Making a doctor

By Kiyoshi Tomono

Daily Bruin Contributor

Countless hours spent poring over medical books, dissecting
cadavers and dealing with sick patients has consumed the life of
Dr. Karen Allsup for the past four years.

For Allsup, and about one hundred other doctors in the UCLA
School of Medicine’s class of 2000, the past few years have
been trying at times and rewarding at others, but they ultimately
serve as mere stepping stones in the long process of becoming a
physician.

“The patients call you a doctor even though you are in a
short lab coat ““ to them, I guess, a medical student is just
as good as a doctor,” Allsup said, referring to the shorter
lab coats that distinguish medical students from doctors.
“Medicine is really about life-long learning ““ I am
very humbled by it.”

The next step for the newfound physicians is to become an intern
in one of several thousand residency programs nationwide, a form of
apprenticeship in the world of medical education.

The programs last anywhere from three to seven years and provide
newly-graduated doctors with clinical training in fields ranging
from family practice to neurosurgery.

The students first learned where they would be assigned
residencies in mid-March, after the National Resident Matching
Program takes place. The event, which doesn’t give students
much of a choice, has simply come to be known as “the
match.”

In the process, applicants and residency programs evaluate and
rank one another, and then a computer program pairs the two based
on those preferences.

“Everybody goes at 8 a.m. to the faculty center, where
they hand us all our results in these sealed envelopes,” said
graduating medical student Dr. Pouneh Beizai. “Some people
were really private about it and went to the bathrooms, other
people were more public about it, though, and opened it up in
groups. I think that most everybody was happy with their
results.”

Before getting that far, the students had to study everything
from biomathematics and biochemistry to proper interview
techniques.

To get into medical school they took the Medical College
Admissions Test and then two parts of the three-part United States
Medical Licensing Exam to graduate. The physicians will take the
third part of the test during their residency.

But as steadfast as examinations are in medical education, a
recent trend has seen a shift away from the traditional schedule of
gross anatomy and pharmacology classes.

While such courses, along with rotations through the medical
center, continue to be the bread and butter of basic training for
medical students, several new classes and concepts are being
introduced into medical school curricula to make more compassionate
doctors.

In a course that was developed just a few years ago, for
instance, the budding doctors in the class of 2000 learned medical
Spanish to communicate with the growing Latino population in
California.

Dr. Gabriel López, the class president, said such courses
are part of a change in medical education that will continue into
the future.

López himself will be heading off for a residency in family
practice at White Memorial Medical Center, a hospital that treats a
predominantly underserved Latino population in East Los
Angeles.

“I think there is a gradual trend to tend to these
underserved areas, especially with the changing demographics in LA.
By the year 2000, one out of four people in California will be
Latino,” López said. “They tend to be of lower
socioeconomic status and med schools are recognizing that
fact.”

“They are meeting that need by introducing classes and
community service projects to help out those communities,” he
added.

But classes alone are not the only emerging trends in the
curriculum at UCLA’s School of Medicine. According to Dr.
Richard Usatine, an assistant dean for student affairs at the
school of medicine, next year’s curriculum will involve the
introduction of four new colleges focusing on critical and acute
care, applied anatomy, primary care and medical science.

“We want to have students involved in helping us build
this new curriculum,” Usatine said. “We want more
faculty involved in working closely with the students and giving
the students a chance to work together in groups with similar
interests so they can bond and learn from each other very closely
in the fourth year.”

Medical education, which at many schools is traditionally
divided into two initial years focusing on classroom science and
two later years learning to treat patients in the clinical setting,
is beginning to see that rigid partition blur.

In its place, medical schools across the country are creating a
series of clinically based classes that span the entirety of
medical school and serve to connect what students learn in the
classroom with what they will see in the exam room.

At UCLA, the series integrating clinical-based learning is
called “Doctoring,” while at other schools, like UC
Irvine, the class is called “The Patient Doctor
course.”

“In the first two years, they teach you anatomy,
physiology, neurobiology, biochemistry, and a doctoring
course,” Allsup said. “The first and second years are
really classroom learning, but you do get in the clinic for half an
afternoon each week.”

In particular, Usatine said the “Doctoring” classes
teach medical students the best way in which to interact with
patients.

“It’s really about learning how to be the best, and
most caring and humane doctor,” Usatine said. “It
starts with interviewing skills, but it also includes ethics,
clinical decision-making, cultural issues, cultural diversity and
some epidemiology so you understand public health.”

“But communication, asking the right questions and being
sensitive ““ those are the biggest things,” he
added.

For some students, though, like Dr. Risa Hoffman, such classes
were interesting but too restrictive.

“I think it’s an exciting experience, but you have
to follow your own path, see outside the lines, and hold onto your
passions,” Hoffman said. “I think it’s a little
bit restrictive because you need to study certain things to learn
what you need to know ““ for some people, it means giving up
your other parts.”

But for Dr. Steven Pletcher, who had his son Samuel during his
fourth year of medical school, the most frustrating factor of his
medical education was the debt it put him in.

The cost of medical education ranges anywhere from a total of
about $96,000 at UCLA to upwards of $184,000 for four years at
USC.

“I think the hardest part is that it’s long,
it’s expensive, and even when you graduate, your residency
involves long hours and a small salary for several years,”
Pletcher said.

Allsup agreed, indicating that the trend of declining salaries
only compounds the problem.

“The money not being there, the biggest problem is paying
off our loans,” Allsup said. “I am $60,000 in debt, but
in terms of medical school, that’s really a
bargain.”

All the pros and cons aside, many of the students agreed that
potential medical students could benefit from exploring their
options before making a final decision on a medical career.

Before coming to UCLA Medical School, Dr. López spent half
a year substitute teaching and another year volunteering in
Americorps. Hoffman, meanwhile, took time off to ski and obtain a
masters degree in public health from Harvard.

“Medicine is a lifelong career. People are in a hurry to
get there, but there’s no reason to be,” Hoffman said.
“For anyone considering going to med school, talk to a lot of
different people. Be sure that it’s really what you
want.”