Moving from Chicago to New Orleans was a culture shock. However, the change from my undergraduate university days to medical school proved to be an even bigger challenge. Until then, I had always been, if not first in my class, at least in the top five percent, and had never received a failing grade on an exam. For the first time in my experience, I found myself surrounded by other students who were able to perform at levels clearly above my own, despite maximal effort on my part. I’ve already written about my struggles through gross anatomy that I was able to attribute partially, at least, to the absence of my lab partner, and which I thankfully survived. However, at the end of the first semester I found myself in the third quartile of my class. Though better than the bottom quartile, this class rank came as a blow to my self-image as a top student, and increased my determination to improve my standing. It also planted a seed of doubt regarding my choice to go to medical school – was this the right place for me?
The new semester began with what turned out to be a disastrous academic experiment. The school decided to teach neuroanatomy as one concentrated three week course, rather than spreading it out over the full semester, along with the other second semester courses of physiology and biochemistry. For those of you who ever crammed for an exam, you know that you may be able to pass an exam on the material you stuffed into your memory, but your long term retention of the knowledge you acquired will be suboptimal. A few of my classmates were able to keep up with the accelerated course as it was presented, but the majority of us struggled throughout. The final exam seemed like a nightmare, and our aggregate poor performance forced the passing curve to be so low that we got through, but the experiment ended with our class. (My personal opinion is that grading on a curve should never be employed in an educational program where people’s lives and well-being depend on the knowledge you are supposed to have.) At this point, I was so demoralized that I was ready to quit school. Fortunately, I sought the advice of my faculty advisor to share my feelings. He explained that I was making a huge mistake in comparing myself to other people. He advised that I should only compare myself to my prior performance, setting reasonable goals for improvement. If I had worked to the best of my ability, I shouldn’t beat myself up, as we are all given unequal talents. He then went on to reassure me that he had seen enough students and had sufficient faith in my abilities that he was confident I would do well, and improve with time. Thankfully, I listened, and his prophecy turned out to be accurate. By the time I graduated, I would be in the top 20% of my class.
Physiology and biochemistry turned out to be courses that proved to be much better suited to my interests and talents. If you studied and understood the basic concepts, there was a lot you could figure out on your own. Also, these were subjects in which I already had a good foundation based on prior studies, so there was less brute memorizing required. And finally, as it happens in life, luck plays a role in the final outcome.
As an undergraduate, we were required to write a thesis related to our major. The subject I picked was the chemistry of serotonin, then a relatively newly described substance with a rapidly growing list of actions within the human body. Being described by Gadum and Tate in a landmark paper as the “substance of sanity”, it was getting recognition not only in the academic but also in the popular press. (Who knows where I could have ended up if I had helped pioneer its research trail?) Regardless, based on the research I did as an undergraduate, I suspect I knew as much, if not more, about serotonin at the time than most of my biochemistry professors. The course had an oral exam as part of its final evaluation, and when it came my turn, the examiner asked me to tell him everything I knew about serotonin. I could hear the groans of my classmates when I was asked to discuss what was then an esoteric topic. I maintained a straight face, went up to the blackboard, and for almost a half hour reviewed the history, chemistry, known biologic actions, and degradation products of serotonin. When I finished, one of the professors smiled at me and said, “Seems like we asked you the right question, didn’t we?” It certainly helped pull up my GPA for the year.
Second semester of medical school was also our first introduction to patients, the reason we all signed up for this career. The course titled “Introduction to Clinical Medicine” taught us the basics of history taking and physical examination, which is the foundation of all patient encounters. We had yet to learn enough about diseases and symptoms to know what questions to ask, but general interviewing techniques along with an awareness of cultural nuances provided important basic building blocks for our clinical rotations. We were introduced to the essentials of physical examination through use of all our senses, as well as our new tools: stethoscope, otoscope, ophthalmoscope, and reflex hammer. These we carried proudly in the pockets of our lab coats, additional badges of our desired new profession. Sadly, the skills we worked so hard to acquire seem in general decline today, at least in part due to decreased time allotted for patient visits and increased reliance on expensive (and sometimes unnecessary) imaging tests.