Failing a Medical School Exam

We had our first information night on clerkship a few days ago, and if you weren’t thinking about clerkship before, you’re definitely thinking about it now.

I also failed my most recent exam (that’s bad). A first for me in medical school (that’s not so bad!).

So there’s a lot on my mind.
But I feel like it’s not immediately accessible.
And that I need to have some intelligent and clever way of articulating it when it does become accessible… which in turn probably inhibits its accessibility…

And I’m sure there are certain practices or routines to engage in to give someone an introspective clairvoyance; mantras, yoga, going for a run in the morning, 20 pushups before breakfast, 15 minutes of John Coltrane after dinner, new-age binaural beats videos on youtube, taking LSD in the forest. Whatever the practice, my struggle is with consistency. I do things for a little while, but not for longer. Brevity seems to be an addiction of mine. Shorter personal encounters, shorter meal times, hell I double speed every video I watch on youtube now, let alone medical school lectures. It’s not about truncating the experiences, but making them happen faster. Most of all, I wish to speed up the time for me to become this intelligent and capable doctor — who aside from being gentle(wo)man and scholar is also a polymath, speaks 5 languages, recites Homer and quotes the Upanishads, and publishes quality work both in science and in arts… no pressure.
But, what were to happen if this journey were to be sped up? Put on double time? Would I be as appreciative in its culmination? Probably not.
Would I feel as deserving of the special privilege a doctor has in caring for those who are sick? Probably not.

Expertise demands slow knowledge, the tenets of which are this: wisdom, not cleverness, is the proper aim of true learning, and that the velocity of knowledge is inversely related to the acquisition of wisdom. Careless application of knowledge can destroy the conditions that permit knowledge of any kind to flourish.

Stepping back and recognizing this has really promoted a stronger connection with the topics we learn, a sentiment I feel gets lost in the structure of medical school examinations and being left with what feels like a defunct pile of random facts that we sweep under the rug at the end of it all to make room for the next. I love being challenged, but I want to be challenged in a purposeful and meaningful way. I felt cheated by the process. In the exam I felt as though many questions fell into a “careless application of knowledge” category, requiring the retention of random fact, and not any valuable or purposeful thinking (disclaimer: I understand medicine requires memorization of a lot of facts, which is all part of being an expert, but I believe there needs to be a balance here).

Google and the immediate access to answers has completely changed our relationship to knowledge. My mark on this exam better reflects a relationship to random fact, and although it made me feel upset and disappointed and bitter at first, it became easy to let go of those feelings once I realized that random facts are not a measure of my intellect, my hard-work, or my aspirations to be a great physician, a form I choose to define with critical thinking, compassion and empathy, and making more meaningful connections between knowledge; aspects of learning that elevate and give meaning to the facts. Aspects of learning that add a level of comedy and absurdity to getting %64 and feeling depressed, vs getting %70 and feeling nothing above being pleased for ‘passing’. Would I have felt any need to reflect and write if I just remembered the side effects of risperidone, Dubowitz’s approach to child neglect, or the equation for mid-parental height, and scored those few extra percentage points? Probably not.

To clarify, I don’t believe that the knowledge we gain in medical school for particular topics are ‘random fact’. I know the vast majority of the content we learn is highly purposeful and has significant implications for patients dealing with illness and taking medications. However, seeing as how we are responsible for remembering insane amounts of information for our examinations it does feel random after seeing something like “list the effects of this thing that was mentioned at the bottom of a slide in that lecture I gave with 60 slides of content in a sea of other lectures that combined have well over 2,500 slides of information”, and you sit there and think, “well shit… if I just looked at that risperidone slide for a little longer, or the Dubowitz thing…”. Being tested in this way seems trivial and I felt disengaged from the material, having to remind myself at a later time, when my emotions had cooled, that this is actually important. I don’t know if the examples I used above resonate with anyone, but I’m sure you can think of your own “risperidone side-effects and Dubowitz’s whach-ya-ma-call-its”.

Back to my intro on clerkship, I did feel anxious after getting my mark back that I am going to have a hard time being a great clerk in 3rd year. However, I’m not under some illusion that performing well on exams will make me a good clerk either, because exams really only measure a fraction of what being a good clerk (med student, resident, or physician) is all about, AND I think exams are given way more weight and worry and energy than they are worth. I can’t imagine it’s the best way to really evaluate the knowledge we gain here. But I also don’t really have any alternative solutions, sooo…

I think as a running mantra I can play in my head to help me keep this all in perspective is to really always be keeping in mind the person behind the things we learn about, imaging that between the lines of a symptom or side-effect list, or treatments and management guidelines, is a person who is forced to deal with it all. I think that will keep it more human, make it feel real, for now at least, because next year it will all be very real.

And it’s not about feeling the full weight of humanity’s needs and suffering on your shoulders, but I think stepping outside of the constructs of modern medical education and looking for the humanity in the content will help us to participate in that suffering.

That to me feels like a far more fulfilling test.