Before medical school, the dream of becoming a physician involves helping people and curing disease. During medical school, that dream matures through educational and clinical experiences into a realization that being a physician is something much deeper, a permanent responsibility that only those who are doctors themselves will understand.
Every patient is a trial and error that can lead to life or death. Is the abdominal pain just constipation, a brewing appendicitis, or even worse, colon cancer? Is the patient presentation worthy of simple reassurance, or perhaps blood work, or—to be safe—diagnostic imaging?
This persistent autonomy in decision-making is a real stress in the lives of physicians. Each day the accumulated knowledge, research, and personal experiences are tested in order to correctly diagnose those seeking the best possible care. These critical thinking skills are essential to handle the mental and emotional wear-and-tear that comes with the territory.
Reading this may be a harsh dose of reality. Even more so, watching the residents and attending physicians make literal life-and-death decisions while on rounds and during codes may lead to thoughts of, “I don’t think I can ever really do this…”
What if I told you that you were lucky?
You’re lucky to think this because no one ever knows for sure whether they can really do this. It is this uncertainty which makes us humans, and ultimately, which makes us better doctors. We need to question ourselves, and we need to question others. This is how we save patients’ lives. Inevitably, you will order extra tests for the patient who just has the stomach flu, and inevitably, you will mistakenly send the patient with cancer home to rest and hydrate and come back if things don’t improve. But you’re lucky because thinking that you can never know or do enough is what will make you an excellent physician.
Let’s take a step back and look at what you’re experiencing in medical school now. Each day you go to class or clinics, and you see things you’ve never seen. You learn things that you may not have even known were possible. After sleepless nights and endless days, you open your study guide to your board exams and you think, “I can’t ever do this. I will never know enough to pass.”
What you’re experiencing now is preparing you for your future. All of the hours in study, the stress, the fatigue – it all has a purpose. Over these four years, you learn little by little how to manage it all, how to schedule your time, how to prioritize, how to navigate. You aren’t just building up your medical knowledge base. You are cultivating yourself to become an all-around physician-human. You are grooming the necessary balancing skills for your future career and life.
To study is to “devote time and attention to acquiring knowledge especially by books”. You can study board exam guides, textbooks, and lecture notes. This can help you pass tests, pass courses, maybe even pass your board exams, but it doesn’t mean you are prepared. To prepare is “to make something ready for use or consideration,” – to make your knowledge ready for use or consideration.
Consider the practice of surgery. To become a surgeon, you don’t just read about the techniques you are going to use on the patient. You practice. You practice sewing stitches as a first year resident on pig feet or fruit, perhaps cadavers, and eventually on your first patient. You prepare your tools – you learn them, you hold them, you practice with them. You go over patient history, visually, audibly; you look for any sign that a procedure might not go as planned. You discuss with fellow surgeons their successes, their failures. You prepare. You take all of that knowledge and prepare it for use on your patient – the life in your hands.
There have consistently (and more frequently as of late) been arguments against board exams and their effectiveness in evaluating whether or not a student will be a competent physician. There are arguments that exams are biased and that there might be students who would make excellent physicians who will never get the chance. Those arguments may be true. However, what if you looked at those exams just a little differently?
I think it’s safe to say that the vast majority (ahem, all) of medical students are extremely goal-oriented. Their entire lives have been about stepping stones. They took the SATs, graduated from high school, and got into the college of their choice. They did well on their exams in college, studied for the MCAT, and got into medical school. What’s the natural progression? They go to their classes in medical school, pass their board exams, and become doctors. Herein lies the problem. These board exams, the exams that qualify a person to become a doctor are just looked at as another stepping-stone.
Imagine, instead, if students looked at their exams as a tool to better themselves and to become more competent physicians…if they prepared for exams to evaluate their knowledge rather than how many facts they’ve memorized, and then utilized their results to focus on areas in which they need to improve…if they prepared their knowledge “to be ready for use or consideration.”
This mindset then ultimately lends itself to a culture of lifelong learning, which is sine qua non for the practicing physician. We are members of a culture in which an infinite amount of information is available at our fingertips. We can read something, use that piece of knowledge for its specific purpose, and forget it because if we ever need it again, we can access it within seconds.
However, it is also necessary as a physician to stay up to date on new drugs, on current clinical trials, and innovative, experimental procedures. It is knowing, evaluating, and comparing that will lead you to the best care of your patient. These critical thinking, lifelong learning skills are what can make a good physician a great one.
Your dreams of healing people and curing diseases are within reach, and no matter how many “I don’t think I really can” experiences you have, you can and you will. Medical school is giving you the skills you need to prepare to become an effective clinician. Test prep – the late nights, the stress, the autonomy – is preparing you to become an effective clinician.
So remember as you’re on your seventh cup of coffee after four hours of sleep and six hours of lectures that your preparation for your test today is preparation for your career and your life.