That Medical Student Syndrome...

http://teddysratlab.blogspot.com [Full link to blog for email clients.][FT:C44]

...No, not that one [where the think they've got every disease they study]... the other one...

It's the one where students try hard to ask their professors a question that the professor can't answer.

To be fair, Medical Students aren't all like that.  I may have mentioned that I am currently working in the medical school curriculum, and some of my students may even be reading this.  They are smart and curious, it's a prerequisite for medicine, but some students can take it a bit too far - and they often know it.

Also, believe it or not, this is meant to be a humorous post.  In retrospect, I have found these incidences to be quite humorous.

Back to the Medical Students:  We have a program that emphasizes "Case-centered" learning.  Students are presented with a patient case, starting with the chief complaint, then the history, physical and test findings.  The info is provided in stages, just like an office or ER visit.  In between bits of info, the students have to brain storm possible causes, eventually leading up to the point where they can start diagnosing diseases.  Along the way they identify stuff they don't know and need to learn.  Students meet in groups of 6-8, with two professors.  One of the professors is a clinician, the other (me) is in a "basic science" field, our job is to keep the discussions within boundaries, help out (a little) when they are stalled, and act as an expert resource when asked.  What we don't do is lecture to them.  They do have some lecture courses, and some laboratory work in anatomy, histology, etc.

However, it was not always that way.  We used to provide nearly all medical school content through lectures and labs.  I attended those lectures nearly 30 years ago, and I used to teach them before the curriculum changed to the case-centered system we now use.

What does this have to do with Teddy's Rat Lab?  Be patient, let me explain a bit more...

In those lectures there was always one or two students - we called them "gunners" (" 'gunning' for the top") and apparently the term is still in use - that tried their darnedest to be at the top of the class.  Grades weren't enough.  All of the students - and professors - needed to know that they were "the" top student in the class.  In a sense, all of the med students are "gunners" compared to their undergraduate classmates, so you can just imagine what it takes to be thought a "Gunner" in a class of 108 others.

What this meant, is that in any lecture there would be questions.  Questions are good, they show that the students are thinking, and they reveal what needs better attention in the lectures.  However, out of every class, there was usually someone who would as THE IMPOSSIBLE QUESTION (or TIQ).  Mind you, I like questions.  I judged a classes interest on the students that came up after lecture with follow-up questions.  Since I taught the basic neurophysiology of ion channels and action potentials, I got questions from chemistry and physics majors wanting more info, or history and music majors that needed more background info.  But I dreaded TIQs.

Usually what happened was that a student had read something brand new in the New England Journal of Medicine and realized they had something that wouldn't be covered in a lecture that was based on material written 5 or more years ago.  TIQs were verbal traps for the professors (not realizing that the NEJM article was likely based on 20 years of research with which the professor is familiar!). When a student asked a TIQ and it was answered with "I don't know," the student had scored, or "counted coup" on the professor. Obviously, if the professor couldn't answer it (and the student could) then the Gunner was smarter than the professor, right?  The Gunners prided themselves on how many times they could score against the professors.

However, TIQs weren't necessarily impossible to answer, they just took time.   See, med school lectures were 50 minutes long.  I was allotted 4 lectures to cover 2 textbook chapters of material, giving mainly the highlights with the students required to read the rest for exams.  If I was 30 minutes into a 50 minute lecture with at least 15 minutes worth of material left and was then asked a TIQ, I had a problem.  So, what shoud I do?

1. Take 10-20 minutes to answer the TIQ, dropping the rest of the lecture and making the students read the rest (or squeeze it into the next lecture)?
2. Try to squeeze in a 5 minute version of the answer, confusing or boring the rest of the class?
3. Tell them to see me after class (but we only had about 7 minutes actual time between the lectures)?
4. Tell them to see me during office hours? (except I don't really have office hours, I don't have an office on that campus, and they would likely spend at least 40 minutes waiting and riding shuttles to get to my office).
5. Or say "I don't know" (or the more appropriate "That's too complicated to explain in the time allowed" - but the students would interpret it as not knowing the answer).

I had about 10 seconds to decide:  #1 and #2 needlessly aggravated the whole class, #2 and #3 didn't provide sufficient time for a decent answer, #3 and #4 frustrated the ones asking the questions, and #5 made it look like the student was smarter than the prof.  I generally opted for #3 and #4, because I could answer the question given enough time, but I know professors that used #5 on a regular basis.

Students asking a TIQ and getting response #4 or #5 generally considered it a win.  Hey, they're back there virtually high-fiving each other.  However, professors talk to each other.  They kept track of who asked the most TIQs and if a particular student did so too often, they were "troublemakers."  Asking questions is the path to knowledge; asking THE IMPOSSIBLE QUESTION (repeatedly) is not.

And you know, I can't help but think that Dr. House, M.D. asked TIQs when he was in med school.

Don't read this the wrong way.  Questions are important! I like answering questions.  Without questions, we don't learn.  However, TIQs are counter productive.  Just because you can think up an Impossible Question, doesn't mean you should ask it (or at least not in a public forum), nor does it really call into question the previous education, experience and writings of the professor.

They are amusing, though, when I look back at the patterns of TIQs and responses and compare them with the types of questions that students must ask if they are going to learn.Especially in today's curriculum where they have to ask questions, then go look them up themselves.  Sometimes they must ask themselves the TIQs!

So, here's what it has to do with Teddy's Rat Lab blog...

The Aug. 8 blog discussed a number of the issues I have faced as a beta reader and scientific adviser to several friends and acquaintances who write science fiction.  I gave several examples of the types of things I would advise against an author using in their story - including an example of XY chromosome-liked genetics.

Boy, did I ask for it!  This blog is automatically posted on a bulletin board I frequent, and I often get questions and comments that show up only on that board. O that's when it started.  I Certainly got questions - and in fact, I'll share some as Mailbag posts in the week to come.  

Yes, I discovered that TIQs are not limited to Medical Students.  They weren't exactly impossible to answer, and I'm more amused by the occurrence than upset at them being asked, but I had correspondents going out of their way to come up with obscure instances of genetic conditions that could meet the conditions that I had advised against writing.  In my defense, I was trying not to be too specific about the author, novel, or specific passages within the novel.  In their defense, they brought up some valid cases, but they were not common, and still did not invalidate my advice in the blog. 

What I find amusing is that TIQs are apparently not limited to Medical Students, in fact they aren't really limited to science.  Sometimes we *have* to ask TIQs.  I suppose they are the consequence of inquisitive and curious people trying to gain a better understanding of what they've read.  At the same time, though, I can't help but think that the ones asking the TIQs - much like Dr. House for the first 50 minutes of each show - are somehow missing the Big Picture.

Until next time - keep asking questions, they are the only way we "feed" our brains!