Who Let the Dogs Out?

Maybe it was your dad who dreamt of being a doctor one day but couldn’t, maybe it was your mum, or perhaps a grandparent saw you wearing a white sheet in their dream and interpreted it as a message from God directing your career choice through their slumber. Though you may not realize it now, your affinity for this road matters a lot; sometimes it is the only thing that keeps you going. Given that a tandem of tests is a norm in medical colleges, the origin of your motivation ranks high on the list of needs in this field. Hence, it is important to analyze and question, ‘Who planted the seed of medicine in your head?’ and more importantly, ‘Do you even want it?’

“Lose something every day. Accept the fluster

of lost door keys, the hour badly spent.

The art of losing isn’t hard to master.

Then practice losing farther, losing faster:

places, and names, and where it was you meant

to travel. None of these will bring disaster.”

(One Art by Elizabeth Bishop)

Practice Questioning, Practice Losing

Most of the time, your destiny, or rather, a prophecy, to end up in the

medical field is announced early in your life to prepare you for the

expectation of “medicine-worthy grades” starting 9-10th grade/ O level,

and because we get used to hearing it, we may end up being convinced

to love the idea of us as doctors as if it were our own. Except,

tricking yourself into falling for an idea is far easier than living the idea

every single day. A 2019 study observed the negative impact of parental

expectations on the career and grades of medical students, reporting

marked effects on students from non-Western countries— getting low

grades in the first year, a strong desire for a career change after the first

year and being prone to burnout in year five.

We shan’t rule out the possibility of it being the dream of a younger you to wear a stethoscope around your neck. However, a child’s worldview and that of an adult differ considerably. It is, in fact, impractical to blindly continue to base your life decisions on the aspirations you had when you were younger. For example, having the energy to do things after school is something that an 11-year-old version of you would probably not have even thought about (and rightfully so! Children are reported to have more endurance than trained athletes) but at 20 the only thing you want to do after the draining 8 a.m. -3 p.m./ 4 p.m. of medical school and encountering a traffic stricken commute home is to strap yourself to the bed and never get up.

While it’s true that the college/ university timings, regardless of your major, fall into the 8 a.m.-3 p.m. time range, what’s different with medical schools is that, while students with other programs may ditch class or have a vast break between classes, as a medical student, these occurrences are as rare as dogs in oceans. Sure, you may not attend classes, but with an increasing number of colleges raising their mandatory attendance percentages to 90%, you’d want to save the limited supply for special occasions, and if you think you won’t hop from a 50-minute biochemistry lecture to two hour-long practicals with only a 45-minute break in the whole day, then you have a train wreck coming and the only casualty is going to be yours.

(Fact: some colleges, such as Rahbar Medical college, have no breaks in their schedules. Their reasoning? They let their students off at 3 p.m. compared to other colleges with a 4 p.m. off time.)

So, before strapping yourself for this journey, ask yourself the “whys.

”

The biggest "why” of all is, ‘Why do you want this?’

(P.S. Wanting to help others is not enough. It's good intent, but nothing more than that. You want to know why you want to do this to yourself, because at 4 a.m. running on no sleep learning the relations of a muscle, or at 2 p.m. with no breakfast, or every time you brush your hair and half of them fall off your head from constant anxiety, or perhaps at the end of grueling 48-hour shifts, you’re going to want an answer to this.)

If you find the answer along the lines of “I don’t really know” or “maybe I don’t want to do it at all,'' know that there is no shame in admitting this or changing your path. Even if you find this answer after you’ve begged and cried for good grades and gotten them in MDCAT, you should do the right thing by yourself. After all, up until after MDCAT, you’re too focused on scoring in the 90th percentile to take a break and check in with yourself. It is a display of courage to know what’s best for you and go for it rather than flow with what others decide for you. Do not let the idea of “what will relatives say'' waver you. Those that are not in the field likely only know the exaggerated, sugarcoated version of it, and whatever your decision may be, they are just spectators.

Know the Facts

The truth of the matter is, medicine is not just your career, it's the Pacman that takes over your entire life. The rigorous curriculum of medicine is not for everyone, and this is not a challenge it is a warning. So many of us fall for the romanticized version of this field. The burden of the creation of these rose coloured glasses falls on the shoulders of medical students and professionals, and its publicity is shouldered by the people who, for one reason or another, didn’t make it to medical school. You have to understand that medicine for the latter equates to “the one that got away”. They find no problems within the field, and even if they do, they reason that compared to the benefits of being a doctor (that exist according to their mental constructs of a doctor), it is a small price to pay.

For the former group, social media use is a coping mechanism. A 2022 study found that the use of social media sites during the COVID-19 pandemic and other high-stress situations has a positive mental health impact by offering psychological detachment. The routine of a medical school and profession and the strain brought on by it is so isolating that oftentimes social media is used as an outlet to combat these negative feelings. Two central themes of doctors and medical student creators are a humorous portrayal of the harsh conditions that students and practitioners of medicine have to face in routine and, ironically, the “blessing” of having medicine as a career. The complete polarity of such a mindset is glaringly apparent. It’s one between which a person associated with medicine oscillates throughout their entire lives.

Do not base your life decisions on this maudlin version of the medical field. Instead, find trusted sources, like current medical students, ask about the challenges faced by them and ask yourself if you want those in your life. This exercise, however, will only be useful to you if you keep your mind open to the answers you may receive. The good, the bad, and the very worst. Having a fixed mindset and expecting someone else to fight and change it is illogical. You should also keep in mind that people will tell you what they are faced with, but they don’t want you to blame them for not choosing the field down the road, so it will most likely be a watered-down version of the events, along with remarks like “Oh, but you get through it”. It is in your hands to decide whether you want to get through life or live it.

An excellent alternative is shadowing doctors, preferably from a wide array of specialties. It not only allows you to have a first-hand view of working conditions and to gain some practical knowledge of the field but also looks great on your CV if you decide to go for the MBBS degree after all.

It’s an Investment and the Returns are Low

Healthcare is an industry, whether you like it or not, and it profits off of low incomes to healthcare providers while simultaneously overcharging patients. The reality of a doctor is long work hours and disproportionate compensation. As an example, the job of a social media influencer pays far better than that of a doctor. Influencers with micro accounts (10K-100K followers) post 3 posts per week. In 2020, the average pricing per post by an average creator in Pakistan in such a category was around 10K Rs (30K/ 365$ per week). On the other hand, the salary of an average doctor (i.e a specialist) in Pakistan per week is 26,700 Rs/ 325 $. Given the working hours of doctors, the responsibility they shoulder, the standards they are held accountable to despite their working conditions, and the money they spend on their education, this number is nothing short of a slap.

A real gut punch though, is the rising trend of unpaid house jobs and the advertisement of seemingly ”paid” jobs but on-site it’s a hospital administration that refuses to compensate its workers for their service.

Despite it all, what matters is what you should be asking yourself, ‘What do I want to do with that MBBS degree?’

…If medicine still tickles your fancy, then your next stop is, of course, MDCAT.

Hello, Who are You?

MCAT, MDCAT, NMDCAT, whatever name we are calling it this week, is at least supposed to be an entrance exam to medical colleges, but its history in Pakistan is long and convoluted. To summarize, both the organizations that are responsible for conducting this test— PMC and PMDC— have been formed (or rather re-formed, if you will) and dissolved thrice since the formation of PMC in 1948. If this isn’t a testament to the stability and reliability of the institution, what is? There will be days during your preparation period when you’ll wake up to the news of PMC overtaking PMDC overnight and sleep to the announcement of the restoration of PMC and all this time in between will be spent boiling in uncertainty and fear because each organization announces its own set of regulations, medium for conducting the test (paper or digital), and syllabus, and so the change of governing body means, quite possibly, two completely different tests to prepare for. Not to mention, both of these institutions have a knack for overthrowing each other at the worst of times. In the year 2022, amidst COVID-19, the MDCAT, which was the National MDCAT at the start of the year under the tutelage of PMC and was to be held starting September 7th according to a planner that had already undergone amendment , was once again, MDCAT under PMDC’s direction by 3rd August 2022. PMC was declared illegal and then… the floods hit. With the country in turmoil, the schedule got amended, for roughly, the third time, and the date was set for September 14th, 2022.

https://senate.gov.pk/uploads/documents/1664947620_834.pdf

Shortsighted

Being responsible for the future of medical students of the entire nation there are a few expectations that one has from the governing institution, one of which is the ability to predict and be prepared to counter issues that may arise in the near future, especially those that may arise due to introduction of a new policy by the organization itself. Here’s an example from the past year:

24 May 2022: Registrations for MDCAT by PMC open.

25 May 2022: Registrations close on account of “internet issues”.

The internet “issues” were, among others, that this year the decision to hold MDCAT in Gilgit, was taken and registrations were online. Stable internet access (3G and 4G) in Gilgit you ask? Nada. In fact, Pakistan ranks 76th out of 100 worldwide according to the 2019 Internet Inclusivity Index. From this vantage point, it seems like PMC “forgot” this fact. In a country where it’s almost a ritual to tear down newly built roads to lay down necessary pipeline underneath, this occurrence isn’t surprising, but for the student who’s preparing day and night for this exam, continued rescheduling makes this experience a nightmare because when you finally get over your (rightful) cynicism and believe the announcement, the date of the exam gets rescheduled.

Smoke and Mirrors

As if not enough chaos has been endured, one more thing that gets added to the mix is fake news. With the rivalry between PMDC and PMC, the rampant rescheduling of the test, syllabus changes, and whatnot, it is imperative to stay on top of the news cycle while preparing for the most important and stressful test of your life. You’ll encounter a wide variety of hoaxes, ranging from phony announcements of test dates to a whole dummy Twitter account of the VC PMC. Given that, like all trustworthy organizations, twitter is the preferred news channel of PMC/ PMDC a dummy account can mean you’ve been believing news about the test from…who?

Ideally, there’d be one unwavering institution in charge of conducting MDCAT, with any new policy being announced to be implemented next year rather than the year of announcement, all official news would be delivered to registered students through email, and rescheduling of the test date would not be allowed unless it was a case of national emergency. These are the bare minimum righteous demands of any MDCAT taker, but it hasn’t happened since 1948, and you best believe it isn’t happening for you either. In fact, whenever you think it can’t get worse than this, one of the two institutions surprises you like never before.

Be Glass

One thing that MDCAT is desperately in need of is transparency. Transparency regarding the syllabus, the marking, the medium of the test, and the in case of computerized testing, the ins and outs of the software being used to test. Up until now, we’ve seen a syllabus that doesn’t quite cover the questions being asked in the exam, a “unique” question paper for every applicant, barring objections to out-of-syllabus questions, an unequal grant of grace marks for out-of-syllabus questions, and an allegedly unlawful bidding for hiring a company for the software design of NMDCAT.

Year after year, it's a story that gets worse. Such tactics steal away the dreams of hardworking students, but perhaps this is exactly what they want because if it's a question of precedence, they don’t have to look further than NUMS or AKU. While every year PMC and PMDC fail to prove their metal NUMS and AKU conduct their entrance exams with such ease that it hurts.

The Best Academy for MDCAT Prep

The answer is none. It’s a scam. After being aware of all the above-mentioned problems, you can probably see why it’s foolish to pay an arm and a leg for a test preparation session at any academy. The test itself, if it is prepared from the given syllabus, is not hard, and you can prepare for it by yourself, augmented with advice from seniors through either WhatsApp groups or Facebook groups dedicated to MDCAT. The non-preparation-related turmoil that MDCAT brings— nobody can prepare you for that. However, if you still feel the need to pay, by all means, go ahead!

You’ve Reached Your Destination

You’ve been through the nightmare — MDCAT and you’ve made it to the merit lists either public or private. What now?

You’ll now make the mistake of judging what college is best for you based on:

• Which merit list you appear on first.
• Which college calls you first.
• Other people’s opinions.
• If the building looks aesthetic enough.

Here’s what you should be focused on instead:

• The grading list by the medical council
• The fee (in the case of private medical colleges)
• The yearly planner of colleges of interest (look for incorporation of extracurriculars, the length of vacations, how they pace their tests)
• The distance from home (the lesser the better! This is a very important factor, judge wisely. You do not want to spend the limited hours of the day traveling to and from college. As for hostelites, smarter people have gone to farther lands and experienced lowered academic performance as a result of depression caused by homesickness. Know yourself)
• Their mandatory attendance percentage (70–75% is just right, do not think that 90% is easily maintained regardless of whoever says it)
• The hospitality/hostility and flexibility of administration (according to the students already enrolled in the college of interest as well as those doing house job because the college administration is your future employer as well)
• The price and quality of food in the cafeteria (It’s a daily expense that most fail to consider, and as for quality— you are what you eat. This does rank low on the list but should be considered.)

During this process, look out for yourself. Think about what works best for you, and then make the decision.

Or Have You?

Perhaps MBBS wasn’t your destination after all. Maybe you wanted to but didn’t get there or didn’t want to go there at all. Whatever happened, you’re now faced with the possibility of a gap year. I must inform you, this is the best thing that could’ve happened to you in your entire life. Think about this: most of the children are admitted to schools by the time they are 3-4 years old. Nowadays, what with the invention of “Pre-kindergarten”, it is perhaps at the age of 2 years that we find ourselves in a classroom and the classrooms are great! They are the hubs of knowledge, but we sometimes forget that there are other ways to acquire knowledge and learn skills. We forget that learning is not just a prerequisite for a career and money. It is the fuel for our minds, the balm for our souls. Your pathway to learning does not have to be linear, and nor should you confine yourself to learning only those skills that are relevant to your field. Why can’t you be both a gardener and a doctor? Or a photographer and a doctor? Or a carpenter and a doctor? Or an event planner and a doctor?

A gap year is a year of possibilities. It’s a year of self-development outside the shell of medicine. You can decide not to be a doctor if something else piques your interest. You can spend it reading books you haven’t had time to read before or you can spend it in hibernation! Possibilities, possibilities, possibilities.

The road to medicine is anything but easy, but it sure is full of possibilities.