Medical School Pre-Clinical Years: Twenty Questions (Part 3)

What About Student Government in Medical School? Waste of Time or What?

Every medical school has some sort of student government. You will have class officers and the usual student body President, Vice-President and other offices filled by medical students looking for…well…who knows? At the basic level it cannot be denied that the predominant impulse for any sojourn into student governance is one of self-aggrandizement. It looks great on your CV, not to mention that some people just like the illusion of power and control.

I say “illusion” because students are largely powerless at most medical schools and, their pretensions to the contrary, are indulged, tolerated, but never taken seriously by a patronizing administration. The time has not arrived when the crafty academic dinosaurs who have fought and eaten their way to the top of the bureaucratic food chain will take direction from the little proto-mammals scurrying about in the ferns. The faculty will smile pleasantly and praise the dedication of the students but the ragged hanks of rotting flesh clinging to their kitchen knife-sized teeth belie their true outlook. Or, to put it another way, the typical medical student doesn’t know enough about anything to be taken seriously and, even if they did, as they have no control of funding, pay, or policy have absolutely zero influence on the way medical schools are run.

This is a universal truth by the way, that management never really cares what the lower-level employees think. Good managers know that certain allowances have to be made if they are to have happy, productive employees but this almost never involves gaining consensus or acting on input from the employees that will effect how the business is run or the all-important bottom line. That’s the General Manager’s job and he doesn’t seek advice from the janitors. Medical students, in the hierarchy, have less input into the administration of their school than the janitors.

My school, for example, implemented a mandatory attendance policy that was roundly condemned and vociferously protested by the entire student body. Tempers grew hot, meetings were held, but in the end the Board of Governors wanted it and that was that. Value of student input? Exactly zero, especially since medical students don’t have the sense to know that you are not occupying the moral high ground when you agitate for the right to skip class. The input of student government is neither desired nor taken seriously on real issue like this and the best that most of these bodies can do is to rubber-stamp the usual twaddle about celebrating diversity or supporting the rights of the freeloader class to medical care on the taxpayer’s dime. You know, harmless, frothy things. But trying to change real policy? Not a chance. You have to have some influence and, as a medical student, you have exactly none and no recourse but useless protest.

What are the medical students going to do? Quit? Strike? Walk out? Please. Not only are most medical students thankful to have made it into medical school and therefore extremely reluctant to rock the boat but most of them don’t have the time or the energy to get involved even if they wanted to which most don’t. About the only people who care about student government are the ones who run for office. Even their level of caring rapidly diminishes as the months roll by. Typically, the enthusiasm for student government peaks early in first year when egos are at their hottest and it seems like you are going to be in medical school forever. By the end of first year, if not sooner, everybody who is still on board can see what a crock the whole thing is and interest falls off drastically. During third year you are too busy to give a crap and when fourth year rolls around, not only does the whole thing still seem silly but it now becomes pointless as you will be gone in a few short months.

Despite all this, Student government is not completely useless. Within the confines of the possible they can do a few things. You will need a social committee, for example, to organize the occasional party. Student government usually organizes the note-taking service (which is always completely independent from the administration) and ours did a great job getting some money to get our student gym refurbished. We also had a “Challenge Committee” that coordinated challenges to exam questions. (On every exam there are some questions that are either ambiguous or flat-out wrong and you can sometimes get credit for them on a “challenge.” I never really cared because my scores were rarely in the range where a half a point would throw me into the next grade but if you’re jockeying for a Dermatology residency, every little bit counts.)

How About One Piece of Advice For First and Second Year?

If I had one piece of advice it would be to stay healthy. During the first two years there is plenty of time in the day to exercise and it is not necessary to get into the intern mode where you are indeed so busy and tired that you can rationalize not working out and making a meal out of vending machine doughnuts and a Dr. Pepper. I was a runner before medical school and found it easy to continue during first and second year. In fact, although I fell off the running wagon a little during the first few months of medical school, once I got the hang of things I had something of a renaissance and easily put in 30 miles a week. It’s just a question of time management. If you make your own health a priority you can take an hour five times a week for some physical activity. Maybe it will detract from your study time but to my mind, there is nothing worse than sitting in library trying to study while tired and feeling like a disgusting fat body. Sometimes you have to get outside or into the gym to just clear your head. The alternative is to try to study feeling like a sloth.

Now, I’m not waggling my finger at anybody. Although I managed to stay in pretty good shape during the entire four years of medical school, once I hit intern year although I tried to exercise regularly, I eventually gave up even trying. My schedule as an intern was so unpredictable that on the rare day when I got home on time all I wanted to do was rest. And I have always had a crappy diet high in bloody, fatty red meat and fried pastries so you can imagine that in the absence of exercise I put on a little weight. I did two intern years as some of you know and, although I now have a regular schedule and am getting back in shape, I have never been in as poor health as I have been since I graduated medical school. The point is that while maybe you can make an excuse for waddling around the hospital as an intern or even in parts of third year when you will be busy beyond a reasonable doubt, during first and second year your schedule is entirely predictable and there is absolutely no reason not to exercise or eat regular meals.

Hell, one of my motivators for studying was the knowledge that when I was done for the day I could throw a leash on Nora, my my beloved and now long-dead Border Collie and Zoe, my German Shepard (who is fourteen and still with us) and go out for a long run.

You also have to see to your mental health. The best advice I ever got from an upperclassman was to “Be Macho.” By this he meant that no matter what, don’t ever get into the self-pity mode. Medical school, while it has its difficult moments, is not generally that hard. Sure, some of the hours in third year can suck and you will not be treated well by many of those over you but it is important to not let this kind of thing bother you. Bad day? Failed a test? Pick yourself up, laugh, and move on. You can, for example, drive yourself crazy obsessing over a particularly low test score and reap a bumper crop of bitterness or you could just accept it as something that is now ancient history and forget about it.

This is not to say that you have to be a Pollyanna about things. Medical students complain all the time but most of them still manage to have fun, even on the worst rotations. You just have to see the humor in everything and enjoy the ludicrousness of the many strange situations in which you will find yourself.

What About “Gunners?”

A “gunner” is a medical student who is so intent on furthering his own career that he will sabotage other students to ensure that he scores higher on tests or looks better on the wards. Medical student lore is filled with dark tales of gunners sequestering old exam questions on loan in the library to keep them from the rest of the class or not only knowing everything about his own patients but yours as well so he can interject information that you don’t know, making you look bad in the process. I believe these tales to be apocryphal. When you think about it, medical school is not really a team sport and there is not much anybody can do to effect your grade. I cannot, for example, think of a single way anybody in my class could have done anything to effect my grade short of stealing my computer or knocking me over the head, both felonies, and not something that the mythical gunners are known to do. On the wards, if you are an ignoramus your secret will get out without help from anybody else. A gunner calling attention to you is just gilding the lily.


20 thoughts on “Medical School Pre-Clinical Years: Twenty Questions (Part 3)

  1. Why don’t hospitals have gym’s? I work with interns in a very busy ER and see how demanding their schedule is, but I wonder if there was a gym in the hospital whether they would work out after work? Maybe come in a half hour early and get a quick run in?

    Is it because hospitals are not interested in catering to the needs of their residents? Do some hospitals have gym’s?

  2. “What are the medical students going to do? Quit? Strike? Walk out? Please… but most of them don’t have the time or the energy to get involved even if they wanted to which most don’t.”

    Congratulations. You’ve stumbled upon the organizing principle of private practice physicians, and law-abiding, tax-paying, members of society, in general.

  3. that’s a great post. should be required reading for entering med students. love the be macho comment. the complaining starts to grate after time. so easy to forget the many people who didn’t get in and would do anything to trade places.

  4. Our hospital actually does have a gym, Alex… it’s just not the best one in the world. Still, we’ve got a treadmill and some basic weights which is I suppose all you can really ask for.

    Like Panda’s saying, the problem is the overwhelming fatigue and the strange schedule, not necessarily the access.

  5. Great advice about keeping in shape.

    I do think you’re a little pessimistic about the efficacy of student governance, though. I’ve found the administration at my school very responsive to student concerns. Obviously, students aren’t calling the shots, but if you present your case intelligently and without whiny entitlement, they will listen and change things if possible. Maybe I just go to an exceptionally benign school.

    (The truth is that I have always viewed college and medical school as a business arrangement.  I pay them money, they provide the education.  I have never, consequently, had much school spirit or any interest at all in how things are run provided the school lives up to its end of the bargain.   As long as I’m getting the lectures and supervision on the wards the rest is just fluff and I had no interest in it.  I just want to go home at the end of the day.  In other words, except for the service provided by the school, it makes no difference to me what the administration does, what their affirmative action policy is, whether they encourage recycling, foster a culture of nepotism, swap wives, take bribes, fight global warming, support the troops, don’t support the troops, or any other thing you can think of provided I graduate with a minimum of fucking around.  I would sooner get involved in the internal affairs of my local grocery store than I would in those of my medical school.  I don’t want to get involved as I have more important things to do with my free time.  -PB)

  6. “I would sooner get involved in the internal affairs of my local grocery store than I would in those of my medical school.”

    I don’t care about many things that my school does, but if it tried to enforce mandatory attendance for the first two years, I’d be furious. It’d be a huge waste of my time and it would really cut into my sleep. I’m paying $30,000 a year, not the other way around, so I’ll show up when I want to show up.

  7. Great advice to Stay Health and Be Macho. These are the coins of the realm for THRIVING in both medical school and residency. I wish I would have adhered to them better as I was going through the process.

    In medical school, I tended to get distracted by various organizational and political issues because I was always curious how things “really worked” and how decisions “really got made.”

    It was entertaining distraction, but time that probably could have been better spent at the gym.

  8. Holy crap PD what kind of an institution are you working in and what did you’re senior resident do to you? You’re second and third paragraphs make me suspect that someone’s been beating you with a stethoscope. Any manager/boss can force an issue but the smart ones will use people’s brains. Consensus building usually results in a number of camps equal to the number of choices but that doesn’t mean you throw out all leadership skills and the life experience of you’re employees’. So far I think the series is fantastic but that 2nd and 3rd paragraph sound too fatalistic for me.

    (It’s not fatalistic, its realistic.  And it’s even more true in medical school than it is in business or residency where it is still true.  The administration doesn’t give a rat’s ass what the students think….which is a good thing most of the time and, as medical school (and college) to me was just a business arrangement, I care about as much about how my local McDonald’s is run as I do how they run the medical school.  As long as I get my hot, juicy double-cheeseburger (also known as Panda Bear Filet Mignon), I don’t care how they arrange things.  It’s not that I don’t have loyalty to some institutions because I certainly do.  The Marine Corps and the Greek Orthodox Church come to mind.  It’s just that educational institutions don’t rise to the threshold of things I really care about.  There is something…I don’t know…silly about “school spirit.”  This is probably why I am indifferent to professional and college sports.  I just don’t care. -PB)

  9. Hey Panda:

    Throughout this med school reflection, you haven’t mentioned how your weekends were during medical school (years 1 and 2.) Just curious if they were 8+ hours of studying per day.

    (I got every weekend (and holiday) off and studied as needed.  Before a test?  three hours a day.  After the test.  Maybe I’d blow it off. -PB) 

  10. Ian: Have you ever worked in private industry? I assure you that no matter what rhetoric they spout, management is precisely as interested in employee opinion as the average farmer is in what his chickens think.

  11. Panda,

    At Chiro School, it was acknowledged and covertly encouraged to memorize the old tests. They were known as P.O.N.Y.s (Pass On to Next Year) every one had an old test or you could get one from one of the dudes in one of the Chiro Frats (that’s right they had Frats there.)

    I offer this so that people know that Chiros don’t even have to study for anything as the tests never changed, just the order of the questions. We did have mandatory attendance, I even flunked one class for lack of attendance (Chiropractic Practice Management.)

  12. Panda, my guess is the reason you do not subscribe to “school spirit” is that you spent your traditional “college years” in the Marines. You consider the Marines a major force in shaping you into the man you are today. I feel that way about my undergrad – not because of sports (we were Division III lol). When I left home at 17 and was “on my own” (as much as you can be in the cradle of undergraduate education), my 4 years at college were extremely influential in teaching me how to think critically, write well (though I know it doesn’t often show in my comments), and mature emotionally as well as intellectually. I have a fondness for the place and the professors because that’s where that happened for me. Mind you, I am in no way comparing Marine service to 4 years of “traditional” college experience; they are entirely different animals in most respects. I refer only to a similarity in our separate allegiances to each institution and offer an analysis why some have more “school spirit” than you. I think that extends out a bit to med school as well, though I agree that I have far less allegiance to my medical school than to my undergrad institution. They extremely different in both form and function.

    (Well maybe, but the Marine Corps, particularly the infantry, is a unique organization which we join because it is the Marines. The Army or the National Guard will not do in this case and they are not interchangeable even if there are similarities.  A medical school is a medical school is a medical school and a university is a university is a university (provided they are accredited, I mean) so one is as good as another as far as I am concerned.  I understand perfectly the power of the “Brand Name” and I think getting into a prestigious school is a smart career move but that’s only because a) whatever I believe, other people do think it is important, and b) you may actually get an incrementally better education at one over the other or at least something that you think is unique…but neither of these two reasons would inspire me to root for a football team or donate money as an alumni.  I simply don’t care.

    They’re just big, bureaucratic institutions run by professional administrators who will throw the students to the wolves at the first sign of trouble as they did at Duke to those lacrosse players simply because a drugged-up prostitute spun a story to avoid getting thrown in jail for DUI. -PB)

  13. Ramdom (specifically) and PB (generally),

    I can see where you’re coming from, and it’s understandable, but you have to look at something deeper that PB (and I, apparently) have/had experienced.

    I’m a hopeful (trying again this year) non-trad, former military (USCG) member, current electrical engineer. While getting my degree (after the CG), one of my best friends at the time was very gung-ho about the school we attended (Div I in Texas), especially school sports and why we “needed” them at the institution. I didn’t care about school “spirit” and was ambivalent about the school, seeing it as PB did/does in that I provide money and they provide a service (education and degree). I tried to convince my friend as to the same, but when I couldn’t change his mind (initially at least) I tried to figure out why. In a moment of pseudo-psychology I came to the conclusion that school was all he knew of the world (at the time), and consequently was the most important thing to him. I think the correlation is that if you get non-trad undergraduate or medical students, and examine their motivation and personal belief stucture, you’ll see that they know there is more to the world than just that moment in time at that particular school. I think this helps foster (it did/does in my case) the ambivalence toward the “spirit” of the institution versus a more grounded understanding of the big picture.

    A Marine is always a Marine, and every one I have ever had the pleasure to meet is included in that envelope, but that is a very different animal than where one obtains a degree. My experience is that in the real world there is less concern with where you were educated versus how well you can use that education.

  14. I think my comments were misunderstood. I specifically said that educational institutions and the Marine Corps are very different institutions. Really my only “point” was that people assign value and “loyalty” to those institutions they consider significant in their development as a person. I wasn’t attempting to say that there were no other factors that separated education and the Marines – only one facet.

  15. Somehow the end of my comment was cut off.

    …only one facet of comparison. If I say “Carissima” to a fellow graduate of my undergrad, there is an understanding of shared experience, as there is between Marines who exchange “Sempre Fi.” Again, I emphasize that I am NOT saying the two types of shared experiences are comparable – military service is not the same as undergraduate education (and visa versa, just to be clear). The link I am drawing is not a parallel, it is only a narrowly-defined similarity in how emotional bonds of loyalty are formed.

  16. I didn’t mean to imply that you were putting military service and secondary education in the same vein – my intent was that the camaraderie and life experiences in the military is/are different, but can be viewed (albeit loosely) similarly to school spirit (or Carissima for Hamilton, or ring dunking for Aggies, etc. etc.). The are certain times in a person’s life that are formative to how they become an adult and member of society – for many it’s the years spent at an institution, for some it’s the military – but for all it becomes a snapshot of time where we realize we have “become” something more than we were. We cling to that memory or feeling, and it often settles into a remembrance we reflect on with fondness(as I’m sure PB will attest to, the “good” memories supercede the “what the #### am I doing this at 0-dark thirty?” memories).

    My intention was to say that for some of us, those that have done other things in life prior to the scholastice experience in question (grad or med school, or even undergrad), often view said scholastic experience as less “all-encompassing” in the big picture, and consequently maybe we are less wont to drink the school-spirit kool aid and instead view the experience in question as (us) paying for a service (education and parchment).

  17. Ah ok then. Yes, that’s basically exactly what I was getting at in my original post. Generally the “primary” experience tends to overshadow whatever comes after, and in Panda’s (and others’) case, Marines supersedes education. 🙂

  18. Thank you a thousand times for these articles on the pre-clinical years. I’m starting med school in the fall, and I will say that stumbling upon these articles this morning has alleviated some of my worries. I look forward to reading anything else you post on this topic!

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