Cluster Bridges

If ever you wonder what it is I do all day - I build bridges. Some are as simple as a plywood plank across a backyard stream, while the importance of others rivals the size and scale of the Brooklyn Bridge - I build bridges all day, and then I walk them - back and forth, and back and forth.

I've realized that that's pretty much all they want us to do - walk down the cluster bridge. When I say that, I'm referring to the learning style here. There's a definite right answer and all the other answers are almost definitely wrong - that being the case, there's usually only one path: the Cluster Bridge. The clusters I refer to are groups of information, which, for my purposes, are given to me in the stems of questions. It is my task, then, to travel down a cluster bridge and arrive at the complementary cluster - the right answer. I call them clusters because they are always groups of pieces of information. If, for example, the cluster I'm given consists of a two-year old with mental retardation, aggressive behavior and hyperuricemia who bites himself - the cluster I respond with consists of Lesch-Nyhan Syndrome, HGPRT deficiency, and X-linked recessive inheritance. Those two clusters are, in my mind, linked by a firm bridge, so well-traveled, that by the time I read the bit about self-biting, I'm already way across the mental chasm, already at the end of the bridge.

Of course, we're being taught to be compassionate, and to relate to patients as people who have placed their trust in us. Right now, though - as I study for the exams which will determine my career, of course thinking of patients will help - but what I'm really trying to do is solidify the ephemeral mental bridges between oftentimes disparate pieces of information. Every time I walk across, the bridges become just a little firmer; repetition and explanation make those cobblestones easier to see. When I'm starting out - just learning something - I have no idea why the hell one bridge links two things. Chloroquine treats malaria? Sure - I'll buy it. I have faith that there's a bridge there. If that's all I had to go on, though, I might just forget where the bridge is - it's hard to see. Wait...what's that? Chloroquine makes it impossible for plasmodium vivax, a malarial parasite, to convert the heme it eats from red blood cells into hemozoin? And regular heme is toxic to the parasites? I may not know exactly why hemozoin isn't toxic, but I can see those cobblestones, and now I have a much firmer, much more comfortable cluster bridge. I'll walk over it again and again, maybe widening it here and there, adding to the supports, slipping in pillars and columns - I build bridges all day.

Exam day is a structural assessment.