I Got the NPLEX Blues…

I am decidedly an empiricist.  No, this doesn’t mean that as a child I used to hover over ant hills with a magnifying glass, observing uncanny details about ant anatomy or looking at leaves under a microscope.  Well, maybe like all children I did this, but that kind of thing doesn’t interest me anymore.  Sadly…

I am an empiricist in the sense that it is hard to derive any value over memorizing what genes create heavy chains or light chains or the steps of the biochemical pathway of gluconeogenesis and how the rate-limiting enzymes are controlled.  I tip my hat to those who spent generations, careers and every waking hour of an entire human life in the thankless struggle to devise ingenious experiments in order to decipher exactly how the body produces glucose, antibodies or any other essential component of the exquisite human body.  However, what was once the beautiful complex labour of empiricism has now been reduced to some acronyms and a diagram in my USMLE Step 1 textbook.  I am required to memorize these concepts with the blind faith that they are actually true and bear some significance to real clinical practice.

A part of me wonders, is this just some kind of test; a psychological exercise, a method of weeding out the weak, a form of artificial selection for med students?  It reminds me of some remnant of the medieval method of education where a student would simply memorize the scriptures and, if able to recite the doctrine back to his teacher, word-for-word, he was allowed to enter the elite club of academia.  Surely in the day of software programming where the day you think of buying a computer the technology is already absolete, we’ve come to value a more practical style of education?

There is something too rational about our education.  We’re presented with some diagrams, a theory and the old, “see? Doesn’t this make sense now?” But rarely are we given any real world proof to cling to.  Learning these days involves too much faith and, while I’ll admit that it may take me a lifetime to truly understand the heavy and light chains of antibody structure, perhaps it’s time we admit that some things are simply not meant to be.  After all, I wonder how many excellent practitioners of medicine are able to, off the cusp, relate back to me the steps of the Kreb’s Cycle or the Electron Transport Chain?  And, if they can’t what does it say about them as practitioners?  Probably nothing at all.

I’m coming to understand why I’ve always enjoyed psychology.  Some call it a “soft science” and other more critical people even call it “psuedoscience”, but there is a truth to psychology that one can observe simply by looking at the life around us and the way we react to each other.  There is no need to take psychological theories at face value.  They can be readily observed by observing human interaction and our own mental processes.  Gluconeogenesis, however, despite the woozy light-headed feeling of low blood sugar that I sometimes get, is not something I can readily observe with the naked eye and appreciate at face value.

Appreciation is drilled into us, through the need to memorize intricate factoids that, let’s face it, none of us truly understands anyways.  It’s the equivalent of forcing Shakespeare down the throats of unwilling teenagers and screeching, “He was a genius, why can’t you worship him?”

I’m trying to worship the Kreb’s Cycle, but my empirical mind is protesting.


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