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We are getting an incredibly rigorous medical education. That is what I learned from my first exam.

As I wrote two weeks ago, I have been preparing intensely for our exam in embryology and histology (with a little physiology thrown in), a module also known as Human Body. We took the test this morning. I — and almost all of my fellow students, by their own report — am lucky if I got two or three points out of 40 total. You need 18 to pass. Last year, rumor has it, only two students out of about 22 passed this exam on the first try. (Students get a number of tries, and scores do improve remarkably over the first two years.) By the professors’ own admission, this first test is intended to help us get a sense of the level of detail we need to know in order to make it through the pre-clinical sciences portion of the entire IMS Milan medical curriculum. The takeaway from this experience? The University of Milan’s academic standards are as high as any medical schools’ in the English-speaking world — and actually, maybe, higher than many in the US.

The testing hall

The testing hall

How to defend such a bold claim? Let us look at the structure and content of the exam. We were given 40 questions, in a format for which I only know the French name (QCM – questionnaire à choix multiple). Do not be fooled by the cognate; this is not a simple multiple-choice exam, where only one answer is right. For each question, you are given a series of five statements, and you have to judge the truth or faslity of all of them. If you get one wrong, then you lose points for the whole question. You could properly evaluate 80% of the statements on this test, and still score a zero.

Furthermore, the content of the questions goes into incredible detail, given that it is the first semester of medical school. In order to prepare for this exam, I read, almost cover-to-cover, a number of the classic first-year medical school textbooks, including two on histology, two on embryology, and another on histology and cell biology, not to mention the relevant portions of Gray’s Anatomy. In this exam, we could have been tested on almost any detailany sentence in these books. Despite my hundreds of hours of preparation, I did not have the content of these books completely memorized. I had mastered a lot of general notions and indeed quite a few specifics, but for any given question on the exam, my preparation served to help me judge only three, or possibly four, of the five statements. In order to pass Human Body, you have to know by heart nearly everything in these textbooks.

The anatomy department building, site of the exam

The anatomy department building, site of the exam

That is excellent. Why? Because medical doctors cannot be permitted shortcuts in their education. The International Medical School at the University of Milan clearly understands this. Its adminstration has stressed that one of its driving values is excellence. Physicians — especially the kind of doctor I want to be, an emergency medicine physician — are in charge of keeping people from dying. They absolutely need to know as much as possible about the human body in order to minimize the chance of error. This theoretical, scientific background is incredibly important.

I will, now, write here probably the most controversial thing that I have ever written on this blog. In the US, medical school lasts four years rather than six, and it is very expensive. I think quality can occasionally suffer as a result, relative to a Western European school.* Some US students do not want to stretch their time over more semesters, lest they find themselves in deeper debt. Indeed, there are many calls, for financial reasons, to shorten medical education in the US. This may lead to culture of cramming and gunning, which can remove joy and intellectual curiosity. US medical students are not necessarily given the time to breathe and develop a deep, cheerful love for their discipline — although certainly, some of them do.

On the other hand, as a sometimes-less-than-ideal alternative to US med schools, you have, around the world, particularly in places such as Romania and the Carribbean, certain (not all!) English-language for-profit medical schools which churn out degrees at high prices. I am sure that some of these schools’ students and professors are top-notch. I also know, however, that there are mixed reports about the strength of the knowledge and clinical skills amid students and faculty some schools, not to mention lack of substantial institutional scientific research. Certain of these schools may be diploma-mills, and as a result, weaken the profession of medicine. The point of mentioning such schools is to note that the IMS Milan is nothing like them, lest it be confused for one, by virtue of its being an English-language medical school abroad.

Rather, the IMS proceeds slowly and very rigorously through its curriculum in the fashion of the great old-world universities like Oxford and Paris. The IMS Milan is international; it is part of a research powerhouse; it is nearly free; and it has no time-limits to degree completion. Milan thus trains medical students of all backgrounds into a well-paced, broad-minded, and deep scholarship. This exam gave me, first the first time, a real taste of that scholarship.

*For the record, I took the famous undergraduate introductory biology course at Columbia University, and IMS Milan makes Columbia seem quite easy. The IMS professors made much of the subject more dynamic and current, as well.

Erik Campano (Milan)

Blog Editor
Erik Campano is a consultant to the English medical school of the University of Turin and doing a Master's degree studying artificial intelligence applications in global health at the University of Umeå, Sweden. He completed his Bachelor’s of science in Symbolic Systems at Stanford University, and then he worked for about eight years as a radio news anchor, before moving to biomedical scientific study and research at the University of Paris and Columbia University. His goal is to develop AI technologies for international emergency humanitarian aid organizations like Doctors without Borders, and to combine medicine and journalism. Erik grew up in Connecticut, and is a citizen of the United States and Germany.
Erik Campano (Milan)