Yes, it’s a cheesy title.
I know of no other medical school that has anything remotely similar to the Medical Independent Learning Examination (MILE). It’s a bit like deep-fried Mars Bars and snow in July — nobody else wants it, and we don’t really blame them. So, a little background: it’s a first year assessment, it works like a really big PBL scenario, and it lasts for 24 hours. There are no prizes for guessing which part we all remember.
I took my MILE on Pancake Tuesday/Ash Wednesday last year (and I know that because, for reasons that are about to become clear, I got no pancakes last year). At 9am, the seventy-odd people who made up Group B were herded into a seminar room and given an exam paper, an answer book, and an attendance card, and turned loose. The exam paper is a clinical case — we were given a 24-year-old woman presenting to her GP with abdominal discomfort, weight loss, and pale, watery, difficult to flush stools, and told that she’d had a blood sample taken and was being sent for a biopsy of her small intestines. We had until 9am the following day to come up with four or five pertinent questions, research them, write them up, and evaluate our work. It was supposed to evaluate how good we were at doing PBL, except that my PBL notes don’t need to be given in, have only rarely been written by hand, are only less than 500 words when I haven’t done it properly, and never include a hand-written and critically-appraised list of references.
But none of that was going to become an issue until many, many hours later.
I was in group that had decided a few weeks earlier that we’d work together, and once the staff had set us free, we headed for our project room, stopping on the way to collect any books that looked as though they might be even a little bit connected to intestines, poo, or biopsies. It seemed that the easiest way to do this would be to treat it just like any other PBL scenario, and that’s what we did, right down to choosing a chair and a scribe. It took longer than it normally would, because we had marks depending on how good our objectives were. In a normal PBL, you can have an objective like, “discuss disorders of the GI tract,” and it doesn’t matter because everyone in the group knows that that doesn’t mean every single disorder of the GI tract. In the MILE, we ended up with, “What are the common disorders of the small intestine that may cause this patient’s signs and symptoms?” It was followed by research — two people to a question and lots of explaining things in feedback and lots of photocopying. The part of the research that took the longest time was standing in line at the photocopier!
The writing up started at 5pm, after group feedback and a very much needed coffee. This was the part that took the time. It’s also the part that has to be done individually, so a few people went home. I didn’t. I knew that if I went home, I would want to go to sleep, and a few members of my group felt the same way. It took time because it meant collating and evaluating every single reference that had been used, getting thirty-odd pages of notes down into as short a report as humanly possible, doing a manual word count, tearing my hair out, editing and rewriting it into a shorter report, doing another manual word count, and again, and again.
At 11pm: “Hi, is that Dominos? Are you still open for delivery? Good. Yes, to the medical school building on University Avenue…”
As the wee small hours rolled around, there were only twelve or thirteen people left in the SL. We started wandering in and out of different rooms, taking breaks, checking on how everyone was doing. I was glad I had stuck around — entirely apart from not wanting to have spent the whole night looking at my bed and wanting to get into it, I wouldn’t have wanted to do it without company.
I finished a draft report with an acceptable word count at two o’clock in the morning, and finished writing and diagramming and referencing and critically appraising and cleaning just in time for me to catch the first bus home at 6am, where I rinsed away the twenty-one hours of unventilated project room stink and fed myself before turning around and going back for hand-in. And VS. If you finish the MILE and have to go to a three hour class on the same morning, you are a very unlucky person and will probably nosedive into your coffee, as I proceeded to demonstrate for the benefit of my VS group.
The MILE is brutal, and I remember being tired right down to my bones when I finally crawled into bed on the Wednesday night, but the thing I remember the most about mine is that it was a bonding experience in the deepest and most true sense. It’s nothing like the ridiculous bonding activity we had foisted upon us in September, and it’s not quite the crisis mentality of pre-exam weekend in the SL, but that night was the first time we’d ever seen each other at our collective messiest and most exhausted. It makes a difference. So, it’s been a year and maybe I’m blocking out the little things (like nosediving into my coffee in VS, or how that afternoon I fell asleep in church and nearly tilted right off the pew), but, while I absolutely understand why nobody else does it and why people might flee a mile from this, it was one of those things that I’ll never forget and that I wouldn’t have missed for the world.
Do you know any triathletes? I think this is kind of how they feel about Ironman.