What drives you to learn?

Hugh Ip student editor Student

BMJEmail: hip@bmj.comStudent BMJ

2008;16:134 17

Like most medical students, my problem is not laziness. I gladly expend my energy on things that I consider worthwhile, like getting a medical degree. Beyond this natural enthusiasm, the possibility of failing a year certainly motivates me; nothing else is quite as effective for kick starting my revision.

Even as I plan my revision I am aware that I have a limited capacity for concentration and retention, so I prioritise the core medical sciences over softer topics, such as patient communication. I focus on learning the relevant pathology, aetiology, clinical presentation, diagnosis, and management of a disease. After all, the weighting of exams reflects the scientific basis of medical practice.

Medical research has traditionally focused on the mechanisms of disease. Perhaps surprisingly, this biomedical model is now providing evidence to support a more holistic approach. Complex interactions between the mind and the body, such as the link between exam stress and immunosuppression, are beginning to be explained by psychoneuroimmunology (p 144). Patients with psychiatric illnesses, such as panic disorder, are affected by physiological, psychological, and social factors; the need to consider the whole person is evident (p 166 ).

As scientists, it is easy for us to understand the crucial role of antibiotics in combating the worldwide problem of tuberculosis (p138 ). But the need for a holistic approach becomes apparent when we consider how individual patients are affected by tuberculosis. Read about the patient who had economic difficulties, family pressures, and social stigma as a consequence of the disease (p 140). As medical students, we are not limited to contact with books and journals, we have the privilege of personally speaking to patients, examining them, and knowing them. In my focus on the scientific curriculum, I may not have given enough time to reflecting on what patients can teach me (p 156).

Despite our best efforts we will never completely empathise with patients unless we have a similar illness ourselves (p 152 ). A medical student writes about her experience of epilepsy: "It has also made me understand the condition more profoundly and realise that in chronic disease the patient is a greater expert on their illness than the doctor. Not only do patients consider the physical impact of disease but also the psychological and social parameters that make up the whole experience of the illness" (p 150).

A year and a half has passed since I last spoke to a patient. I will recommence my clinical studies in a few months; I hope to be inspired by something more than the drive to pass exams, and live up to the Christian faith I profess (p 158).

Wallahua'lam