By Michael Dauzvardis
In The Beginning
It was June of 1977 and I had just begun my graduate career in anatomy. Little did I know that I would be taking all my major classes with the medical students. A lifelong journey in accompanying medical students in various ways had begun.
The Lecture Hall
A typical day in anatomy class began with 130 or so medical students, shuffling sleepy eyed into their small seats with swing out mini desk tops. They came bearing newspapers, coffee mugs, 3 course breakfasts, adorned in hair too long and shorts too short. Bell bottoms, blue jeans, and baseball caps ruled the day. I quickly assimilated by wearing my new Levi overalls. On the right side of the room (while facing the podium) was a sign affixed to the wall which declared “No Smoking This Side of Room.” Now I must say that on the opposite side of the room I did not observe a lot of smoking but on more than one occasion I observed a student chewing tobacco and spitting into a large plastic cup during lecture. The class of 122 consisted of 90 men, and 32 women– with a racial and ethnic composition of 1 black person, 3 Latinos, 7 Asian-Americans, and 111 Caucasians. Forty-six of the men had mustaches, with the majority of those also sporting beards. It was the prime of the disco period and it showed.
A portion of a newspaper containing the daily crossword puzzle would be passed around for each student to contribute. The instructors drew on a thing called a chalk board while some students tried to keep up on their yellow pads of legal paper. Audiovisuals consisted of carousels of 35 mm slides projected onto a pull down screen in the front of the room. On more than one occasion I observed a professor drop his entire tray of slides before lecture. The slides would fly in all directions. Students and staff, eager to be helpful, would assist in reloading the carousel, but since slides needed to be placed upside down and reversed in order to be projected correctly, this usually resulted in much confusion and sore necks during the lecture. These slide carousals also provided for the mischievous opportunity of inserting bogus slides into the lecture. If a lecturer wanted to show a “film strip” he had to notify the AV department in advance so they could bring in a reel-to-reel projector, whose sound never worked and which often melted the film.
There were no computers or cell phones (two payphones were mounted outside the lecture halls). Pocket calculators were the rage–and I even saw an occasional slide rule. Virtually all students participated for 15 dollars in a co-op note club. Each student would be assigned a lecture at which he or she would take detailed notes. These were typed out, mimeographed and distributed to the entire class.
The lecture hall had a center aisle, but no side aisle. As a result, students had to climb over each other to get to and from the end seats. Furthermore, the floor slanted at almost 45 degrees toward the front such that a dropped pencil or spilled cup of coffee made it all the way down to the lecturer. The lecture hall spanned two floors with the upper half flanked by the outer windows in a manner leaving a precarious eight-foot drop hidden by curtains– which on more than one occasion gobbled up a medical student like a bug in a Venus flytrap.
There was a long, often leaky, run-down hallway that connected the medical school and hospital with the dental school, a dark tiny basketball court, an old theater, and the beloved pub. The pub served pizza and sandwiches and soft drinks for lunch during the week. But, at 2:55 pm on Fridays, students, staff, and faculty could be seen with their tongues attached to the outside of the pub windows like lampreys on a shark. On Fridays at 3 pm the pub began to serve beer till 1 am. The steady stream of warm Stroh’s beer fueled discussions on research and politics. Relationships were made and broken. For five dollars you received a punch card that allowed you ten cups of beer– or 1 pitcher– unless you knew one of the dental students that ran the place. Then you drank for free.
The library was an old set of rooms, spanning part of the 3rd floor and extending down to the basement. Occasional flooding had imparted an odd musty odor to the thousands of journals and scientific books. Leather bound copies of Gray’s and Grant’s Anatomy could be found in the stacks. In the dark windowless basement, the ceiling was low and the shelves were packed together, punctuated with tiny reclusive study carrels. These provided a very insular place for study but at the same time instilled the fear that one would probably be trapped and instantly cremated if a fire started. For a rather large fee the librarian would run a Medline search on a given topic, providing one with a dot matrix printout that spanned from the moon and back. I worked weekends in the library for a year, passing some of the late Sunday nights by repeatedly riding a three-foot square dumbwaiter designed to transport books from the basement to the top floor and back.
The gross anatomy lab was built out of a remnant of the old adjacent VA hospital that was situated just across the street. It was a dilapidated one story red brick building, heated with a row of steam radiators and cooled by open windows. The floor was orange linoleum, the cabinets were yellow, and the ceiling consisted of stained, bowed, and often missing suspended tiles. There were 40 cadaver tables that rotated like a Ferris wheel. Each table held 2 cadavers. Medical students met three days a week, dental students 2 days a week. Tables were rotated accordingly. There was a caretaker or diener’s office to one side, which was basically a shed add-on with no foundation. When it rained, the warped office floor would collect about three inches of rain that ran down the leaky wall. The frustrated diener finally drilled holes in the floor, allowing the water to drain out as it came in.
Students had no locker room or even a bathroom to use nearby. Both male and female students could often be observed in an adjacent hallway, partially clad, donning their laboratory attire. The lab was open 24 hours and students could be found dissecting after midnight, especially near an exam. Lab exams or practicals as they were called, consisted of students having one minute to identify each of some 75 tagged cadaver structures. For some, these were nerve-racking tests. To provide a morsel of relief, comment sheets were provided at “rest stations” such that students could anonymously vent about questions, faculty, or fellow students.
The head of the anatomy class, a 75-year-old German native, snuck away each lab for a quick smoke on the loading platform adjacent to the diener’s office.
As previously mentioned, there was a tiny gymnasium down the long quarter-mile hall. It was akin to a grade school gym– very small and dark. One could occasionally find a pick-up basketball game in session. These games were usually dominated by dental students who for some reason were better jocks at the time. There also was a small balcony where (don’t let it out) I took aerobic classes for a semester. The locker room could be best described as a large petri dish. The dark, damp, crusty, and crumbling cave seemed almost alive with newly evolved and yet unclassified lifeforms.
Fast Forward 42 years . . .
The Lecture Hall 2019
In 1997 a new medical school building was constructed. Two new classrooms were built that could each hold approximately 180 students. The students now sit behind comfortable long rows of tables. Each station has power and internet access. Accommodations exist for hearing or ambulatory impaired students. A giant screen and the window shades are all computer controlled. A state of the art laser projector displays Power Point lectures. All lectures are automatically recorded and streamed on the internet. All handouts and ancillary learning materials are also posted electronically. Exams are given online and then instantly graded. Every student has a cell phone, laptop, or tablet– or even all three. Students follow along with the lecturer, writing their own notes on their computers with a stylus. Others are shopping on Amazon, checking Facebook or posting on Instagram. Walls and tables are trimmed in cherry wood. Videos of patient encounters are only a click away.
The freshman class currently consists of 168 students. The makeup is 15 African-Americans, 21 Latinos, 43 Asian-Americans, and 89 Euro-Americans. There are 106 women, 62 men. Only 10 men have mustaches. Only 1 man has hair considered to be long. The rest have buzz cuts or hair under 1 inch in length.
The classrooms and educational tools are truly a marvel. Only 30% of the class regularly attends lecture.
The Pub is dead. Insurance liabilities and new construction hastened its demise in the early 90’s. Mysteriously, the lack of alcohol on campus also coincided with the closing of the dental school.
The library now exists in the new nursing school. It is a beautiful space, spanning only one floor yet seemingly expansive with its massive windows and plentiful lighting. The library has no books but relies on digital media. Students can access free online textbooks and study aids while cocooning themselves away in several of the soundproof study rooms. The library also houses an extensive collection of skulls and anatomical models. Students seem to love it.
The new anatomy lab is replete with state of the art equipment and facilities. Each of the four dissection bays has a ceiling-mounted digital camera and a 65-inch wall mounted monitor. Each bay also has a computer. The lab has a fantastic air quality control system. Male and female locker rooms contain showers, benches, and plenty of lockers. One of the cameras has the ability to project dissections to the two large lecture halls in the building.
Due to changes in overall space allotment, emphasis on other classes, and a reduction in anatomy faculty, cadaver usage has dropped from 35 to about 6. The four main cadavers used in the course are prosected by the faculty. Students now rotate through the lab in 40-minute sessions in groups of 15 students each. They observe the pre-dissected cadavers by watching the faculty demonstrate structures on the TV monitors. Gone are the walk-around practicals–replaced by digital images and multiple choice questions added to the sit-down main exams. The lab is open 24 hours but students rarely return after their mandatory 40 minute demonstration. The course has been truncated from its original full semester length to only 10 weeks.
A beautiful two story health club was included in the construction of the new medical school. It houses a track, swimming pool, over 50 treadmills, a collegiate sized basketball court and private areas for yoga and spinning classes. Locker rooms are clean, modern, and free of new life forms. Students enjoy the facility, i.e., healthy body/healthy mind.
Today I am fortunate enough to teach anatomy to medical students in the same medical school that I received my doctorate. I have noticed some changes over my 40 plus years of spending time with medical students.
Although it’s not fair to “paint“ the personality of a given student body using a broad brush or roller, several observations can be made when comparing medical students across generations. A sense of entitlement seems to have seeped into the psyche of some of today’s students. Declarations like the following can sometimes be heard echoing in the hallways: “I’m paying $50,000 a year and the anatomy handout is not printed in color!” Like never before, students are questioning the necessity of starting classes before 9 a.m., holding classes after 3 p.m., attending lectures or lab at all, and even entering the school building more than once a week. In the face of such digital wonders as Facebook, Instagram, Twitter, and YouTube, students are demanding a higher quality of lecture with more bells and whistles than ever before. While there is nothing wrong with expecting one’s school to provide top-notch pedagogy, demanding that the learning environment be tailored to one’s personal preferences seems to be little more than an expression of self-centeredness.
Who’s to blame for this apparent darker side of privilege? We as parents of course. Every generation of parents has always coddled their offspring a little more. The first generation of Neanderthals gifted their children at puberty with a shiny rock. The next generation of cavemen gifted 2 shiny rocks. Although we thought of ourselves as “rugged individualists” 42 years ago with our outrageous sense of style and cigarettes, the prior generations would surely have viewed us as self-indulgent and our environment as too filled with trivial conveniences. Today’s parents enroll their children in every after school event and summer sports camp, spending thousands to give their child a jump start in life. To our sensibilities this seems outrageous.
Who knows what the future will bring? One thing is for sure– the increase of female enrollment to over 50% and the rise in admissions of underrepresented minorities (including DACA students) will better prepare physicians of the future to address gender sensitive issues and meet the needs of underserved communities. In addition, we may hope that the myriad of digital wonders now at the disposal of these future clinicians will not serve as a crutch but will vault the quality of patient care into the ionosphere. Regardless of what the future holds, for me the last 42 years of taking classes and teaching at this institution have been an exciting and joyous ride. Taking classes with medical students gave me an appreciation of the trials and struggles that these gifted and determined students had to face in their journey to becoming physicians. Furthermore, becoming a teacher, and helping to guide these students on that journey has been most rewarding. It is wonderful to see that some of those students that I taught 30 years ago on how to place a new blade on a scalpel are now world renowned surgeons, heads of medical departments, deans, and even my boss.
Michael Dauzvardis, PhD, is Assistant Professor of Medical Education at the Loyola University Chicago Stritch School of Medicine. He holds a doctorate in anatomy from Loyola and has been recognized by the Stritch students with numerous teaching awards.