm studying with 18/19 year olds: Fresh out of highschool, 2 year excellerated biomed degree, 4 yr post-grad med, "Hello, I'm gradating from my post-grad degree just in time for my 23rd birthday!"
and yes...a lot of students have never (!!!) had jobs. wtf?
That condescending inclination has huge hilarity potential though doesn't it :)
ps. Thanks for the procrasto-studying fodder.