1 year into medschool...

one year ago, i put my scientific career on hold to start an adventure... med school in cambridge.
i took this leap in order to work more closely with people rather than proteins, to do something more applicable that may perhaps lead me to a new direction of (potentially more fundable) research in the future. even though i loved my job, the science and academic life, i wanted to do something more tangible and be able to approach science with a much broader perspective.

so i moved from oxford to cambridge in september 2010, ultra-keen and excited about what was to come. so now, after my first year in medschool, what are the conclusions i can draw?

it has definitely been a year of adjustments... it started off with my initial expectations meeting reality (see this previous post), and then getting on with things and studying for the exams. now that i've passed the 1st year exams and gained some more experience, i can look back and evaluate:

would i choose cambridge again?

* cambridge's special focus on science
the cambridge graduate course is one of the few in the country that does NOT compress two years of pre-clinical teaching into one year, but keeps two full years of pre-clinical science on the curriculum. these two years are accompanied by an accelerated version of the first clinical year of the standard course, taught during the term "holidays". after these initial two years, one enters straight into the 2nd clinical year of the standard course, i.e. the penultimate year of medical school, making it a 4-year course in total.
since obtaining a broad and in-depth foundation of the science involved in medicine was one of my reasons for starting medschool in the first place, i have definitely enjoyed this aspect of the course.
working through the material my own way, i definitely got a lot out of it and am full of ideas for the future. in that way i can only recommend it to anyone interested in science.
but contrasting the amount of cambridge's scientific teaching with the required working knowledge of a physician, one can perhaps understand why other medical schools choose to define their focus differently. given that this is a graduate course and there is also a lot of medicine to learn, the two years of intense science are perhaps a bit of an indulgence. that's why i recommend choosing any particular medical course carefully based on one's preferences of how much science one wishes to encounter... :-)

* tailoring of the course to graduate students
the course organisation i described in the previous paragraph means that the graduate students work alongside the undergrads during termtime of years one and two, and have their own separate clinical teaching during the term "holidays". after pre-clinical finals in the 2nd year, the graduates join a more advanced cohort of undergrads for the full-time clinical training for another 2 years.
so apart from the few weeks of clinical teaching in the first two years, very little course content has actually been specifically designed for graduates. the grads do almost everything the undergrads do, only in less time and with much less time off.
in my opinion, the course hardly takes into consideration or even exploits the different starting points and skill sets of graduates and professionals compared to younger undergrads. while this is a pity, it would be much less of a shortcoming if it wasn't for the relatively ineffective timetabling and execution of the course. the time constraints of the graduate course (and without wanting to sound snobbish: perhaps also the higher degree of university and life-experience??) definitely highlight any redundancy or inefficiency of teaching. while it was definitely painful to sit through practicals teaching you how to hold a pipette, no matter how many times you have done it before, it was worse to suffer through full schedules of compulsory attendance, leaving you little freedom to organise your time in a way that makes learning most efficient for you, something that a mature student could definitely be entrusted with.
finally, with only very few weeks off during the year (in total ~5, of which at least 2 have to be used for studying), there just isn't much flexibility for any unforeseen events that life throws at you (such as parents falling ill etc... sadly more likely to happen as you get older), or to simply coordinate your life with that of your family or partner.
i wonder if other medical schools offering accelerated courses have incorporated more obvious strategies for teaching older students. at least the titles of some other courses (e.g. "graduate/professional entry" at king's college london) suggests some awareness in that direction.

considering these aspects, the course has definitely been quite disappointing. but then again, there is no guarantee that it will be better anywhere else... ;-)

* to sum up...
given that cambridge is a beautiful and convenient place to study, i'd probably still choose cambridge again. but if i could start over, i would equip myself with thick skin and various coping mechanisms right away:
- keep your expectations low and your humor high
- keep up as much of an outside life as you can
- keep some aspect of your previous career going to give you some affirmation
- never loose sight of the big picture.

Seeing the world with the eyes of....

I don't know about you, but when I study a particular subject in depth, my view of the world changes... literally!!! It has happened to me before, but now that I am studying medicine, it is happening again.

During my first degree in chemistry, I spent four years looking at chemical formulas learning about the molecular make-up of the world. Since then, without intending to, my brain has tried to identify chemistry everywhere, most commonly on car license plates:

During my PhD in Biochemistry, I spent day and night analysing NMR data, i.e. looking at spectra with different constellations of dots, in order to identify amino acids and their close neighbours in a protein sequence (for more detail on how this works, see here). After doing this for a while, my brain automatically tried finding protein sequences everywhere. I could no longer look at the night-sky without seeing amino acid side-chains:

 

This year I have been studying anatomy. My colleagues and I have spent more than 50 hours in the dissection room, cutting into cadavers to explore the human body. I have seen a lot of organs, nerves, muscles and tendons. The other day I was in a place where they did some building works, and my brain identified the cables hanging out of the wall as the flexor compartment of the forearm:

 

With this little presentation, I acknowledge the presence of this development, but hope it won't extend too far. Some things are better appreciated as they are... ;-)

Where are you Benjamin?

In the very last episode of Star Trek Deep Space Nine, Benjamin Sisko threw himself into the Fire Cages on Bajor along with Gul Dukat. This put an end to his corporeal existence and since then, he's been living with the prophets in the Celestial Temple (the wormhole). He said, however, that he will return one day.

Well, Benjamin, it's been 12 years - where are you?

I am waiting!

SCHI again, and my behaviour of secondary deviance

Tomorrow is our SCHI exam (social context of health and illness, see an older post), and so I've spent some time reading about medical sociology. It's really interesting to get to know the different way of thinking in this field (perhaps something to blog about another time), as well as to see how medicine and science are perceived from an external point of view.

I've been reading quite a bit about "deviance", the sociological term for behaviour outside society's norms. Deviance describes any type of criminal act, but also includes generally strange/morally flawed behaviour - anything that sets you apart from "normality".
Once deviance has occurred, let's say a person's lie has been discovered, society has certain preconceptions about what the deviant person is like... in this case the "liar". A "liar" will then be treated in a particular way, for example he/she will no longer be trusted. There are many such stereotypes, even for people with red hair (like me)... ;-)

Sociologists further distinguish between two types of deviance: primary and secondary.
Primary deviance is the initial instance of deviance, i.e. lying, stealing, looking different, being ill, etc... Secondary deviance describes additional deviant acts that are a result of the first. For example, someone who lied once may eventually become a a liar, act like a liar, because he/she knows that others think of him/her as such now. Secondary deviance is to behave according to the stereotype associated with the deviant act. It's a self-fulfilling prophecy.

Having this stuff in my head, I've noticed over the past few days that I display behaviour of secondary deviance, too!

Many have heard me whinge in the past few months about how I'm annoyed about how the students are treated around here (see previous post). On many occasions here in Cambridge, students are not taken seriously, not treated professionally, easily patronised or talked down to. According to the SCHI teachings, being a student is the primary deviance.
Now onto the secondary deviance: When I arrived here fresh from the real world, I treated the people I encountered in my new student life just as professionally as I was used to deal with people in my previous job. This week I noticed that this has changed.... I found myself acting like a stubborn teenager! I arrived late, refused to cooperate and was intentionally unprepared, so that I could be "as dumb as they want me to be"... really, why bother?
Then it dawned on me: this is definitely secondary deviance - I was treated like a child, so why act like an adult?

Of course, I put a stop to my secondary deviance at once. After all, I should try to keep up the standards.
But nevertheless, I acknowledge the sociologists for giving me this insight - thank you SCHI!!!

Einzug mit Narrhalla-Marsch!!!! (Carnival in the Rhine valley... and every week in Oxford?)

Today is "Rosenmontag", the most important day of the carnival season in the Rhine valley. Inspite of that, I had to go to work today, and even worse, I had to wear my normal clothes!! Not a single "Helau" was to be heard in the streets of Cambridge ("Helau" is the carnival-outcry of my region, it usually comes in threes) and not a single shot of Schnaps was offered to me in the streets. I pity myself!!!!! ;-)


I have been living abroad for almost ten years now, but it's the carnival week-end that brings with it the highest waves of home-sickness (so does the wine-week, which I describe here, but that's not until August). You would expect Christmas to be worse, but it's not. I should have booked a flight home!

Maybe it's because I was born on the 11th of November, which marks the beginning of the carnival season every year. It starts exactly at 11.11am (I was born at 11.51am) and lasts until Ash Wednesday (as you may have gathered, eleven is the official number of the carnival). Of course we used to celebrate the carnival every year for longer than I can remember. In my teens, I even danced in the show-ballet of a carnival club for a few years. No wonder I am so attached to it!

Every year it's strange for me to spend this week-end calm and quietly, rather than out in the streets dressed in a costume at one of the many carnival parades in my region. The only carnivalesque thing I managed to do this week-end was to have a doughnut, which represents the closest substitute available in the UK to a carnival cake (in my region, we call them "Kreppel", see blow). The crappy doughnut I managed to find did not taste good, but it felt good!

There is one more essential element of the carnival to mention here, and it's just as ridiculous as the rest of the carneval: the Narrhalla-Marsch. It's a piece of music you hear all the time in the Mainzer carnival (Mainz is one of the most important carnival towns, just on the other side of the Rhine from my hometown Wiesbaden). During the carnival shows (evenings where people dress up and watch a show with funny speeches and dances and stuff), the Narrhalla-Marsch accompanies the entrance and exit of every show act:

During my time in Oxford, when I had high-table dining rights at Somerville College, I was reminded of the Narrhalla-Marsch during every formal dinner. When the members of the Senior Common Room entered to walk up to the high table, all the students stood up until we had taken our seats in silence. With all the fellows marching in like this, I always felt it was a Narrhalla-Marsch moment. It made me laugh, and once I had thought of it, the Narrhalla-Marsch would play in my head whenever I'd enter hall during formals. Now you know why I was smiling then.

My current college does not have a high table, and even if it did I would not be allowed to sit on it... So bad doughnuts are all I have to remind me of the carnival, until I buy a ticket home next year to join in the celebrations once more!

Exit with Narrhalla-Marsch.

Helau!

The Social Context of Health and Illness (SCHI)

I am going to write about our SCHI course today, a course about the "social context of health and disease"... and about interacting with patients. I've been planning to write about this for a while, but today I am also creating this entry for opportunistic reasons: I need to motivate myself to study SCHI later tonight... the exam is in two weeks!

SCHI is part of the 1st year medical course in Cambridge. It's where students learn about sociology, anthropology and some ethics of medicine. It's where we are reminded that we will deal with patients, which is easily forgotten during the seemingly endless science lectures and practicals. The SCHI course is really well organised and consists of tutorials (ok, supervisions!) and lectures in which we are given factual introductions to the topics, but also meet patients and learn about their experiences in coping with an illness.

Amongst our many science lectures, SCHI offered a welcome break in our schedule where we could remind ourselves of the altruistic reasons for studying medicine in the first place, and realise that science cannot (ok, in some cases, not yet, but certainly not always) explain everything or represent the sole basis for dealing with patients. Obviously, doctors don't deal with the patients' bodies in isolation, but with the entire human being who is real, whose life is embedded into social surroundings, a particular culture, and a society.

I was therefore quite surprised to find out that many medical scholars do not think highly of the course and question its necessity, that the course was apparently imposed onto Cambridge by the GMC (the General Medical Council), and therefore introduced rather reluctantly. (Be aware, this is gossip!)

How interesting. But how can this be?

These opinions of SCHI reminded me of an impression I've had during the first term of medschool, actually starting in the very first week. During that week, the graduates spent time in the hospital and I personally spent an afternoon in the emergency department, where I saw my first open wound and lots of blood. A colleague and I were shadowing a nurse, who seemed to be very good at her job, very experienced, but also somehow roughened up after many years of hard work. We watched her stitch up a young woman with a laceration on her hand. I was surprised by her lack of empathy and harshness towards the poor lady who would not be able to work in her job for a while and would be left with an ugly scar on her hand. Obviously, this was no case of malpractice, but it left a certain impression that kept being reinforced from this point onwards: that the idealism with which one starts medical school must wear off quite quickly.

Back in Cambridge, I then noticed that the loss of idealism is not only discouraged, but sometimes even encouraged (you've just got to imagine that the first patient a standard course medical student meets is a dead one in the dissection room...). Perhaps it is also a result of the huge amount of science taught in the first two years of med school, which somehow makes you lose sight of the more human aspects of medicine.

I guess the subject of sociology does not fit in with this initial desensitisation of the students. Maybe the course brings up topics that doctors don't like to be reminded of, after all it must be very hard to make it through a lifetime of medical practice without gaining some degree of cynicism. Perhaps it also has to do with the fact that a huge part of the first years of medical school is taught and organised by scientists, who can easily relate to the science behind medicine, but maybe not as easily to other "softer" aspects involving care, leaving them dismissive of the subject.

I have decided not to become roughened up yet (hopefully not ever), to keep enjoying the topic and not give up my altruistic intentions too soon.
But it's sad to see that so many undergraduates are drawn in by this atmosphere so dismissive of anything not strictly biomedical. You can truly watch them being molded into shape, so that they will carry on the hubris of the medical profession into the next generation.
Wow, that's getting dramatic now... Now I really have to start studying!!!!

That's it....

Not long ago today, Karl-Theodor zu Guttenberg resigned from his position as Minister of Defense.

In his speech he explained that he made the decision partly because of his doctoral thesis and partly because of his responsibility for the soldiers. He stressed that under the circumstances, he cannot devote full concentration to his duties and attention is being diverted away from the soldiers, who put their lives on the line every day. It should remain obvious though that the core of any of the given reasons for his resignation is his blatant plagiarism. It was yet another statement in which he merely used the word "mistake" with regards to how his thesis was produced, without explaining anything or acknowledging the severity of his actions*. I find this very disappointing.

What also remains is great disappointment with Angela Merkel. She accepted his resignation "with a heavy heart" and somewhat reluctantly. As a doctor of natural sciences, she of all people should have seen that systematic cheating in order to obtain an academic qualification cannot be compatible with a public office. She should have removed him from office in the first place, rather than now appear surprised or even sad about the resignation.

It's shocking how many people seem to think that committing fraud in science is only a serious offense within the world of science. This is very sad given that scientific efforts make an enormous contribution to the advance of our society. These events in Germany therefore tell us scientists that we have to explain much better what we are actually doing, rather than lock ourselves up in the lab every day.


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*Ok, he does say that he will "help to answer" remaining questions regarding his thesis, but that seems bizzarre given that he as the supposed writer should be able to answer any questions on the spot.