Questioning the Unquestionable!
As you would all agree with me, medicine is a field of vast knowledge and being able to stumble upon even the edges of that knowledge requires a tremendous amount of background knowledge and expertise. so when you view this world from the eyes of a newcomer -being me- it seems rather terrifying than welcoming. medical students tend to get scared -if not petrified- when they first encounter this vast realm of knowledge and experiment, thus sometimes even leaping into periods of depression and anxiety -As I did myself- while struggling to adjust to the new environment.
When it comes to adjustment, most of us medical students tend to bend to the limits that are somehow enforced upon us by the system that we have to deal with. to clarify the matters let me give you an example, I study in Tehran University of Medical Sciences and it would be a disservice not to call it reputable -if not overwhelming- among medical schools in Iran. When I got the chance to be part of it -As promising as it sounded at that time- I was full of joy and in my perspective the path ahead was illuminated by excellence in the field I loved and adored more than any other, Medicine!. Well let's face it, and by saying this I don't want to be unthankful or ignorant to all the great things I got from this university, today after 5 years I couldn't have been more disappointed, and even worse hopeless about the future.
I have a great interest in how our cognitive function and thinking can be affected by environmental factors and to be honest now that I get the chance to look back, I see that I ow most -if not all- of my current perspective to then neglected classes of critical thinking. we used to have these courses of clinical skills and among them clinical thinking -which might be considered among evadable classes of the first years- with this great professor who was an endocrinologist but at the same time he held a degree in philosophy. Having said all of this, I tend to look at things and systems as adjustable entities of the environment I interact with, rather than solid protocols and rules I have to adapt to. after all I have a reputation for not following the system when it tends to deviate me from the goals I aspire, so my problem with the system started right from the beginning.
In Iran medical education and evaluation is mostly concentrated on how capable you are in remembering stuff that you read and the knowledge that you acquire from several thousands of pages of textbooks. we have MCQs all through our years of study that we have to pass and among all those practical tests that we have to pass sometimes, seldom comes a time when your true skills are tested rather than your ability to memorize checklists and prep questions. I always considered medicine to be multidimensional, and I'm not an expert in this field but I can assure you that I don't need to be an expert to be able to talk about somethings. well overconfidence bias aside, we are talking about pure ration and logic so given the postulated premises every man with the power of ration must be able to deduce what I'm about to -so humbly- talk about. apart from those wonderful critical thinking classes - and other courses I later picked up in this field- no-one ever told me in the course of my medical education that it was more important to fix the way I think, the way I reason, than what I memorize so adorably with the help of staying up all night and the taste of coffee.
So here is where I start talking about how I want to question the unquestionable, that unquestionable being how medical education authorities can have a better say in how we have to be educated than those who are on the receiving end of this education system. I know some of you might not agree with me when I say, sometimes expertise is not what we need but rather novel ideas that would take us out of the dead-ends we have been locked in for years, but I can reason you out of this idea if you just bear with me a couple of more paragraphs.
I always hated that I have to study too many things that either I wouldn't have been able to remember months later or if I had done so, I wouldn’t have been able to use them in a proper and practical way. pure knowledge as alluring and shining as it looks, never captured my attention the way it deserved. you can still argue that I'm not only one who doesn't like studying long nights and countless hours memorizing signs and symptoms -let alone treatments; well you are perfectly right on that matter, but what you don't consider is, I'm more than willing to spend all these hours and even more, if it was not mere waste of time. before you all start criticizing me for all the skepticism I tend to spread, just give me a chance to illustrate the matter more.
If you consider medical education as a service being offered by universities, then it makes us customers of that service. so when I buy a pair of shoes from NIKE, no-one would criticize me if I said the shoe was a total disaster, after all I was the one who paid money for the shoes and by doing so I had every right to express my dissatisfaction in any form possible. no one would even think of saying, how dare you question product of such reputable manufacturer when you wouldn't be able to produce a shoelace by yourself let alone a pair of shoes. so tell me do I need the expertise of medical education to know what I'm receiving is less than optimum? Do I need years of clinical expertise to just simply question how I want to be educated and How I want my intellectual needs to be met?
We can always crush those below us when it comes to hierarchal systems, and medicine in it's way has hierarchy of it's own - just like army, yet from down beneath I'm trying to shed a light on what I think is most easily and worse than that, ignorantly neglected by those in power. We need to be thought how to think, how to act and react, how to practice and how to acquire knowledge. the rest can simply be done by a google search!
Pouya Bastani
Medical Student
Tehran University of Medical Sciences