Saturday, December 19, 2009

Retention

I got out of bed this morning to the realization that I’ve finished 1/8 of med school and 1/4 of the classroom portion. My first week of school honestly feels as distant as my arrival to college. Either I’ve aged that much over the last few months or I’ve forced most of those memories out in favor of the molecular cell bio from the first few weeks (that I’ve already mostly forgotten the details from). There are a few questions that I want to explore and I realize the format of these Blogspot blogs doesn’t have great readability, so I’ll break them down into separate posts. Since I have a few weeks somewhat off from studying, I’ll imagine I’ll be writing quite a bit. Aided mostly by the frustrating quantity of information I’ve had to gulp down, I’ve been questioning the traditional teaching methods of the first two years of medical school. This has been a frequent topic of discussion amongst my peers as we grouse about the level of detail in our basic sciences course. So, on to the first question.

Will I retain the majority of what I’ve learned? I can’t speak in definite terms for the future Aron, but I can say with reasonably good certainty that I won’t remember the specifics of almost everything I’ve learned in basic science classes. Odds are I’ll re-learn everything at least once more, and then choosing a specialty will cause me to become very intimate again with the details of a particular region or system.

My trip to Boston over Thanksgiving helped me understand that much. Between my sister the resident or my brother-in-law’s two visiting friends (an M3 and an M4) gave me the opportunity to test this hypothesis. As I was preparing for a cumulative biochemistry exam, I’d occasionally throw out a simple quiz to see what remained important down the road. With all three sitting in the room, I offered up HMG CoA Reductase and was met with blank stares. Despite the emphasis by professors that this particular enzyme is important (it’s the rate limiting step in cholesterol synthesis and as such is the target for the family of drugs like Lipitor), it wasn’t until I recited its purpose that all three had knowing nods. It’s probably important to note that none of the three are headed towards cardiology, because then my question would have produced different results. Still, with the amount of energy we spend learning the names and function of nearly every enzyme in metabolic pathways, did it all go to waste?

I don’t think so, or at least not entirely. One of the biggest problems early on is that we learn fine detail about small parts of the body without having a good idea of how the whole body works together, the function of each organ involved outside of it’s job with respect to the task in question, or much of the clinical ramifications. My professors have done a good job interlacing vignettes throughout our learning, which certainly helps anchor concepts and remind us that pathology stems from errors in processes we learn about in basic sciences. Down the road, I’ll continue to remember the general concepts well enough to understand disease processes. Still, if it’s the concepts that are important down the road, why not shift some of the weight of focus onto concept?