Bulimia Academica: A Model for Medical School?

The current structure medical education at University Medical School (and, in the United States as a whole) promotes an educational disorder called Bulimia Academica.

Bulimia Academica is defined as:

A. Recurrent episodes of binge learning. An episode of binge learning is characterized by both of the following:

(1)Learning, in a discrete period of time (e.g., within any 2-hour period), an amount of knowledge that is definitely larger than most people would learn during a similar period of time and under similar circumstances.

(2) A sense of lack of control over learning during the episode (e.g., a feeling that one must not stop learning or control what or how much one is learning ).
B. Recurrent inappropriate compensatory behavior in order to prolong studying, such as self-induced insomnia, misuse of Red Bull , 5-Hour Energy, Ritalin, or other medications; fasting, or excessive exercise.

C. The binge learning and inappropriate compensatory behaviors occur, on average, at least five days a week for three years.

D. Self-evaluation is unduly influenced by test scores.

E. The disturbance does not occur exclusively during episodes of Anorexia Academica (a.k.a. Summertime).

Type: Purging Type vs. Non-purging Type (vacationing & drinking ethyl alcohol to compensate).

Medical school is the story of forgetting, not remembering. We have classes, then take tests, then have other classes, then take other tests, and then after 18-24-36 months (depending on how “progressive” your medical school is), you take a series of national board exams (Step 1 – Step 2 CK – Step 2 CS). But, all in all, the goal of every medical student is to forget everything they have learned as soon as a class is over.

Why would this be our goal, you might ask? Simple: it’s who we are. The medical school admissions process selects people who are able to divine and ruthlessly adhere to assessment criteria. Oh, so I need a 3.6 to get in to med school*? Okay, I’ll make sure my GPA matches that. Oh, now you tell me that I need to take some science classes? Okay, I’ll take the ones that are most likely to give me the grade I need. Oh, so now I have to take a standardized test? No problem! I’ve been training for this one since before I could walk. Essays? Pssh, whatever. Application deadlines: now that’s actually a problem for me …

(* = I didn’t have a 3.6 GPA. But I also had an MCAT score that was 2SD above the mean for University Medical School)

After setting up all of these hurdles, only a certain type of person jumps over all of them and makes it to medical school: someone who is very good at jumping over hurdles. Doesn’t matter what the hurdles are – we can figure out what you want us to do, and (because what you want us to do is almost always not what we want to do) the least amount of effort required to go from Fail to Pass (or High Pass or Honors, at some schools). Oh and don’t even start with the “essays” or “interviews” – those are just different kinds of hurdles and we approach them in the same ways we approach everything else.

So since medical students are selected for their ability to rigidly follow the incentive structure that medical schools have created, is anyone surprised that we don’t review Microbiology during our Cardiovascular system (except for those bugs and drugs that are related directly and narrowly to cardiology exams)? Is anyone surprised that I’ve forgotten the anatomy of the brachial plexus (last tested on it in December of ’09)?

Now, as a medical school, maybe you want students to forget the brachial plexus. Maybe you want us to learn in silos, to binge and purge. Maybe you actually buy into the propaganda that we can “study on our own.” Right – on my own time, I’m going to do something I don’t like that won’t tangibly benefit me. Now, maybe there are people who do this kind of thing, but they would never make it through the medical school admissions process (and, if they did, they wouldn’t like what they found on the other side).

So, we drink from the firehose, and then vomit it all up a few days or weeks later. Then “boards” (Step 1 – 2CS/CK – 3) come around and we do it all again. Bulimia Academica is our disease – and if you want to cure us, you should first start the structures you set up to channel our attention and motivate us. But that is a story for another post …


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