University of Michigan Medical and Nursing School - Aequanimitas Yearbook (Ann Arbor, MI)

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THE VACANT LECTER Obsei'vaii'0ns Regarding Medical Education ana' Teaching ai the Uniiienssiiy of ilflicfiigan A medical school, like any other sort of school, is our society's institutionalized means of answering future generations of individuals learned in special bodies of knowledge and skilled in special techniques. Once a school-an institutionalized system-has been organized, it is left to professionals to run, and society at large loses interest, expecting the system to turn out properly educated individuals in an orderly fashion, with a minimum of muss, fuss or bother. The interest of the general public in the system is regained only under two circumstances: either the sorts of indi- viduals wanted are not emerging from the schools, or the orderly fashion breaks down and the proportion of muss, fuss, and bother gets out of hand. The attention of society has turned to the universities in this and the past few years mostly because of the latter. The turmoil on campus so dear to the late evening news is nonetheless real, and while the fast reaction of many is Hthrow the long-haired bastards injailw the reaction of a few deeper thinkers is slower in coming, as they take the time to re-examine the educational system and see if it really is an optimum one. However, this aspect of society's interest in education is a superficial one that will quickly wane as peace and tranquility are restored. The interest of society in medical educa- tion is a more fundamental one, less likely to quickly fade. Neither the sorts of doctors the public thinks it wants nor the public thinks it wants nor the numbers it needs are being produced. Inability to find a doctor when sick Cor at least a doctor with timej is not something to be lightly forgotten. Likewise, the gradual disappearance of Hwhole- patienti' medical attention with the neces- sity of being treated in pieces is genuinely distressing. The medical profession in general and medical schools in particular will probably remain under public scrutiny until these problems appear to be on their way to solu- tion. What has this to do with medical educa- tion at Michigan? Certainly as one of the largest schools in the United States Michi- . flees' ! ....

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AEQU NIMITAS 7969 :Y H f There are at least two theories regarding the content of yearbooks. One view holds that a yearbook should be solely a happy memories volume, recording in words and pictures only pleasant episodes, and except in sports sections, only victories and no defeats. The second view is that a yearbook should be a reasonably accurate reflection of what students have experienced in their year or years at school, presenting not only sweetness and light, but any significant darkness that they may have encountered along the way. Aequanimitas 1969 has chosen to follow the second theory of operation. Perhaps it is a reflection of our particular generation: we have not been raised as Pollyannas. But neither do we subscribe to the theory of some of our contemporaries, criticizing for the sake of criticism, believing that nearly all existing institutions are evil and must be destroyed simply because we do not approve of them. We rather attempt, like a mirror, to reflect those things we see before us. But unlike inanimate mirrors, our reflections cannot help but be tempered and distorted by our personal experiences and philoso- phies. We know that the resulting images will not be pleasing to the eye of every viewer-but the only way to offend no one is to say nothing. , P --W1 . M ttts .. f,,.t.,- ,L Ng.. H .. .,.., .,ggNwm., ik- V1 Saying nothing is of course another alter- native that may be taken in a yearbook. In fact, the editors of one past Aequanimitas did exactly that, presenting as justification the argument that since nobody reads yearbooks anyway, why write anything?,' It is true that very few read everything written in a yearbook at once, or even attempt it. But yearbooks are made to be put away, and taken out and perused at intervals of months, years, and decades. With the pas- sage of years pictures stale, some of their meanings are forgotten, and the printed word becomes relatively more important. Further, as perspectives change over time, we will view those things we have written in a different light and their meanings will change-but we will better remember how we were for thought we wereb if -at least part of it is written down. In this book, we have attempted to pre- sent at least a partial view of the experiences of the medical student at the University of Michigan. Impressions of each of the four years are presented at least in part by authors who have recently completed them. As we are at school to learn, teaching con- cerns us, and a major proportion of our features section is concerned with teaching, and those who do it well. Other articles attempt to describe aspects of medical stu- dents' experiences. Aequanimitas 1969 is of course not just the yearbook of the medical school. A sub- stantial number of our pages are devoted to the School of Nursing. We regret that we cannot please some of our critics and better integratev the medical and nursing sections. But as we are two separate schools, educat- ing students in entirely different systems, and only overlapping through use of the same hospital-how can it really be otherwise? Further uintegrationf' them of the medical and nursing sections would be a forced achievement, and a false reflection. So this is Aequanimitas 1969: an attempt to tell it like it isn about the experience of the student, recording both the good and the not so good. And beyond our attempt to tell it like it is is an implicit attempt to tell it like it ought to be. -j. V. W.

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gan is doing its share in providing many new M.D.'s every year. Surely they are as good as they ever have been. Why, even the curriculum has undergone extensive revi- sion in an effort to improve the quality of education, and in a small way to improve the quality of student life. What then is the problem? Despite the above-mentioned efforts at meeting society's demands on medical edu- cation, the alterations have been largely of form: much of the substance remains the same. There is no real overall goal in the medical school except to graduate M.D.'s. Each department treats students as it sees fit. Students are thus educated in separate pieces, much as they learn to treat patients and it is no wonder that each graduating class participates in the trend toward higher percentages of specialists. What else do they see here? There is no one teaching an inte- grated overview of patient care-just a lot of departments, each with its own little piece of the action. But more basically, students know that the attitude of most of the medical school has not changed. The supposed purpose of medical school is to educate physicians-but how many of our faculty would give up a move on the academic chess board in order to turn out better M.D.'s-better in knowl- edge, better in concern for patients, better as human beings and physicians. Students know that there are too few such-and morels the pity. But better pens than this have stated the problem in other ways. The following excerpts help to illustrate our point: Visiting Premedical Student: You students at Michi- gan are fortunate to have so many teachers. Medicine must be well taught here. First Senior: On the contrary, I thought that profes- sors ofMedicine were nearly an extinct species. Second Senior: I thought so too, but I saw onejust the other day. He even growled at me. But it is true, professors ofmedicine are rare. Premedical Student: I don'tjust refer to 'full profes- sors. What I mean are all those who have teaching appointments in Internal Medicine. First Senior.' Well, you include residents and interns. . . Premedical Student: No, I mean professors, asso- ciate professors, and so on through instructors. tors. First Senior: Let's see-I had one professor as a rounder in medicine, junior year. And there were one or two during senior specialty rota- tions. Uh yes, maybe seven or eight lectured to us junior year. Second Senior: Those were whole class lectures. I think I've had one or two teachers who taught me individually and two or three more who taught in small groups. But aber all, there are so many students and not too many teachers. What can you expect? Premedical Student: Do you mean to say that each of you has had exposure toronly nine or ten teach- ers in medicine? These must be dzjferent for each of you. First Senior: No, mostly the same ones. Second Senior: I think we leh out one we had sopho- more year. But there were also a few teachers in surgery, pediatrics, and otherhelds. Premedical Student: No, I was asking just about internal medicine. Are you sure of those numbers? First Senior: Well, we may have seen a professor or two in conferences, but no more than ten or so ever taught us anything. Premedical Student: How many professors, associate professors, etc., in internal medicine do you think there are in all at Michigan? First Senior: Oh, I'd say thirty, approximately. Second Senior: There must be more than that, I'c say forty to jhfty, although we only are taught by afraction ofthem. Premedical Student: Have you two ever read the Medical School catalog? First Senior: Must have at some time. Why? Premedical Student: It lists one hundred and twenty- two persons holding teaching positions in internal medicine at Michigan. First Senior fafter a longpausej: Goddamn! Second Senior: I don ,t believe it! Premedical Student.' See for yourseU There are 23 professors, 33 associate professors, 26 assistant professors, 4 clinical assistant professors, 77 instructors, and 79 teaching associates. That makes 722. You guys should be overwhelmed with teaching in internal medicine. First Senior: We're not overwhelmed in any held. Least ofall, medicine. Second Senior: Let's see. Une-fourth of the junior class-that,s about 50 students-are in medi- cine sections at any one time. And about 20 seniors are to be found in scheduled medicine sections in rotation. That's about 70 students in all rotating through the department of medi- cine at any given moment, Premedical Student: But there are more faculty with listed teaching appointments than that. It is unbelieveable that teaching is not superb. Why, you would receive individual, one-to-one attention, and still have about 50 teachingfac- ulty left over. Second Senior: I still don't believe it. Are you sure there are 700 or so? Premedical Student: Get your own catalog. By the way, does this situation hold in most other departments?