It’s a hot Friday afternoon, and I am in MDD 230 sitting on the right side of the auditorium, 4th row from the back and somewhere in the middle, cramped between two other students, waiting to hear Dr. DeWaay’s wrap-up to two weeks of introductions, workshops, and poverty simulations. After a long day, I am only partially tuned in to what she says; the poor guy next to me let his head drop to the table midway through. The only thought running through my head is: “When can I go home?” Finally, I hear the magic words, “Go home, and remember, don’t do anything this weekend!” Professions of Health (POH) comes to a close, and next week, the firehose valve opens.
Full of excitement and fear, I went home and looked for the Course 1 schedule on Canvas. I soon noticed two pages, Course 1a (Musculoskeletal System) and Course 1b (Cancer Biology). Oddly enough, the consolidated schedule was only on the Cancer Biology page. I sat there and thought for a moment. “Why Cancer and Musculoskeletal (MSK)? They have nothing in common besides cells.” It didn’t make sense to me, but I didn’t really care. I was excited and ready to embark on my journey through medical school! Poor, little, naïve me had no idea what turbulent seas were waiting just beyond the shoreline.
I kicked off the week with a packed schedule. Monday, lecture from 8AM until 12PM followed by Cadaver and Imaging Labs until 5PM, depending on the group. Tuesday, lecture again from 8AM-12PM followed by Doctoring for Tuesday people until 5PM. Then Wednesday, the day I drowned under the tsunami of PowerPoints. Lecture began at 8AM and went until 5PM with a 1-hour lunch to break the repeating monotony of DNA this and RNA that. By 3PM, my brain had officially reached its breaking point and collapsed into mush. I stared blankly at Dr. Dominguez-Rieg as she stood at the front of the auditorium talking about osmosis and turkey brines; next thing I knew, my eyes were closed, and my head was face down on the table. That day, I lost a valiant battle to the PowerPoint. Thankfully, the rest of the week went ok with Thursday being a free day for everyone except the SELECT students and Thursday Doctoring people. “HAHA, suckers! Wait! I’m a SELECT student, and I’m in Thursday Doctoring! Great…” I had to get out of my grave and somehow get through the day. “Why couldn’t I just rest in peace (RIP) with all of my fallen comrades? What cruelty!” I somehow made it through the day and went home to prepare for Friday. The last day of the first week finally arrived – although it felt like a month had already passed – and I made it through the day’s lectures. “The weekend has finally come!” I was relieved to be free from all the torture. My weekend was filled with pre-lab and post-lab quizzes, lecture reviews, and figuring out how to get Anki in order. “At least I survived the first week of information overload, from the Warburg Effect to the rotator cuff. Now, I just have to survive 5 more weeks; BRING IT ON!”
As the weeks flew by, I noticed the uphill battle I faced when having to constantly switch from focusing on the mechanisms of cancer metastasis to the gluteal and posterior thigh regions. The sharp dichotomy of these topics made it hard to integrate the information. At some point, it felt like my brain encoded the following thought into my memory: “Primary tumor formation leads to sentinel lymph node invasion then Trendelenburg gait, a problem with primary hip abductors resulting in Cytotoxic T-cell activation to gluteus medius.” Huh? Yeah, it makes no sense. Eventually, my brain was able to organize all the information being thrown at it, but it came at a cost. The rest of the course felt like I was trying to play catch-up with the material of both courses. I wondered how much time I should spend on each topic since my time was limited and the next exam was just around the corner. It was taxing to say the least, but thankfully, I survived and made it to Course 2.
Looking back at Course 1, I pondered why I felt constantly overwhelmed, struggling just to keep up. I asked many of my peers their thoughts, and many felt the same way, so I tried to figure out why we felt this way about Course 1 compared to Course 2. Then, I remembered a study I did on elderly participants using electroencephalography (EEG) that revealed the burden of switch cost (a reduction in performance accuracy or speed that results from shifting between tasks) was higher in participants at high risk of developing Alzheimer’s compared to those with a lower risk 1 2. I did a little thinking and formed a hypothesis. “Compared to Course 2, the material of Course 1 incurs a significantly higher switching cost leading to increased mental exhaustion.”
Switch cost is a widely studied concept that has shown individuals that shift their focus almost always take longer to complete a task and do so with more errors compared to focusing on one task or topic 3. Neuroimaging studies using functional Magnetic Resonance Imaging (fMRI) and EEG have both reached the same conclusion. Imaging studies go a step further to show that nodes of the frontoparietal control network and dorsal attention network were more active during switch blocks, revealing increased neurocognitive demands associated with switching 4 2. This means that having multiple task goals places greater demands on the frontoparietal control and dorsal attention networks, which are limited in their capacities. This not only consumes more energy but also this can cause interference and complex interactions between attention and control brain networks reducing the efficiency that come from staying focused on a single task.
Now it all made sense. The constant switching from cancer to MSK was placing such a high neurocognitive burden on my poor brain that it was always struggling to keep up, something I do not find myself feeling in Course 2 since the topics are all closely related. Although I can’t know for sure if higher switch cost was the reason why many of my peers and I felt this way about Course 1, the paradigm fits nicely and would make for an interesting study. If anything, it is something all institutions should consider when making course schedules because they might be unnecessarily overtaxing their students.
1. Rochart R, Liu Q, Fonteh AN, Harrington MG, Arakaki X. Compromised Behavior and Gamma Power During Working Memory in Cognitively Healthy Individuals With Abnormal CSF Amyloid/Tau. Front Aging Neurosci. 2020;12:574214. doi:10.3389/fnagi.2020.574214
2. Arechavala RJ, Rochart R, Kloner RA, et al. Task switching reveals abnormal brain-heart electrophysiological signatures in cognitively healthy individuals with abnormal CSF amyloid/tau, a pilot study. Int J Psychophysiol. Oct 17 2021;170:102-111. doi:10.1016/j.ijpsycho.2021.10.007
3. Madore KP, Wagner AD. Multicosts of Multitasking. Cerebrum. Mar-Apr 2019;20194. Braver TS, Reynolds JR, Donaldson DI. Neural mechanisms of transient and sustained cognitive control during task switching. Neuron. Aug 14 2003;39(4):713-26. doi:10.1016/s0896-6273(03)00466-5