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

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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?

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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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First Senior: Itprobably does. I'm afraid to look. Second Senior.' I'm depressed enough as it is. Premedical Student.' Well, I have to go. Need to look at other medical schools, you know. Thanksfor a most enlightening discussion. fDeparts, with a shake ofheadj. First Senior: One hundred and twenty-two teachers just in internal medicine. Where have they been the last two years? Second Senior.' Maybe they were teaching residents or interns or something. First Senior: But the residents and interns complain ofthe same problem-little teaching. Second Senior: One hundred and twenty-two teach- ers . , . First Senior.' Goddamn! and as another author sees it: The Galens Shovel Award, pictured here, is presented annually to that member of the clinical faculty judged most ejective as a teacher. The Crosby Award is presented for similar achievement to a member of the basic science faculty. In fact, we do know what's wrong with medical school, but we haven 't been able to articulate the basic frustrations behind the petty gripes they give rise to, the basic inad- equacies that are the source of our very real resentment, or the dynamics that tum us into second-class citizens at this medical school. The meeting made two objectives very clear,' we must understand ourselves, what we think and what our experience has been, and then communicate these insights to the faculty, because in some important ways the faculty did not understand what we were driving at. For example.' To the criticism of boring lectures the faculty asked if we felt that we should be entertained. They said we felt we should be exposed to all types of men, dry as well as dynamic, that people have different tastes in lecturers, and that much of the subject mat- ter is intrinsically unexciting. And if we were really complaining of boredom in the sense that they understood us, their com- ments would have been relevant. But we aren't really complaining of boredom. When I wash dishes at home I am certainly bored but I don 't resent doing them because they are my dishes and I am engaged by the clear necessity that the dishes must be washed. Many medical students long for even this simple sense of engagement with their work. Lectures make us feel shujled down an assembly line from one subject to the next. The only part we play in our own education is to drag our bodies in every moming-not to debate, not to discuss, not to raise issues or explore possibilities, but to shut up and listen, one anonymous face among 200. Does this get any closer to what we mean by boredom? To the student criticism that there is no personal student faculty contact, the faculty said there were Phi Chi parties and besides you can 't build personal relationships into an institutional sturcture, that they grow individually and spontaneously. The misun- derstanding here was that we all wanted to be assigned to a big brother M.D. when we entered as freshmen, but this sort of institu- tionalized personal contact is not what we are talking about. We would like more contact with the faculty and we know that the institutional structure provides neither space nor the time for it. When Ijirst came here I tried to find out where people go to hand around, to exchange gossip and drink coffee until I realized that from my vantage point as a freshman and now as a sopho- more, it was nowhere. One student said, What am I supposed to do, walk down a hall and introduce myseU' to the first long white coat I meet? But the traditional walls between stu- dents andfaculty will not crumble by setting up a cofee room, a tutorial program, or anything else, so long as the overwhelming attitude toward the student is that they are the trainees, the uninitiate whom thefaculty has the responsibility to whip into shape in four years. So as far as I'm concerned, Phi Chi parties are token integration. We don? want to be pals with the faculty. We have our own friends. But we think of ourselves as responsible men and women who have taken Medicine to be our life's work and therefore essentially as colleagues of the faculty. We pnd this elitist attitude of theirs humiliating and feel that the boot camp philosophy of medical education died with Arrowsmith. We feel that the student- teacher relationship can be seriously built only on mutual respect, not of pals or big brothers, but of man to man. Does this clar- Uy what we mean by student faculty contact? We do not mean to say that any of the aforementioned problems here at Michigan are due to deliberate intention. Rather, they stem from simple neglect while attention has been directed to the pressures of research, publication, and getting ahead. But society--and students as its representatives' -are once again demanding that more attention be paid to both the process of medical education and its end product. With this in mind, the staff of the Aequanimitas would like to present some of those few who have been selected by the student body as good teachers, evidenced by the award of the Galens Shovel or the Crosby Award. We have tried to show just what it is that makes each effective. We have fotmd them each individuals as teachers, with no consistency of systems or styles. But there is one thing consistently characteristic of each and every one-a deep concern for medical education, and each has done some- thing about it in his own way. In short, this section is dedicated to those it portrays, and a few others-those who really give a damn. 'Why do we blithely make students representatives of society ? Do students have some special claim? We think perhaps they may Medical students in particular, as not yet fully initiate, have a foot in both camps, and remain involved in the problems of both the medical and non-medical worlds. But more basically, recent college graduates are supposedly the finished product of our system of education, and should therefore be brimful of those values which society seeks to inculcate in its young. If you think they are not-then where has your educational system gone awry? 17