By KIMBERLEY MANNING, MD

On May 19, 1996, I graduated from medical school. And although I look and seem ridiculously youthful (I know, that’s what you were saying) it’s beenâ€"as my patients at Grady like to sayâ€"”a mi-nute” since I was a medical student. This week, for a myriad of reasons, I have been reflecting on how much as changed since I was a medical student.

As a medical educator of both resident physicians and medical students, I get to see this evolution taking place before my very eyes. Some of the changes have definitely been for the better. But real talk? Some of them have probably been for the worse.

Today, I bring you the top ten things that have sho’ nuff changed since I was a medical studentâ€"good, bad, and . . .let’s just say. . .different.

#10. Class.

For most folks who went to medical school in the early to mid-nineties like I did, the first two years were all pre-clinical and all in class.

We didn’t go near any patients until third year. And no, I’m not counting the Physical Diagnosis class that we participated in for the second half of our second year. If I recall correctly, that clinical time was spent either shadowing some busy doctor OR scaring the crap out of yourselves by listening to your Physical Diagnosis partner and making very off diagnoses. (Like the ganglion cyst behind my ear that me and my partner Ernest P. decided was a slow-growing lymphoma. . . um, yeah.)

Anyways. We had class all day, every day Monday through Friday. And what’s interesting is that the culture was that we went to class without fail. Skipping class was not cool. So for that reason, there were very few people in my class who didn’t regularly attend class. Unfortunately, this isn’t so much the case these days.

Verdict:

Not being in class 24 â€" 7 is a good thing. Getting clinical experience early in the game (our students start seeing patients in the first semester of the first year!) is a sho’ nuff great thing. But thinking that you can learn medicine from transcripts, from studying on your couch or in Starbucks without going to the like 2 to 3 hours TOPS of lectures that most medical schools have evolved to having? Wompity womp womp. Thumbs way down, dude. Medical school is not an on-line adventure. Period.

#9

The Internet.

So how ’bout we Xeroxed everything back in the 90’s. Waitâ€"do y’all even know what it means to “Xerox” something? Do people even say that any more? Dang.

Old tests were schlepped around in a big box and shared between friends or at Kinko’s. There was no following the lecture on Power Point or any such thing. You took your butt to class. You busted out your highlighters and rollerball pens, and you took notes. Old school style.

Verdict:

Having the internet for resources, learning and sharing of material is definitely a sho’ nuff good change.

Having one hundred and thirty people intermittently “poking” each other on Facebook during a lecture that you spent twenty hours preparing since they know that the transcript service will have it posted on line later? Boo hisss.

#8 Clinical work.
When I was in medical school, we had this rotation called the “acting internship.” They do still have that now, but a lot has changed since we were in that role. We used to have two fourth year medical students join a team, and somehow that became the equivalent of one intern. We were folded into the call schedule, we wrote notes and orders, and we cross-covered sick patients overnight just like any intern would. And if you weren’t there? Oh, you were definitely missed. And not just missed because you’re niceâ€"but missed because you were literally acting as an intern.

It was terrifying.

These days, the acting interns, or “sub-i” as they are affectionately called, do get to do more than the third year clerksâ€"but as far as being exactly like interns? Uhhhh, not so much. Now it’s not because they don’t want to. But more because there are a lot more laws about who can write notes and orders and all that jive. It also requires more work out of the supervising resident since they have to be there to cosign and make every decision official. In other wordsâ€"more layers between the student and the medical decision making really waters down the experience. And that “being terrified” thing? It’s actually very necessary.

My classmate Jada R. and I were doing an away rotation at a very fancy-schmancy institution during our fourth year. We signed up for what we thought was a month of Ambulatory Pediatrics. SIKE! We arrived and promptly had a big ol’ call schedule grid handed to us with our combined names as the “intern” on one of the teams for that month. It was crazy. What made matters worse was that we had the laziest senior resident of all time covering us who regularly said to us:

“Call me if you need me, but need me if you call me.” (Right before he toodled off to the call room to post up with a tiny portable black and white television.)

Um, yeah. I will never forget the day that we both stood in front of the bed of this acutely ill child and, after doing all that we knew to do, decided to call a code. Us. The medical students. Called a code. And did I mention that this automatically made us the first responders? Lawd. Talk about some tremulous chest compressions. . . .

“First rule in a code: Check your own pulse . . .” ~ The House of God

Verdict:

Senior students getting less autonomy on acting internships? Uhhh, yeah. I’d say the old way was better, as long as the supervision was appropriate. Patient care is kind of like running long distance. The only way to learn to run long distance is to run long distance. Feel me?

#7 The clothes.

When I was a medical student on the wards, we were anatomically different. Seriously. I am pretty sure that no one had a belly button, an upper thigh, or cleavage. If they did, I didn’t know about itâ€"because their ass got sent home by one of the senior faculty long before anyone could catch a glimpse of it.

Verdict:

Clothes for the club should be kept separate from clothes for the clinic. That’s all I’ll say on that.

#6 Cell phones.

I still have no idea how any of us knew how to find each other. My first cell phone was this scary contraption that I bought for emergencies only at the end of my senior year of medical school. Every call was five-trillion dollars per second and, for that reason, no one had your number. Matter of fact, if by chance you did give your closest friend your number, it didn’t matter because you couldn’t afford to answer the phone.

Verdict:

Being able to find each other is a good thing when you’re a med student. Having cell phones sure would have saved a lot of folks from a lot of unnecessary fumbles. A quick text could have alerted you to all sorts of things before they happened:

“Girl, you need to change that short skirt ’cause Dr. Johnson is here today.”

“Aww, damn! I’m too short?”

“Yeah, playa. Don’t forget the stockings in case he’s really tripping.”

“Good lookin’ out!”

Instead, all you could do is wince when such things happened.

#5 Breaks.

The only breaks we ever had were for major holidays connected to Jesus either being born or being resurrected. I’m sayingâ€"I cannot keep up with all the breaks that our students get. Spring breaks, fall breaks, intersessions, discovery periodsâ€"and when I tell you these students make the most of this time away? Baby, I mean it.

I ask the students what they are doing for their break and if often is one or all of the following:

“Vail”
“The Galapagos Islands and Machu Picchu!”
“South Africa.”
“China.”
“Bangkok.”
“Hong Kong.”
“Paris and then maybe Amsterdam for a bit.”
“The Amalfi Coast.”
“St. Tropez.”
“The MOON.”

Um, yeah. I promise you that I am not exaggerating AT ALL. Ohâ€"and if I sound like I’m hating, oh it’s only because I am considering the only place me and my friends went was Chattanooga, Tennessee to the outlet mall. One, because we were broke. Two, because we were broke. And three, because we NEVER had a large enough chunk of time to go anywhere other than Subway for a five dollar footlong between study breaks.

Verdict:

Becoming a doctor can be heavy. Taking time out for breaks and personal enrichment is a good change if you ask me.

#4 The Verbal Filter.

When I was a medical student, we called everyone who was already a doctor “doctor.” We followed directions and showed up where we were supposed to show up and 99% of the time felt so freakin’ happy to be in medical school that we wouldn’t dare not act like it.

So this is probably one of the most disturbing new developments I’ve seen. Now, first, let me give the disclaimer that there are many, many wonderful, insightful, humble, and respectful medical students all across the country. But. There is also a growing culture of disturbingly entitled learners who not only look gift horses in their mouths but kick them in the teeth, too.

I overheard a student say this about a part of their curriculum that they didn’t like:

Student: “This whole part of the curriculum is bullshit and a waste of time.”

Faculty: “Well, it’s mandatory, so if you don’t go, you won’t graduate.”

Student: “Like I really won’t graduate. Yeah right.”

(SCRATCH THE NEEDLE ON THE RECORD)

Wait, huh? Awww, hee-yaaaallll nawww!!!

(Picture me kicking over a chair.)

Are you, like, kidding me? Yeah, now this? This is not something that would have gone down when I was a medical student. This exchange was in the presence of a faculty member. When I think about how much work, how many babysitters get hired, how many spouses get angry, and how many meetings we all go to just to work on the curriculum. . . . .all I can say is this:

Them’s fightin’ words.

Check it: There are goo-gads of studies looking unprofessional attitudes and behaviors in med students and how it all pans out for future disciplinary actions like litigation and state board problems. No shockâ€"even the smart kids who have had professionalism issues are much more likely to find themselves in trouble at some point. And this isn’t just my opinion. This is evidence-based.

Telling a professor to “stick it” by quasi-boycotting a part of the curriculum that they worked hard on or just fussing about that curriculum in the most unproductive way ever is not only entitled and immature, but painfully unprofessional. When I recertified for the Internal Medicine boards last year, I was required to do over twenty something hours worth of question banks, literature searches, surveys and much more. It was horrible. But you know what else it was? Mandatory. Now. If, by chance, someone has asked me my opinion on the whole thing, I would have wanted to say:

“I am a clinician educator. I work with medical students and residents in a teaching hospital every single day. I read. I teach. So forcing me to do fifty five hours worth of homework is like a giant thorn jabbed directly into my side.”

The key word is “wanted.” Just because you are thinking something doesn’t mean you say it. And just because you don’t exactly want to do something that is professionally mandatory, doesn’t mean that you are so special that you get to be the one who doesn’t. Be that the maintenance of certification process. Or just, as my husband the military dude would say, shutting your piehole and doing what you are supposed to doâ€"like participate in a part of your med school curriculum.

Newsflash: That’s life. Especially in medicine.

Verdict:

Some of that old school deference should be recaptured. To those who do “get it”â€" I’m not talking to you. To those who are smirking at this and calling it stupid, here’s my wise words for you: check yourself before your wreck yourself. Oh yeah, and while you’re at it? Do what all of us grown ups and professionals do when we are faced with mandatory hoops that we must but don’t wish to jump through:

Suck. It. Up.

Ugggh!

#3. The Library.

A literature search used to involve waiting twelve thousand years for a librarian to help you find the paper that you located in the antiquated INDEX MEDICUS. There was nothing quick about a lit search back then. And it was PAIN. FULL. Oh and did I mention that since we did not have internet access during my intern year and med school years that our questions were found in big, fat, textbooks. That we carried around in our backpacks. Crazy, I know.

Verdict:

Hallelujah for Pub Med.

#2 The Confusion.

I have to give the medical students these days credit. These kids are scary smart. I recall quite a few times in medical school where I was frozen in terror during a lecture. I’d realize that, after taking three pages of notes, that I had NO IDEA what the professor was talking about. Whatsoever.

But the med students these days? Fuggeddaboudit. They are all over this stuff. They type 100 words per minute and they ask us questions so hard that we immediately question our medical school diplomas. I don’t know if it’s me, but the learners seem smarter than we were. Now, the work ethic seems to be a lot differentâ€"but sheer smarts? They’ve got that.

It’s amazing how well these students can digest information and multitask. They grasp the most complicated concepts all while tweeting a friend, reading the New York Times on their iPads from the back of the room, and balancing their checkbooks at the same time. That part really impresses me.

Verdict:

The future of medicine includes some really bright minds. Which if you ask me, is a GOOD thing.

#1 The Friends and the Fun.

Boy did we have fun in med school. I’m talking a full on blast. We worked hard, yes. But man did we play hard. I made some of the best friends I’ve ever known in med school who remain my closest confidants to this very day. I’d like to think that our crazy duty hours and ridiculous schedules created that in us. I’m even tempted to say that we were WAAAAY closer than these young bucks in medical school these days.

But I can’t.

The good news? It looks like that part hasn’t changed one bit. I’ve witnessed some rich friendships grow out of the the medical school, and even a few love matches to boot. It warms my heart to know that the same ties that were fostered by those all nighters and post-exam parties in the 90’s still live on.

Verdict:

A lot has changed. But some things always remain the same.

Kimberly Manning, MD, is an assistant professor in the Department of Medicine at Grady Memorial Hospital in Atlanta. As both a clinician and educator, she teaches pre-clinical medical students and residents and serves as residency program director for the Transitional Year Residency Program. She blogs regularly at Reflections of a Grady Doctor.

Additional posts on THCB by Kimberly Manning:

Perspective

Filed Under: THCB

Mar 27, 2011