Before starting medical school, I’d heard from people in the field about the incredible speed with which knowledge is acquired in the preclerkship years. However, now that I’m actually in medical school, I’m struck less by the speed and density of the curriculum, and more by the process of it all—the ways in which I find myself learning.
In order to retain the enormous body of knowledge covered in medical school, the material needs to be continuously reviewed, not just to remember prior lectures, but also to integrate the old material with the new. We start out with a blank slate, slowly adding topics as we advance through the curriculum. Slowly, we accrue more and more information, until it feels like we might actually have a working knowledge of the broad categories of disease that can affect the entire human body. But the material must be revisited often if we hope to retain it, and given that disease rarely affects one organ system in isolation, we must continuously try to make connections between different topics.
It feels less like studying than building. It’s the construction of a framework on which to hang a lifetime of medical knowledge. In the beginning, there are only a few sections of the framework built—a few rooms in a house, let’s say; perhaps a cardiac chamber and a lung lounge—and they’re only sparsely furnished. But, with time, additional living spaces are crafted, even entirely new floors. As new additions are created, the older rooms—the foundations— start to get dusty and might even require some repairs. To ensure the entire structure remains stable, older sections must be periodically reviewed and maintained, and in the process, one might even bring some decorations from the new rooms to spruce up the older furnishings. In the cardiac chamber, a flowchart might be added to the wall showing how to differentiate acid reflux from a heart attack, and in the lung lounge, an outline of the way in which thyroid hormones increase respiratory rate could be hung.
Over time, the framework becomes increasingly solid—and functional. It becomes a living, breathing part of everyday thought processes, something that can be inhabited and searched while speaking with patients about their symptoms. However, despite its stability, it will never be static and, even ten years into practice as a physician, renovations will be necessary—removing parts that aren’t relevant anymore and adding new acquisitions—maybe even a secret stairway—when clinical research reveals novel pathways.
Only a few months into my medical education, I have a few rooms put together, but they’ve got nothing more than a couple of IKEA shelves in them with a handful of posters on the wall. I can’t wait to continue building, not just during my schooling years, but throughout a lifetime of medical experience. Not only will I continue to acquire new knowledge but, eventually, there will start to be additions in the form of memories—people whose lives we were able to touch thanks to years of careful construction. Because as joyful as the learning process is in itself, it is for these new decorations—the lasting impacts on the lives of our patients—that we build our house of medical knowledge in the first place.