Medical School and Graduate School: An anthropological comparison

Like many/most biological anthropology graduate students have to do at some point in their careers, I’m taking gross anatomy and histology with the first year medical students this fall.  What a culture shock!

A few observations that make me chuckle:

  • Medical students begin all of their questions with “What exactly…”  What exactly does the gluteus maximus do? Why exactly do mitochondria stain darker?  What exactly do we have to know about the brachial plexus in order to pass the test?
  • The one class that I don’t have to take that they do have to take is a “personality” class where they learn that wearing too much perfume is unprofessional. Instead of that class, I take a research ethics class where we learn that feeding radioactive oatmeal to children is wrong.
  • “Do non-medical doctors get to be called ‘doctor’ when I e-mail them to ask for help?”
  • The look of astonishment on their faces when I know what I’m talking about or am able to teach them something that they didn’t know, Like bony landmarks, or who John Lennon was.
  • “I thought most grad students were medical school drop-outs.”
  • How impatient they get when someone asks a question and I say, “Well let’s think this through…”
  • “It’s cute that you are actually interested in this.”
  • When I go back to normal anthropology school, fellow students say, “I bet they don’t even know what an australopithecine is!”
  • “I’m so bad at coming up with research ideas.  Maybe I should just go to medical school and do rote memorization for the rest of my life.”

It’s funny to observe what the different groups of students find important and desirable and “smart.”  For medical students, the fact that I study “monkey bones” makes me a much less serious student than they perceive themselves to be. Even though I keep up with them when we do drills or study together, they assume I’m not as smart because if I were, I’d be in medical school. They require answers and need to know how to do things, not why we do things, or how we learned to do things, or that there may be two or three ways to do things that give equally good results. They are very goal-oriented, and have no time for things that have nothing to do with achieving that goal.

On the other hand, the graduate students have an attitude that they are more intellectually curious and therefore smarter than kids who went to medical school.  They seem a lot more comfortable with uncertainty, to the point where they probably don’t study as hard as they could.  They have tunnel vision in that they sometimes get so focused on what they are interested in that they can’t grasp that other people might be interested in other things. And that tunnel vision has the unfortunate property of having no end in sight.  You can never know EVERYTHING about what you are trying to learn about, so goals are harder to define and “finished” is almost impossible.

I’m sure both groups will mature into wonderfully smart and perceptive doctors (medical or otherwise), but it’s funny how distinctive the two personality types seem to be at this early point in their careers.  I wonder if it’s learned through four years of undergrad, or if the two careers just naturally attract two different personality types.  One piece of advice that was passed down to me, and that I think applies to both groups, is this:  You are both not as smart as you think you are, and smarter than you think you are.

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15 responses to “Medical School and Graduate School: An anthropological comparison

  1. Zachary Cofran October 9, 2010 at 6:01 pm

    I think you summed up the grad-med student dichotomy perfectly

  2. Michael Caton October 10, 2010 at 1:13 am

    I was very interested to read this. I’m a second year medical student who has been making similar observations. I’m a non-trad student (36 yo) so weight my comment accordingly. Maybe I have a little more perspective than other med students from interacting with non-age-peer, non-career-track people in my past life.

    1) In my class there are not many people with the attitude you describe (i.e. “If you’re studying any life science and you’re not in medical school, you either must have tried and failed to get into medical school, or you’re so stupid you don’t even realize medical school is the best choice.”) I think most med students (the ones I know) do recognize that in our utility calculations we all weight money, status, intellectual challenge and social value of work differently. But while I’m at it: one thing I do get tired of from grad students is an attitude I occasionally detect when I mention money and status as figuring at all prominently in my considerations. I’ll just say that your idealistic 27-year-old self may not care that when you’re 42 you’ll be on your second post-doc or a non-tenure track position, but your 42 year-old-self might disagree. Then again, you get to sleep on a normal schedule and not take out ridiculous loans. I do agree that it’s interesting how you can already seen at this early stage how personality types determine career choices.

    2) In general I think that in both camps there’s an intellectual buyer’s remorse effect (you alluded briefly to it in your post). That is, when confronted with knowledge that is out of their territory or deeper than they’re accustomed to learning, medical students sometimes tend to write it off as beer-hour trivia or pointless nit-picking, which is unfortunate. On the other side, in grad classes I’ve taken, grad students sometimes seem surprised when I express greater-than-superficial interest in a topic for its own sake. This is usually couched in positive terms but I can’t help but be annoyed by it. (Kind of like Christians who tell atheist friends, “I don’t think you’re really an atheist. You’re a nice person.”)

    3) I, and many of my medical school classmates, would absolutely LOVE to be able to go more in depth on many of the topics we study. In my case I really would like to get more background on the evolutionary origins of some of the systems that are prone to breaking. Unfortunately, medical knowledge doubles every (5?) years, and medical school hasn’t gotten any longer, and we still have to be ready to fix whatever’s wrong once we’re out the door in four years. We have tests to pass, and there are only so many hours in a day.

  3. zinjanthropus October 10, 2010 at 1:05 pm

    “I’ll just say that your idealistic 27-year-old self may not care that when you’re 42 you’ll be on your second post-doc or a non-tenure track position, but your 42 year-old-self might disagree. Then again, you get to sleep on a normal schedule and not take out ridiculous loans.”
    I’m not sure if you realize, but that is extremely patronizing, and exactly the kind of attitude I was talking about. And people say it to grad students all the time. The “You made an irresponsible life choice but still don’t know what real sacrifice is” attitude. Especially when most of the students in my cohort are non-traditional students who left reasonably comfortable careers and have since racked up debt so deep that they’ll probably never pay it all off. If we were more fiscally responsible, we would have gone to medical school, right?

    As for point number 3, I hear you: Medical school is hard. Being a doctor is hard, too, so medical school should be hard. It’s just interesting to me that so many medical students don’t realize that graduate school is also very hard. We have tests to pass, grants to write, papers to publish, classes to teach, data to collect, and dissertations to write, and there are only so many hours in a day, and five or so years before our funding expires. We also have to deal with the exponential expansion of knowledge in our field, and we, too, don’t have time to study things that are at the periphery of our field but could expand our knowledge vastly. But- and this is something that neither group really “gets”- there are other groups of people who have to work twice as hard for half the reward that either of us get. We are all so, so lucky to get to do what we get to do. Let’s get over ourselves and get back to work, shall we?

    I’m not trying to make some big overarching point here about who is smarter or better or harder-working. It’s just that I noticed that both groups seem to think that they are all of those things, and I think that’s funny.

  4. Michael Caton October 10, 2010 at 5:52 pm

    I agree that the culture differences between the two groups are funny and interesting, which is why I enjoyed your post and commented. The 27 vs 42 yo comment *would* be patronizing if I had made it in isolation, but I was trying to make clear that there are reasons for both paths and trade-offs for both paths. This principle applies to decisions people make in every career path, academic or otherwise. There are a lot of unhappy 42 yo physicians who have woken up from chasing medical-career-track “prizes” and realized too late they’re on a bad-lifestyle treadmill. Yes, of course we all make the career commitment we believe is superior for ourselves, and our personalities and values differ, so we take different paths. That’s patronizing?

    Forgive me if I seem annoyed but since we’re apparently resuming hostilities between the two cultures, I’ll add that in my experience graduate students are oversensitive to medical students reflecting on these matters, maybe because they more often seem unable or unwilling to think critically about their own values; strange, because medical students understand that graduate students are trained to be better critical thinkers. Knowing this, I went out of my way to point out that *both* graduate school and medical school have drawbacks and the right choice depends on the individual’s goals. The grad student judgmental “attitude” I mentioned in my first comment is that money and status are not worthy goals for oneself (that’s fine) but anyone else who considers it in their career goals is a jerk (that’s not fine). In my experience, medical students actually have a much more “live and let live, everyone makes choices for their own reasons” attitude toward other career choices than graduate students do, and it makes me wonder where your institution is (Northeast?) for med students to be making the kinds of a-hole comments you describe, and which I have literally never heard anybody in my institution make.

  5. Laura October 10, 2010 at 8:29 pm

    I currently teach med students as a TA for gross anatomy. The most striking thing for me is how little many of them care about learning the material for being able to understand their patients, but rather they care about it for the exam. “Do I have to know this for the exam?” Well, no, we might not pin the left recurrent laryngeal nerve on the practical but you have to know it loops around the aorta because it has important meaning clinically.

    I am not saying this is wrong- indeed, the people who are medical students have gone through such an incredibly competitive process that it’s their *habit* to be test-oriented. But, there was a case last year where some students were complaining and asking us to make the exam easier. My response was no, because I’d rather have doctors that know their anatomy. So I try in little ways, here and there, to plant the seeds and change their perspective that maybe they should know the information because they’re going to be treating the human body.

    But then, they are also trying to do well in these courses so that they can get the specialty/residency they want. So, I still don’t blame them for having that attitude, even though it’s exhausting sometimes.

    As for your exchange with Michael Caton: I have to agree with him in certain respects. I often find the medical students have a higher opinion of me, because I am pursuing my PhD, and treat me as smarter than them. But, now that I reflect on it, that attitude may have changed once I became one of their instructors, versus when I took the course. The year I took gross anatomy, the students were pretty mean as a whole (but frequently meaner to each other than the few grad students that were in the course).

  6. Eric October 10, 2010 at 8:50 pm

    Well honestly I’m not able to say anything competent about this whole “Med- vs. Gradschool”-thing. But I still think I might add something valuable to this whole discussion.
    Being a student of physical Anthropology in Germany is quite exotic, back in 2005 when I started, there were at best three Universities in Germany which acutally offered a Program in it. So in the last five years I spent a lot of time explaining to other people what exactly I’m doing and, more importantly, what I intend to do, once I’m finished. The last point actually is loaded with a huge amount of uncertainty, so even now while I’m nearly done, I’m only able to give some very vague answers on this issue (e.g. “going into research” or something like that, but in german and with proper grammar).
    Let’s face it, it’s propably quite stupid to hope to actually get a job in one of the”economical irrelevant” fields, such as Anthropology. This is why I think, many people who actually intend to do this, develop a certain attitude towards people who decided to go a more “pragmatical” way.

    Well, at least this is what I experienced on myself. I often said to myself that those people “just don’t get it” and become very arrogant. But to be honest, I need to admit that I’m quite lucky to life in a society which is so rich that it’s able to pay jerks like me, who actually don’t want to contribute anything productive to it, but will (hopefully) spent the most time of their life arguing with other jerks, if “lump of bone A” acutally is closer related to “lump of bones B” or “this one half broken tooth C”.
    So I’m quite happy that there are some people who actually want to hold this state of prosperity by doing, what seems in my eyes, tedious and boring work.
    This however, do not qualify those “other” people to critisize someone who actually wants to get a job in the “economical irrelevant” research. It still takes a huge amount of courage and dedication (or stupidity) to choose this way.

    I hope something of this stuff I wrote apply to this whole discussion. I had to take a different approach because so far I didn’t make the same experiences as you but I came to situtations which were similiar to the ones you wrote about.

  7. Michael Caton October 10, 2010 at 10:57 pm

    Eric: one of my frustrations about studying medicine is that I sometimes feel like I’ve decided to be a mechanic (as opposted to an automotive engineer). For the foreseeable future there will be an ample supply of diabetics to treat, but if you really want to eliminate suffering, you get to the root of the problem. All economic growth ultimately comes from innovation, which in biomedicine means basic research. So thank you (seriously) for doing the tedious work you mention of comparing bones, because it often has wealth-generating implications that allow the society you mention to improve. I should also mention that one of my best friends is an anthro prof and he does a lot of heavily medical stuff. He often bugs me with questions about hematology and cardiology and doesn’t mask his frustration with my superficial understanding.

    Laura: I must be very lucky. I heard all these horror stories before I started school about back-stabbing ubercompetitive “mean” medical students, and what I have experienced instead is a group of very bright and motivated and ethical people who are here for the right reasons and support each other. As in, when a classmate creates a study aid that helps him or her, s/he shares them with the other classmates and with succeeding classes. Not what I was expecting at all.

  8. Carl J. Armstrong Jr. October 11, 2010 at 5:48 am

    Breezing by…

    As a (practically) Anthro undergrad, former medic, potential evo or bio anthro grad student (I hope), and former employee of MD’s and DVM’s…

    I think, if you work backwards from the profession to the schooling, MD’s and DVM’s are always “bottom line” oriented in practice and that probably bleeds through towards the education side as well. Literally, both types of medical professionals live and/or die professionally based on tests–either academic or the test of diagnosis.

    The biggest illustration I saw of this was actually the interface between (military) Physician’s Assistants (almost all of which were long-service medical NCO’s before PA school) and MD’s, often fresh from medical school. PA’s were always focused on the patient’s basic health and the (iterative) diagnostic procedures, often based on a healthy understanding that they (the PA’s) had gaps in their knowledge. MD’s, on the other hand, expected themselves to both have the right answer available (if only the right tests are selected) and that they must find it. Older MD’s (and DVM’s) seem to slowly figure this out.

    Another useful comparison was the difference between working with/for MD’s and DVM’s. The essential differences in the two are primarily focus on treated organism(s), the latitude of treatments allowed (specifically euthenasia in DVM’s), and economics. Once again, the several DVM’s I got to work for (primarily admin) seem to have a more holistic approach to knowledge than the MD’s and DO’s. Possibly because of the economics (vet care is “pay to play” so diagnostics, though available in theory, are often off the table), the idea that the correct answer is always available isn’t there as much in DVM’s.

    So, my hypothesis is that this difference in beliefs–”I can know the answer and I must know the answer” vs. “I may not be able to know the answer”–is possibly the core difference between the groups. For the MD/DO students, they see a correlation between getting the right answer and the payoff (often in economic terms) and reward themselves and others for right, knowable answers.

    At the same time, all of us interested in science deal with the prospect of the answer not being there or not being able to be found and see the rewards in the process–research, teaching, etc.–instead of the answer. (DVM’s still see the answer as the goal, but are willing to trade some of the payoff for the process.)

    So… that’s a philosophical, hypothetical take…

  9. Michael Caton October 11, 2010 at 11:21 pm

    And for the record, I just came out of my first anatomy exam ever. It was really hard. Hats off to people who do anatomy-related science, especially when the hominid you’re looking at didn’t have the common courtesy to lay down just before it died in anatomical position with all its features neatly tagged.

  10. occamseraser October 12, 2010 at 10:38 pm

    Apples, oranges. I teach dissection-based human anatomy to both, and both are plenty smart. But what dismays me is how many med students proclaim that they don’t “believe” in evolution — usually for religious “reasons”. That’s a failure in the pre-med curriculum (and high school bio for that matter), and a recent report in PNAS has made the unequivocal recommendation that evolutionary biology be a required part of pre-med preparation for medical school. I’m not holding my breath …

  11. Michael Caton October 13, 2010 at 2:13 am

    occamseraser, I’ve noticed this unfortunate trend too, although I imagine it’s probably more prevalent outside the West Coast – that I know of, in my own class, the ratio of creationists to evolution is about 1:122. I’vd always been curious about why this might be but don’t have any good theories. But for this very reason I’m seriously thinking about starting a rationalist/secular med student group at my own institution although that’s off the topic of this discussion.

  12. Carl J. Armstrong Jr. October 13, 2010 at 3:11 am

    Religion–especially when it has costly norms at odds with others around them involved–tends to need reinforcement. My bet is that creationism and religion has a “critical density” to get started in a population where density is a function of both numbers and social connections. (i.e. high numbers and low “outgroup” social connection contribute to the existence of the belief in numbers.)

  13. Pingback: Afarensis: Anthropology, Evolution, and Science

  14. Beth Routledge May 13, 2011 at 2:07 pm

    Re: your third, fourth, fifth, and seventh points.

    Genuinely, please allow me to apologise on behalf of my profession. I swear we’re not all like this!

  15. Arthur Skains November 6, 2012 at 6:42 pm

    Medical career related jobs are always high paying so i always look for it. ;

    Consider our own homepage as well
    http://www.prettygoddess.com

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