Friday, April 25, 2008

Amazing! Things are happening here

Ever since I read Panda Bear's post about the futility of student governance in med school, I've been dying to write a rebuttal. I graduated from a university where student self-governance was practically a founding principle, like liberty in the Declaration of Independence. I had plenty of examples of students effecting change in undergrad, but med school's a very different system, so I decided to hold off until I had a more concrete success than "They modify lectures based on student feedback after each block."

You see, since about January, there have been rumblings of eliminating Honors from the second-year grading scheme. (We are pass/fail for first year, H/P/F for second, and actual grades for third and fourth.) We all felt honors was a carrot of competition they held in front of us, creating extra short-term stress with little long-term yield -- "everyone knows" residency directors don't really care about grades in the pre-clinical years. Anecdotally, there's also a lot of faculty support for the change. There is a big curriculum reorganization in the offing, and the Big People already decided to make the preclinical months honors-free. So why not for us?

A couple of weeks ago, we had a curriculum survey of the entire first year. On the question of honors, almost 80% of the class voted to remove it and go to a straight P/F system. In light of that result, we had an open meeting with the dean of students and the curriculum committee chair. It was remarkably well-attended, much better than lectures for sure. I got the impression that Dr. D, the chair of the curriculum committee and kind of an old-school guy, was very pro-honors and that he would be the one we'd have to win over if we wanted this change to occur.

After the meeting and question/answer session, we took another survey, which revealed that 86% of the class wanted to remove honors from the system. The results were presented at the curriculum committee meeting this morning, after which we received an email informing us that second-year, like first, would now be pass/fail.

So you see, the administration, at least at this august institution, can and does listen to student input.

Now, if we can just convince them to waive our tuition....

Sunday, April 6, 2008


I've been back for a week now. Without anatomy (I passed!), I have copious amounts of free time, which I fill by watching videos on youtube and strolling around the city. It's wonderful.

We started psych med on Tuesday and have thus far learned about the Mental Status Exam. The examples given in the book are very novelistic ("She seductively sweeps her bangs away from her face....") and so I present for your amusement a quick game of Guess the Patient.

Patient X is a student (age debatable), about 5'10 and 160 pounds. His facial appearance is marked by distinct pallor, which contrasts sharply with the inky black of his open doublet and dirty socks that fall around his ankles. He enters the room in a distracted fashion, looking around him as though afraid of being followed. The knocking of his knees also suggests fear. As the interviewer rose to greet him, Patient X drews his right hand slowly to his forehead, then extended it in a flowing motion to meet the interviewer's outstretched hand. He then sank into a chair, where he remained for the duration of the interview.

The patient answers all the interviewer's questions readily. His speech pattern alternates between slow, monotonous responses and garrulous outbursts. When asked about his mood, he says that he is "very like a whale." On being asked to explain, he winked at the interviewer but did not elaborate.

He has a full range of affect, although occasionally a question about his family causes a shadow to pass over his face and shuts down his emotional response. This is brief, however. Thought process is circumstantial and tangential; long digression of the death of an older man who played with him as a child and appears to have been a surrogate father figure. Some loosening of associations. Thought content is obsessive, centering on the recent death of his father and his mother's subsequent remarriage. Grandiose delusions of his "destiny" as the savior of his family and friends. His girlfriend recently broke up with him, an event he attributes to the influence of her father, a friend of his stepfather.

Some evidence of visual and auditory hallucinations, primarily of his father. These hallucinations command him to avenge his father's death. Admits to passive suicidal ideations (longing for the "sleep of death") but has not made a plan due to fear of the afterlife he believes to exist. He also shows evidence of homicidal ideation against his mother, stepfather, and girlfriend's father.

Cognition: fair. Alert and oriented to self; described interviewer as "fishmonger." Recalls 3/3 objects in two minutes. Digit span 7 forward, 5 reverse. Does not know own age or age of father at death. Frequently confused two childhood friends. Fund of knowledge good on current events, somewhat shaky on chronology and dates of the past. Above average intelligence, reflected in sophisticated vocabulary. Occasionally invents words.

Poor insight. Patient is aware that his friends and family are "concerned" about his recent behavior. He insists that he is "but mad north by northwest."

Judgment: Patient does not appear to understand the need for treatment. Recommend hospitalization for suicidal and homicidal ideations.