This Month’s Student Submission: Why I Come to Class (Justin Lam)

This time last year, I had a great idea. But before I tell you about that idea, I must share two discoveries with you to put everything in context. First: I had noticed, as you probably have as well, that it was faster and more efficient to watch the recorded lectures, which you could speed up, slow down, or pause at will. Our lecturer’s voice at 1.5x speed became the new normal, and every time I came back to lecture, I felt like the lecturer was moving through temporal quicksand, trapped in an alternate dimension of slowed expression. Second: I had noticed that watching lectures by myself meant that I was holed up in my apartment all day with no human contact whatsoever, and it drove me crazy. I came to lectures to be social, to see not just my friends, but also the people who made up our class.

Enter my great idea. What if I got a group of my friends to skip class, and instead just meet up to watch the lectures together? That way, we would get the best of both worlds – the perfect combination of efficiency and social connection. I suggested this to some of my friends, and even tried it once or twice. In first year, though, this idea was doomed to fail, as we were not yet comfortable with the idea of skipping lectures and watching them afterwards. Now in second year, however, more and more of us seem to have lost this qualm.  As the number of students attending class began to fall this year, I once again began to consider this idea. Certainly, my friends were much more open to the idea now. But, I was uncomfortable with it. Something about playing truant for the sake of efficiency just didn’t feel right to me. For some reason, this great idea just didn’t seem that great anymore, and after some thought, I’ve identified several reasons for this.

First, there seems to me to be a willingness to trade coming to class for efficiency, sacrificing the experience of attending lecture, of seeing our friends, acquaintances, and strangers (to this day, there are still people in our class whom I have not yet met) – the human beings that make up the class of 1T7. Yes, a core part of our medical school experience is in the acquisition of medical knowledge, but another critical aspect of this experience is in the amazing people who make up our class. In fact, I would argue that a significant portion of our education lies in the latter, human part of our class. It is with these classmates that we will heal, comfort, and release our patients, and with these classmates that we will experience our emotional zeniths and nadirs, from the rise of a baby’s first breath to the fall of a patient’s last. It is through our interactions with these classmates that our eyes will be opened to new perspectives and experiences, things that we would have never known or thought or seen before. But how are we to call ourselves a class if many of us are missing from the very activity that defines us as a class?

I, too, have felt the pull of this need for efficiency. I have rationalized these urges by telling myself that by getting through lectures more quickly, I will have more time to spend with friends. But then I thought: when else am I going to spend 5 hours of time in a day with my friends? And studying with them before an exam doesn’t count. Sure, it might not be the highest quality time spent together, but having passed days watching lectures by myself, I have noticed the impact of simply being in the presence of my friends and peers in the classroom. I’ve noticed the difference between hearing the joke on the recorded lecture and chuckling to myself, and hearing the lecturer deliver the punch line and laughing with everybody else in the class at that moment. I feel more present and connected to those around me even if I don’t know everybody in the room incredibly well, and I feel that this human element is lost, sometimes, in the pursuit of efficiency.

By the same token, I find great utility in our recorded lectures in the flexibility it affords us. It frees us to shadow, to have meetings, to do research, or to pursue other passions during the day, and makes life easier for commuter students and students who live further away as well. It means that if an unforeseen circumstance arises, such as a family emergency, a particularly nasty strain of the flu (get that flu shot!), or the TTC breaking down (#TypicalTTC), you won’t be unfairly punished for missing a lecture. Even more useful is the ability to pause, rewind, and re-listen when a lecturer attempts to explain a tricky concept or “busy” slide.  And in this sense, the recorded lectures are a godsend.

What worries me, however, is when these recorded lectures become the primary mode of learning in medical school. I have always seen these recordings as backups, meant to supplement and reinforce our learning instead of being the exclusive provider of our education. And I believe this partly because of the lost camaraderie that I’ve mentioned above, but also out of respect for our lecturers, many of whom are busy clinicians taking time from their working day when they could be billing patients to share their knowledge with us. Another way to look at it is that by choosing to skip lecture to save my own time, I am essentially saying that my time is more valuable than that of the lecturer, and that’s quite a presumption to make as a 2nd year medical student. Here, we have world-class professionals coming to lecture us, only to face a classroom that is osteoporotically skeletal in attendance at best. If anything, coming to class is a sign of much due respect to the doctors and other professionals who have come before us. And while there has been much criticism of the didactic lecture and its pedagogical effectiveness, it is what we have right now, and it is up to us to decide whether we want to experience it in person or through a computer screen.

This issue is particularly relevant, I feel, in a time when operational models from the world of business have already infiltrated the core practices of medicine. Efficiency in the clinic and profits are now key measures of success along with excellent patient care, and if we’re not careful, I fear that we may be losing something in our relentless pursuit of maximal efficiency. I firmly believe that an emphasis and focus on the experience itself must be balanced with a focus on achieving a certain result. In other words, I believe that coming to class and seeing your classmates, friends or otherwise, will ultimately lead to a richer and more fulfilling experience in medical school compared to day after day of watching lectures in solitude (I guess this could be mediated by working with friends, but even then, you lose out on the interactions with the rest of your class).  Furthermore, I believe that coming to class will connect us to our classmates better, whether that’s as close friends or just as another familiar face, creating, nevertheless, a social support network that will ultimately make us better doctors.

To close, I’m reminded of a proverb that has stuck with me since the beginning of medical school that I will share with you now:

“If you want to go fast, go alone. But if you want to go far, go with friends.”

1T7’s, let’s go far.

5 thoughts on “This Month’s Student Submission: Why I Come to Class (Justin Lam)”

  1. This is a nice piece. I always find it interesting that there are many students in our class that wont show up unless its absolutely mandatory and even then they will be asking whether they actually have to show up to the entire thing.

    The fact that remains is that in a few short months your sitting behind the desk and being bored or excited by the lecturer will be OVER. Technically you will not have this experience EVER again. You may decide on taking courses, becoming a MSc student, PhD student etc but believe you me it is not the same experience. The number of people in class are different and the experience is just not the same. Its a shame that not more come to class, share stories with someone sitting on a different side of the room they haven’t talked to in a while, and just get to know the person from a non-medicine perspective.

    As a kid, my parents would say: “enjoy going to class because you will miss it!” but it wasn’t until I was done with undergrad that I knew what they really meant. I was excited to start school again because it gave me a 2 year window to have that experience again. I hope your essay brings some of those in hiding out again!

    Thanks for sharing!

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  2. This was a great and well-balanced Justin, that provides a refreshing perspective on attending class outside of the immediate benefits to ourselves (saving time, efficiency etc.). Thanks for raising these great issues!

    However, I don’t think I necessarily agree with the generalities of this statement: “This issue is particularly relevant, I feel, in a time when operational models from the world of business have already infiltrated the core practices of medicine. Efficiency in the clinic and profits are now key measures of success along with excellent patient care, and if we’re not careful, I fear that we may be losing something in our relentless pursuit of maximal efficiency.”

    I believe and hope that the business world and medical world can collaborate and come together to work towards our ultimate goal of patient-centred care in both an individual patient and systems capacity. Both mindsets and approaches are needed and I believe complementary to improving healthcare.

    I’m currently taking a Health Sectors course through the Rotman MBA program where many of my MBA classmates are dedicated, thoughtful individuals who use their business skills to tackle important and progressively-increasing issues in health systems. While there is definitely a different perspective in how they care about and work towards issues in healthcare, I believe it’s complementary and shouldn’t necessarily be seen as solely valuing efficiency and profits. Often, that is a goal on a systems level that benefits patients and our communities as a whole – and it’s an important one! These improvements have far-reaching and deep effects for all patients, especially with the resource restrictions that our system faces.

    However, you raise a great point that these goals shouldn’t trump compassion, patient-centeredness and other tenements of good medical care. I just think we should also keep an open mind and collaborative approach to the benefits that business can bring too. Administrators and policy makers are a valuable and crucial part of our healthcare team and often enhance our mutual core practices with the focus on patient care, for all patients.

    Just another perspective to this discussion! Happy to talk and discuss more. As someone who is a taking two extra courses this term in two different domains (medical storytelling through the Health, Arts, and Humanities program, and this Rotman course), I always appreciate the intersection and conversations between the two! 🙂

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    1. Thanks for your thoughtful comments and for sharing your experiences in your course at Rotman, Paige! I definitely agree that there can be synergies between the business and the medical world, and that these collaborations are essential to providing excellent patient care that aims to provide the best care possible while being aware of systems-level factors. As you point out, my point is mainly that these goals of efficiency and productivity (and the potential proclivity towards this sole mindset!) should be carefully balanced with compassionate, altruistic, and humanistic patient care 🙂

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