How to learn medicine

It can be difficult being a medical student. I remember having at least twice as many timetabled teaching sessions as my non-medic friends and there was a huge amount of stuff to learn. Sometimes I felt like I was using my brain purely to stuff textbooks into instead of to think with. The practicals were better although some of the physiology ones seemed to be mild forms of initiation ritual. We did a lot of carefully measured breathing and urinating in them.

I did a traditional style course, something the Angry Medic is battling through at the moment and wondering if one of the shiny new style integrated PBL based fashionable courses would have been a better choice. I can’t really say because I haven’t done one, but before the traditional style course gets chucked out like those Dallas style shoulderpads at the end of the 80s, I’d like to remember the good aspects of the course.

Most of the time there was only one textbook to consult. When I was learning anatomy I looked in the anatomy book. Simple. None of this trying to learn the anatomy, physiology, pharmacology, pathology and treatment of a heart attack all at once. It also meant we had anatomists teaching us anatomy, pharmacologists teaching us pharmacology etc unlike having a pathologist trying to teach you about all the medical aspects of a hernia. By the time we were let loose on patients we already knew where their organs were and how they worked and a bit about how their drugs worked, it might not seem much but it helps.

But the best bit was when it suddenly all made sense; sometime in third year the reason for learning everything I’d learnt before became clear. Maybe it was a long time to wait but so what. We were in a teaching session with one of the cardiologists, who took us to see a patient who had been admitted with chest pain a few days before. The cardiologist asked us what conditions could cause chest pain. Er…heart attack….er…..angina. We didn’t do too well until she told us to think of all the structures in the chest that the pain might have come from and now we were back to basic anatomy. It was suddenly much easier. It could be pain from the heart (MI, angina), oesophagus (oesophagitis, reflux), pericardium, pleura (pleuritis, pneumonia), ribs, chest wall muscles, nerves (shingles), costochondral junctions etc. Basic physiology told us why the patient might have gone into heart failure after a heart attack, and a bit of pathology and pharmacology explained the use of aspirin and nitrates. The knowledge was there in our heads and now it was time to do something with it.

The basic sciences are vital. I don’t know if they are covered as well in new integrated courses or sidelined in favour of communication skills. Surely part of being able to communicate with patients is having something useful and accurate to tell them about their illness, why it has happened, why it causes the problems they are having, what you are going to do about it and what is going to happen to them. Or maybe even why you don’t yet know what the problem is, what it might be and how you’re going to find out.

The best way of teaching medicine is still causing controversy and there are various discussions on doctorsnet (if you have access) about different courses and different medical schools. But if you walk down the street in the UK you’ll see some 80s fashions are coming back again. maybe medical courses just follow fashion too.