I struggled during my first two years of medical school in the University of the Philippines (UP). This I can say only in retrospect, not because of a lack of awareness at that time, but more so because I refused to acknowledge how I felt. I thought I was OK. I wanted to believe I was OK. Many years later, as a doctor and teacher at the same medical school, I can say I wasn’t.
Our class was among the first to use exam answer sheets that a scanning machine could check automatically. Whereas it would take weeks to release the results of a manually corrected exam, the waiting time was reduced to a few days, a week at the most with this new system. As soon as word got out that the scores of the last lecture or laboratory exam had been released, first year medical students, in their lab gowns stained with bodily fluids and reeking of formalin, would make their way from Calderon Hall’s dissection laboratory to the Department of Anatomy’s computer room one floor below, and huddle in front of the few working desktop computers.
The results were tabulated in an Excel file and displayed using our codenames (Mine was sphenethmoid, a tribute to frog anatomy), arranged from highest to lowest. For the top ten students in each exam, however, the names were always revealed. Even before you could manage to squeeze into the front of the pack, high fives, congratulations, and “Libre naman diyan!” would already echo in the room, and the names of the top-performing students floated in conversations for the rest of the afternoon. In first year, you always celebrated these triumphs.
Except for one exam towards the end of the semester, in which I got the top 9 spot, I was far from stellar in anatomy. In one exam, I almost failed. Each time I silently hoped that one of my friends would be among the first to look at exam scores and get back to me with good news, but I only ended up disappointed for failing to meet expectations. Always, I waited for the crowd to dissipate before checking how I did.
I was the topnotcher of the INTARMED program*, and yet when our class of 40 students was joined by 120 more, mostly honor graduates from UP Diliman and UP Manila, I felt that I could not keep up. I would not say this openly though; it would be utterly insensitive to my other classmates who tip-toed on the passing mark. Only INTARMED friends who knew me well enough could decipher my facial expression and offer words of consolation or frank advice. Sometimes both.
Outcome was only rarely proportional to effort. For the most part, this was the root of my disillusionment early on in medical school. I envied my classmates who could memorize lecture transcriptions, find time to read the preferred textbooks for each subject, and subsequently earn top marks. I could not figure out what I was doing wrong. I was putting in long hours but hardly getting the results that I wanted.
This cycle of hard work, anticipation, and frustration would drag on for two years. I struggled most in anatomy, histology, and pathology, subjects that relied heavily on rote learning. Even biochemistry, whose pathways I relished as a pre-med student, mutated into a fanged creature that I could not tame with my clipboard and study lamp.
I was not comfortable with just passing, and the straightforward reason: I could not risk losing my academic scholarship that required a 2.0 general weighted average at the end of each year. Admittedly, and I now laugh at this, underperforming also bruised my ego.
I had a more profound, idealistic reason, though: I was afraid I was not learning enough. Even though I passed my exams, not much information was retained afterward, and I felt this was tantamount to shortchanging my future patients. The countless nights spent studying could be endured, but this nagging feeling of inadequacy was much more difficult to bear, like the frayed edges of your white uniform, or the whisper of doubt that you hear just after inserting the eartips of your stethoscope.
Several weeks ago, a UP medical student’s rancid post went viral in Facebook. It was strongly worded, urging aspiring doctors, “HUWAG NA KAYO MAG-UP MED” (Don’t go to UP College of Medicine) because of “tremendous amount of stress” and “rampant crab mentality and neurotic ambition to get the perfect grades,” at one point even calling the national university’s medical school a “hellhole.”
This is what disillusionment does. And this happens not just in UP. I say this as a teacher and a blogger who has had the chance to speak to and interact with medical students from all over the country.
If I could talk to this person and my first year self, this is what I would tell both:
At the start of medical school, we get fixated on this concept of a medical student who excels in academics, finds time for worthwhile extracurricular activities, has an active social life, is well-loved by everyone, and seems right on track to becoming a successful physician.
The perfect medical student does not exist. Even the best and the brightest have moments of solitude, when they doubt their ability to heal a patient.
Nobody goes through medical school unscathed. Take care of yourself and each other. You need that part of you that is kind and empathetic to remain intact at the end of all this. What we have is an imperfect system. It may be necessary to study to pass, but it is more important to study to learn.
When doubt and disillusionment enfold you during the most difficult of days, I hope you find fortitude in your why. Remember the person you were at the beginning, and focus on the doctor you aspire to be at the end. Realize that all the hard work you put in now is just because one day, you would want to be of service to others as a physician.
For me, things got better in third year, when I began to see patients in the clinics regularly. It all started to make sense, and I saw how information I used to just memorize could be life-changing, even life-saving at the right moment. I continued to hold myself to a high standard, but I let go and stopped comparing with everybody else.
During Otorhinolaryngology (i.e., Ear Nose Throat or ENT) rotation in internship, I saw one of my classmates lingering at her patient’s bedside after work hours. She was holding up a magic slate and showing her patient how to use the writing device. Later, I would find out that her patient was scheduled for total laryngectomy. In this operation, the larynx or voice box is removed completely and a patient would lose voice permanently. The magic slate was my classmate’s gift.
Medical school is never just about grades.
*INTARMED students only take two years of pre-med subjects mostly at the College of Arts and Sciences in Padre Faura, before going into four years of medical school proper at the College of Medicine in Pedro Gil and one year of internship in Philippine General Hospital.