More Coherence

So I've been doing high diving shows for about a week. I'm still in that nice hotel in California, but over the past few days the insomnia has slowly started to set in. Our shows are from 5 PM to 10 PM but I'm up at like 5 AM everyday and I just sit in the hotel room on the internet. I bought a 350 GB external hard drive and I've been loading it up with resources for the upcoming year. The financial crisis has me worried because one of the private student loans I was approved for and waiting for sent me an email saying that because of the crisis in the capital markets they wouldn't be able to give me that loan after all. School starts next tuesday and I just want to get back to Prague and hope that my Stafford loan has come in so I can just have my last year payed for and under way.

I still haven't heard about my Step 2 CS score. I imagine it will be a few weeks yet. I hope I pass, I imagine there's a possibility that I could fail but to tell you the truth the test which worried me more was the Step 2 CK. I really felt that there was more real world doctor knowledge involved in that. Although I don't feel as though my school has done much to get me to becoming a doctor I actually feel like I have come very far under my own steam. In the past two years I have been studying continuously and I have noticed how much I have come to learn. I hope that I get a job quickly after school because I actually feel that I would be competent. I feel like I have learned all that I can from books, have seen all that I can as a spectator and it's just time to actually start doing something. In a way I'm happy that I've had time to read all the medical texts I have, but I find the education paradigm here to be way too painful and way too drawn out. 6 years really is too much time. I'm glad that I took the USMLEs when I did even though taking them at a later date might have given me a better score because now one week before I start my last year of medical school I can say that I have had contact with all fields of medicine. All the subjects that we haven't done in school yet like Pediatrics, Ob-GYN, and more Surgery I can say I have some knowledge of. I feel like instead of learning things for the first time this year and being behind the eight ball I will get to spend more time pulling together all my knowledge into a workable form. I start every year hopeful that it will be the year where everything gels together and I'm sadly let down by the end of the first week, but I think this might be the year I'm not let down. I am going to have more time to spend with the Anesthesia-Critical Care department I think too. I applied for residencies in America for the 2009 year and in the event I get one the amount of anesthesia time I will have done this year should prove helpful.

Another word about the USMLEs. I applied to some anesthesia and internal medicine residencies for the coming year. I have to finish all of my coursework ahead of time in order to start a residency which might be possible, but the limiting factor so far has been my USMLE grades. I have automatically been rejected from a few just because of USMLE grades. I understand that my grades aren't that good and they have hundreds of applicants and it's the easiest way to weed out applicants but still the idea that I am just the sum of my USMLEs is aggravating. As I have spent more and more time abroad I have become a greater proponent of standardized testing for physicians. After seeing how little knowledge you need to have to make it through some oral examinations I think a thorough, comprehensive, computer based test is a good idea for future doctors. But I find the USMLE to be a bit ridiculous. In medical school your teachers tell you that you can't jump to diagnosis. You may see a symptom or sign and you may even see one pathognomic of a disease or syndrome but you must establish a differential diagnosis and confirm a presumptive diagnosis by some ancillary test. Why is it we are taught this, but tested in the totally opposite way? The USMLE is a long, laborious, written exam which allows you about 70 seconds per question. You read a long passage describing a patient which takes about 30-40 seconds and then you have like 30 seconds to read through several answer choices. Typically people who do really well on the USMLE had prepared with some test preparation company like Kaplan or USMLEworld and they look for key phrases that are taught to them in the question. You see the key phrase, you see the answer, bingo. In my mind this dumbs us down. This type of testing is counterproductive to the differential diagnostics skills we are supposed to acquire while student doctors. In my mind test formats like the current USMLE teach us to approach everything with blinders, look for certain signs and symptoms, and pick the right answer. This might work on test day but in the real world it might cause us to fail.

I'm a little bewildered going into my last year of school. My future is uncertain. I don't know if I will get a residency for this coming July or if I will be unemployed for a while. Although I feel as though I have come a long way in my learning I know that there is still a long way to go and there is no end in sight probably because the end to medical education doesn't exist. I sit here writing this passage excited of what might lie ahead, scared of what could become of me, lamentful of some of the past, and hopeful that it all works out.....but certain that it won't, at least not on the first try.....nothing is ever that smooth.