Residents: Dispelling the myth of Medical Education?

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I've been told that finding an excellent residency program is more important in molding someone into a good doctor than the choice of medical school.

can anyone support or refute this statement?

Seems to be what a lot of people say.

Agree with above. Residency is when you specialize and train to do what will do for the remainder of your professional life. It is also where you develop connections.
So it matters little if you went to a big name school and ranked in the lower half because of the bright people around you. A guy from a less competitive school with AOA credentials and good USMLE will get into better spots than you will.
What this means is go to a place that you would and your family would enjoy and most importantly, you will do well compared to your peers to attain the AOA.

I'm gonna dare to disagree here. Medical school makes a big difference as to what type of physician one becomes. For anyone who wants to go into academics and research, it means nearly everything, because the elite residency program directors care very much where their interns come from. That doesn't necessarily mean you have to go to Harvard to be a resident at UCSF, but program directors know which medical schools turn out competent residents. For people focusing on clinical work, the 1st 2 years of med school are mostly worthless, but the 3rd and 4th year are where you learn the comprehensive foundation of medical practice. A student who trains as a med student in a poor program without exposure to a breadth and depth of medical topics of all specialties will not be a superior clinician, regardless of which residency program you come from. Residency is extremely important, but great physicians are made before intern year.

I'M GONNA DISAGREE WITH SUMMERTIME (sorry about the caps)
medical school is important only to what caliber residency you go to...but i remember when i graduated from medical school, i knew nothing...and I went to a highly respected and ranked school in the country...
throughout resiency and training i have become a competent physician.
the years post med school determine what type of physician (in character and skill)
i guess if you want to go into academics then you must go to a top school to go to a top program...althoug this can be argued strongly against

I'll disagree with all of ya.

Medical school does not turn out "competent residents". Good residency programs do.

Neither medical school or residency can make good character. The formative years of your childhood and young adulthood do. You cannot make someone care about other people but you can teach someone with basic intelligence the facts of medicine, how to think critically and manage patients. And as the old saying goes, "you can teach a monkey to operate, but it takes skill to teach a resident to think critically and learn how to manage a patient."

Originally posted by summertime
For people focusing on clinical work, the 1st 2 years of med school are mostly worthless, but the 3rd and 4th year are where you learn the comprehensive foundation of medical practice.

I hope, if you are a medical student, that you are not being serious. If you are, I hope that the inevitable experiences that will show you that you are wrong are made early in your career, when senior physicians may hopefully be in a position to salvage the disastrous disservice you will do to your patients.

Best of luck on your road to true physicianhood.

Here's a sample question from those "1st 2 Years":

1. What country has the highest incidence of IgA nephropathy?


Now, overall, our school does a pretty good job with our education. And I won't go so far as to say these 1st 2 years are worthless. But sometimes, they can seem rather pointless...

I stand behind both my statements, even though nobody seems to agree with me. Medical school training goes a long way towards becoming a competent physician. I happen to attend a "top 25" program, but I don't put much stock in those rankings anyway. I can think of several excellent med schools (3 of which come to mind are Med. Coll. of GA, UT-Memphis, and LSU-New Orleans) which have average/below average residency programs and very little national recognition, but which consistently turn out excellent med students who go on to become outstanding residents and physicians. Of course, not every med student at Duke will be a superior resident, and not every med student from a DO school will be terrible (stereotypes serve no good purpose here), but it is obvious, at least to me throughout my rotations, when some interns come from poorer med school training that they are always a step behind their fellow interns. I don't think AOA or high USMLE scores has any predictive value on who will be a good physician, because any monkey can read a book and memorize a few things for a test. I think I'm being misunderstood when I say the first 2 years are worthless - the basic science foundation is important to understanding the principles of medicine. But, if you're working in the ER and a car crash victim rolls in unconscious, you're not thinking "Hmm, now which collagen type is it that is setting up the matrix for that big scalp lac to heal?"....you're thinking "ABCs" (I hope). The 3rd and 4th years are the real formative years - and I think any residency director will tell you that clinical rotation grades and evaluations count much more than the basic science years (at my school, the 1st 2 years combined carry the same GPA weight as the 3rd year alone). Furthermore, I think a good medical school training program will push its students. At my school, for example, students are pushed to the brink, our 3rd year is hellish. But as 4th years, right now, we are treated as interns. We're not called sub-interns, we're called acting interns - it's semantics, but it's an important philosophy. We're given a brutal 3rd year so that by the start of 4th year, we are already ready to be interns. It's little things which separate good physicians from outstanding ones, and those are things you fine-tune as an MS-4. And just so whoever you are understands - in my entire clinical training, only one of my patients has ever died, and we actually found his aortoenteric fistula, but unfortunately he bled out on the OR table before it could be repaired. I've never had a patient get upset with me, and I don't intend to ever let one down either.

"... Med. Coll. of GA, UT-Memphis, and LSU-New Orleans) which have average/below average residency programs..."

"Below average" what- U.S. News rankings stats? Hmmm, I beg to differ. I interviewed (and rotated) through several of the "bigger and badder" general surgery institutions and by far, I was most impressed with UT-Memphis. They have an absolutely excellent caliber of residents, both in knowledge database and professional demeanor, faculty with outstanding dedication to teaching... much more impressive than what I have seen at some of the more "prestigous" programs. Not to say that it doesn't have a good reputation- regionally, it is well-respected in general surgery and ortho.

none of my patients have ever died?
that doesn't mean much at all my friend.

Originally posted by summertime
And just so whoever you are understands - in my entire clinical training, only one of my patients has ever died, and we actually found his aortoenteric fistula, but unfortunately he bled out on the OR table before it could be repaired. I've never had a patient get upset with me, and I don't intend to ever let one down either.

Only one of your patients has ever died? Does your hospice program recruit patients in the ER or does the ER just discharge those patients that are doomed home to die? It sounds like you are a fourth year, and one seems like a very low number to me. I've had 3 patients die in my medicine rotation alone, and I expect to have a lot more patients die during my shock trauma rotation (mortality ~50%) and a MICU rotation that I plan on doing during my fourth yr (mortality ~30-70%). Learning to deal with death and caring for dying patients is probably just as important as learning how to care for the ones that are discharged alive during medical school IMO.

I do agree with you that where you go to medical school will have a significant impact on your level of competence as a physician. First two years probably don't matter all that much, but where you do your clinical clerkships will impact how competent you are when you graduate. I'm sure that it's possible for interns and residents whose medical education was deficient can eventually catch up, but if your school consistently produces deficient interns (and residency programs do eventually learn which schools do this by past performance), then your chance of getting into a descent residency program diminishes and a vicious cycle is produced. That being said, I think that it is almost impossible for the average pre-med to gauge how strong a school's clerkship program is. Most US med schools are strong, but after you get past the top 25 in US news world, I'm sure that there are some schools whose programs leave much to be desired.

I'm going to have to disagree with the comments made by Kim Cox that "any monkey"can operate and that real skill comes in patient management, as I think this downplays just how hard it is to acquire top technical surgical skills.

First off, anybody can do a mediocre job at ANYTHING. You can be mediocre technical surgeon as well as a mediocre in managing your patients post-op.
However, neither one takes more skill than the other if you truly want to be good at it. Putting it another way, you can teach "any monkey" to run fast or do math...but how many of them are going to be champion sprinters or earning PhDs in math? In other words, you can teach almost anybody to do anything at a mediocre level.

Sure you can train a lot of people to cut, but how many of them are going to be excellent at it? There are a lot of good surgeons out there, but there are far and few who are so good that even other surgeons are in awe of their technical abilities. One that comes to mind is Denton Cooley...I don't know if he's still operating at his age, but surgeons from around the world would come to Texas just to watch him operate even on routine CABG cases because he was so technically proficient and above all others.

The same can be said of post-op patient management. I mean you can also say that you can train "any monkey to look after patients", but in reality that is not true if you want them to be good at it.

Also, regarding summertime's comment that "any monkey" can get a high USMLE score (darn guys, leave the poor monkeys alone), this also downplays how hard it is to get a top USMLE score. Not anybody can do it, otherwise a high USMLE score would be the norm and not something so sought after by all med students.

Originally posted by SomeFakeName
I'm going to have to disagree with the comments made by Kim Cox that "any monkey"can operate and that real skill comes in patient management, as I think this downplays just how hard it is to acquire top technical surgical skills.

I think you're missing my point...

first, that was not my saying but rather one I've heard OVER AND OVER AND OVER again by surgical faculty. What they are essentially saying is that it is not difficult to learn the basics of surgical technique but that the hardest part of resident education is training us to think critically and how to manage patients.

Secondly, no one was arguing that having superior technical skills isn't another breed of surgeon entirely. You'll note that I DID NOT say that "any monkey" could be a top notch surgeon - I agree that there are a special few who are so technically gifted that even the worst teaching could not dampen it. There are others who benefit from great teaching - however, with few exceptions learning procedural technique does not require intellectual or physical genius.

IBDCURE, I think you were missing the forest for the trees. I know very well that UT-Memphis has a good surgery residency - my attending on general surgery as a 3rd year was proof enough of that. My point was only that med centers that don't have much national clout, like UT-Memphis, can still produce quality med students who go on to become excellent physicians.

As for the morbidity/mortality issue, sure I've sent patients to hospice to die in peace. Death is a part of life. I can remember one particular night on medicine as a 3rd year when we admitted 3 patients who we all expected to be dead by morning rounds. The whole team kinda sat around depressed all night, preparing the families for the worst, but by some miracle, all 3 managed to survive. My point in saying that I've only had one person die in the hospital while under my care was just to defend myself and to say that I don't make mistakes. I'm not saying I'm perfect, nobody is, but I'm not a walking disaster, as seemed to be implied in a previous post. I'm not satisfied until my patients are satisfied, whether that means going home healthy or heading to hospice care.

No, I didn't miss the forest- I'm aware of the big point. I just had to throw my $0.02 in for a program I really think has something great to offer.

Actually, I agree that less well-known medical schools can train and produce excellent physicians. I'm sure all sorts of medical schools can crank out a few crackpots amongst many great doctors; in other words, I think you have to take advantage of the learning opportunities your school offers. Medical schools generally don't force-feed experiences to you- a person who puts forth little effort in a great institution is unlikely to be the most knowledgeable intern.

To answer the original question, even the shortest residency programs are 3 years long, with surgery/ surgical subspecialties being at least 5. Most medical schools have really only 2 years of clinical experience. So although medical school will give you some background and a start, it's only the beginning. Medical students are not the ones who give the final word on patient care- I do not think it is legal (or IMO, ethical) for a hospital to allow orders to be carried out that are not signed/reviewed by an MD/DO. In other words, I think a person's learning curve should be expected to increase dramatically once the decision-making power is thrown into his/her hands as a resident. Not to say that a person who graduated medical school with several chest tubes/lines/LP's will not have any advantage over a person who hasn't had any; I think the less-experienced graduate will just have a bit more catching up to do as an intern.

To quote Kimberli:
"Medical school does not turn out "competent residents". Good residency programs do.

Neither medical school or residency can make good character. The formative years of your childhood and young adulthood do. You cannot make someone care about other people but you can teach someone with basic intelligence the facts of medicine, how to think critically and manage patients."

Absolutely.

To "LetGo" (if you're a pre-med)- good luck in your search for a medical school

Originally posted by summertime
My point in saying that I've only had one person die in the hospital while under my care was just to defend myself and to say that I don't make mistakes. I'm not saying I'm perfect, nobody is, but I'm not a walking disaster, as seemed to be implied in a previous post. I'm not satisfied until my patients are satisfied, whether that means going home healthy or heading to hospice care.

If patient mortality is determined by medical student competence at you medical school, it must be a VERY scary place. I sure hope no one I know ends up being taken care of there.

"If patient mortality is determined by medical student competence at you medical school, it must be a VERY scary place. I sure hope no one I know ends up being taken care of there."


Thanks, you just made my point. I happen to go to a large nationally known med center with a top 25 medical school, and our patients tend to survive fairly often under that system. At my med school, the residents and faculty trust the medical students and give us responsibility over our patients. Of course they look over our shoulders (it's not med students gone wild while the upper level residents are sleeping), but like I said, they treat us like interns and expect us to perform. If you haven't had that kind of responsibility during med school, you'll be a step behind as an intern.

Originally posted by summertime
[Thanks, you just made my point. I happen to go to a large nationally known med center with a top 25 medical school, and our patients tend to survive fairly often under that system. At my med school, the residents and faculty trust the medical students and give us responsibility over our patients. Of course they look over our shoulders (it's not med students gone wild while the upper level residents are sleeping), but like I said, they treat us like interns and expect us to perform. If you haven't had that kind of responsibility during med school, you'll be a step behind as an intern. [/B]

No, I think you missed the point completely. You can't have it both ways. If you truly believe that one can determine your competency as a medical student by looking at the number of patients that DIED under your care, then students are not receiving adequate supervision. If the patients survive because your "nationally known, top 25" medical school (whatever that means) insures that patients get proper care by having attendings "look over the shoulders" of medical students, then the mortality rate of your patients while your a medical student is independent of your clinical abilities. Probably the best way to clarify this is by asking you the following question: do you have classmates that have demonstrated that they are not as competent as you because they have had more patients die under their care than you have?
If your answer is yes, then I think most people would say that your institution is a scary place because patients die because medical students aren't adequately supervised. If you answer is no, then the fact that "only one of your patient's has died" does not mean that you are a superior medical student.

BTW, I think it is fairly obvious from your posts that you are very confident about the quality of your training. Confidence is good, but yours boarders on arrogance. My feeling is that at my stage in training I still have a lot to learn (I'm also an MS4). While I also feel that my education has been very good, it is in my patients' best interests (as well as my own) to have a good deal of humility. I have to agree with the other posters that have said that the majority of learning occurs during residency. Certainly you have to start with a good substrate, and medical school is part of that, but I think that I will really learn the tricks of my chosen field during residency. Good luck.

Dunehog, you have an amazing ability to skim a few words and phrases and come to a completely wrong conclusion. Like I said before, the medical students are treated like interns, given essentially the same responsibility as interns, and expected to perform at that level. Maybe you just don't understand what intern year is about. When we graduate in May, we will all have MD after our name - that means we are supposed to be prepared to be a doctor. Residency is Graduate Medical Education - where you hone your skills in whatever branch of medicine you intend to pursue. It is extremely important to what kind of physician you become, but at the same time, if you get poor medical school training, you will be a poor intern and throughout residency you will be a step behind your peers. What separates a competent physician from a great physician are little things which add up over time. Once you get out on your own, nobody likes the internist who calls for a Gyn consult for every pelvic exam, the Cardiologist who consults Neuro for syncopal seizures, or the surgeon who consults Medicine for diabetes management. Residency programs focus on making you great at your specialty, but they will not make you a great all-around physician - medical school does that, or at least lays the foundation for it. In the end, of course, it is all up to the individual. I'm not at all arrogant, but if you don't feel like at this very moment you are ready to be an intern and function fully as one, I feel sorry for your fellow interns and upper levels wherever you match who will have to go out of their way to make up for your deficiencies.

Maybe you just don't understand what intern year is about. When we graduate in May, we will all have MD after our name - that means we are supposed to be prepared to be a doctor.

Thank you for the primer on internship. I'm not quite sure what all this has to do with my original point of contention. I can't make it any clearer for you. If you want to continue to think that you are god's gift to patient care because you only had one patient die during medical school, it's obvious that I'm not going to stop you.

It is extremely important to what kind of physician you become, but at the same time, if you get poor medical school training, you will be a poor intern and throughout residency you will be a step behind your peers. What separates a competent physician from a great physician are little things which add up over time. Once you get out on your own, nobody likes the internist who calls for a Gyn consult for every pelvic exam, the Cardiologist who consults Neuro for syncopal seizures, or the surgeon who consults Medicine for diabetes management.

I would agree with you that medical school is important in making someone a good physician. But I still maintain that residency is more important. I suppose it just depends on how you define a great physician. If I were a patient looking for a "great physician" to do my carotid endarterectomy (for example) I would rather have a surgeon that calls medicine to help with my diabetes but makes sure that I don't stroke out on the table.

if you don't feel like at this very moment you are ready to be an intern and function fully as one, I feel sorry for your fellow interns and upper levels wherever you match who will have to go out of their way to make up for your deficiencies.

One can value the importance of humility and still be a good intern and physician. I'm certainly not here to defend my clinical skills to you. I just hope that when that first patient crashes during your internship you don't push everyone out of the way yelling "Look out, I have an MD from a TOP 25 medical school! Only ONE of my patients has DIED before! I know what I'm doing so get out of my way!"

whoah...I don't think your responses have anything to do with this discussion...you just seem to have a chip on your shoulder about something. Are you just not happy at the school you're at or what? This is all getting a little ridiculous.

Like the OP I am trying to figure out where to go to medical school and I find this thread interesting. I have 2 offers at top 25 schools and one offer from my unranked state school. Since everyone on this thread seems to be such a US News fan I have a question to ask. Is there any validity to the primary care ranking? When I was deciding where to apply I kind of used four criteria 1. Location 2. Research Ranking 3. Primary Care ranking 4. Nebulous overall Reputation. My reasoning behind using the primary care ranking was that some of the top ranked research schools might not produce the best clinicians, at least initially, due to the strong pure research interest. I wanted strong clinical training as well as research options that might open residency doors, because I am interested in academic medicine. Now that I am deeper into the process I am realizing that cost probably should have been a stronger consideration. What do you guys think shell out the extra $100,000 for the private top 25 school? Or attend the state school and save big bucks. Note starvation might reduce my effectiveness as a resident. The state school by the way has what I consider to be a very strong and modern curriculum. My only complaint about the state school is that it has an MCAT average below the national mean. I liked all of the schools equally (maybe a slight preference to one of the private schools). Sorry for the thread hijack but it is medical education related.

I chose to go to a public medical school 4 years ago solely due to cost. I felt it'd be great to be $100,000 less in debt as well and I didn't think it'd matter very much in the long run as long as the school was accredited.

Personally, (5 months from graduation,) I very am happy with my clinical experience, and the average of my Step 1 and 2 scores is >240. People here often do match at competitive places, even though there is not much research available or "connections." Plus, if you tend to be a strong test-taker, you're more likely to be near the top of the class at a state school.

On the other hand, if big name is important to you deep down, you will probably be much happier at a private school, regardless of cost. I have several friends whose first choice would have been to go to a private school (they either thought they could not afford it or were not accepted.) They are to this day still justifying their decision and can be defensive and bitter over it. And no matter how hard you work/how well you score on the boards, there will always be some out there who are judgemental over school name. Another big thing is that many public schools try to get their students to go into primary care so if you end up being interested in something like surgery or ortho, you may have to work independently & much harder to find out about programs and get to know people.

When I was 21, the difference between less than $100,000 and ~$300,000 seemed enormous to me. Costs raise, however; the projected cost of my medical education 4 years ago was $20,000 less than what it will really end up being. At this point, I feel like the > $100,000 in debt I am in now is still an enormous amount. However, I think we will all find a way to pay it off eventually. That said, if I could do it over, I probably would have done the same thing. I've gotten lots of interviews (I'm going for surgery) at all sorts of places and have really liked many of them. My only other advice is if 2 places look equally as attractive, try to explore the city before you make a choice.

Good luck!

The elephant in the corner of the room that all you guys are ignoring is that:

THERE IS A CORRELATION BETWEEN MED SCHOOL AND RESIDENCY.

Take a look at the match lists for harvard, UCSF, hopkins, Washu etc and then come back here and tell me that they are equivalent to the lower tier med schools.

you'd be laughed out of here, because we all know that it isnt true.

And before you all come back with your little anecdotes about how you went from a low ranked med school to a top residency, please remember i'm talking about the statistics/averages shown in match lists, not individual cases. We all know there are exceptions to the trend. But the exception does NOT disprove the rule.

In response to the previous post:

No doubt a higher % of people from whatever you consider the "top-tier" (for the record, that term makes me want to gag) medical schools to be are going on to match at "big name" places. I won't deny that, nor would many on this board.

Many people out there are impressed with name/prestige/connections; I'd be willing to bet this will remain true as our careers progress. I do stand by my conviction that the sort of education you receive is a completely different ball of wax and doesn't necessarily correlate to "rankings." I also beleive that you have to examine what statistics really represent. What percentage of the class, from let's say, Duke, applied for really competitive programs versus East Carolina? I'd be willing to bet that the statistics are more reflective in the sort of interests the students pursued (and were to encouraged to go for) more so than an incapability of a state institution to match students into a highly-ranked program. That's what I think people need to keep in mind when fretting over rankings.

In retrospect, I think the people who had the best expereince in medical school are the ones whose schools offered the educational style, opportunities, personal, and professional ethics that they find most important. If your largest motivation is to have a name that impresses others and you get the opportunity to go to a place (be it medical school or residency) with the name power that fills in the holes of an insecure ego, absolutely, go for it. You don't want to walk around feeling that you have to justify your training to your colleagues/patients/family/whatever for the rest of your career. Leave the state schools for those of us who are happy there and don't really give a **** who we impress.

Hey Wack, I think you're making a mistake basing your med school decision on 4 principles, 3 of which are reputation. If I were you I'd use 4 factors: Location, Price, Happiness of students, and Percent of students matching at their top residency pick. I'm not at a "top 25" school but I still managed to do great on the USMLE and I have every interview I wanted for residency. Go where you'll be happy, and that is where you will learn the best and perform the best. Reputation should play a very small part in your decision, if any at all. (I turned down the number one primary care school and a top ten overall school to go here, and I don't regret it a bit.) When making that $100,000 decision ($150,000 by the time you pay all the interest,) keep in mind that most primary care docs only make $90-130K per year.

Now, for the main question of this forum. I'm going to have to say that Medical School and Residency are just two different parts of the same process. There was a much bigger change between my 2nd and 3rd year of medical school, than there will be between my 4th year and internship. Its just one long process, with no one part being clearly the "physician-maker." All medical school and residency do is provide the tools to make yourself a great physician, what you do with them is a much greater factor than how nice the "tools" were.

Wow! This thread has become interesting. I wanted to put my two cents in.......first of all I went to a medical school considered by all accounts to be strong but certainly not in the "top 25" (as established by the crock rating of US News and World Report). If you look at the ratings, the mail list it is for Research, not patient care or quality of education. It is based on number of NIH grants, amount research dollars awarded etc....and my favorite ethereal category "prestige". Of course Harvard and Yale are more prestigious than UConn, but is there quality of education greater? You can't look at match lists and say Yale had a better match than UConn, because in my experience residency positions/interviews are affected my prestige. Is a Yale student is more likely to get a residency position than UConn with equivalent background, based on name alone? Dunno. But I think so. (I will probably be accosted for saying these things)

What I do know is that my school and many other quality small schools match students into good quality programs. Uconn alone placed people in Hopkins IM, MGH IM, Boston Childrens, Duke rads and anesthesia, UPenn, Yale, ophtho, derm, plastics etc.....What are considered top programs. What is more telling to me is that every single person in my class matched, and even better matched in the program/residency they desired.
I don't think the schools without the prestige produce any less of a quality resident/doctor.

I too am frightened that a student is basing his/her skills on patient mortality rates. Throughout my intern year, I have come to realize that there are some patients no matter how hard you try or how competent you are will die on you. It is just their time.
The goal as an intern and medical student to learn from them as much as you can.
Finally, yes a student should feel comfortable assuming the role of doctor and entering the next step of training. However a feeling of discomfort is natural and not an indication of incompetence. If we were really that comfortable we wouldn't need residency would we?
I felt ready to be a doctor, but I realize being creates a basic foundation of confidence, competence and experience to attain your true skills in whichever field you enter.
I am tired after a long shift.......Merry Christmas.......and most likely this will read terribly in the morning.

One attending calls medical students "wedges" (not to their faces and only in jest): man's simplest tool

First of all, Summertime, your hubris scares me. Despite your blunder about having one patient sick enough to die on you (how dare they?), you still claim this was actually good training (an obvious contradiction) by saying:

if you don't feel like at this very moment you are ready to be an intern and function fully as one, I feel sorry for your fellow interns and upper levels wherever you match who will have to go out of their way to make up for your deficiencies.

Well, I feel sorry for you and yours. It'll probably take you a long time to realize all the things wrong with this statement, including all the wrong attitudes and assumptions that underlie it. But one of your assumptions has to do with the original post and I'll address it:

The idea that residency and med school are at all the same or that being a good med student and a good intern correlate in a 1:1 ratio.

Based on my experiance as a PGY-3, they do not. Nothing you do during your 4th year can prepare you for your internship, which is sad because med school, in a way, fails in its role of trade school. SO might as well head out somewhere warm and fun.

Being a good med student is essentially showing up, kissing ass, and being good at pimp questions. Being a good intern is (firstly) disregarding all that, keeping your head down, doing your job, following up on everything but knowing what corners to nip, never showing how tired you are, and not going home until its all done. And therein lie entire levels of suffering you've never met (yet).

But I expect you'll see for yourself. Let us know, eh?

As far as the strength of the med school and the ability to become a doctor. The only thing that matters is where you are at the moment, be that residency, fellowship, real job. Plenty of Harvard grads go into settings sitting side by side with state U grads as attendings and the only difference is the size of their loan checks. Residency match lists don't really mean all that much in terms of outcomes with regard to fellowship and, especially, attending jobs.

To me, and I don't know if anyone will agree, the ONLY determinate of a good doctor is the individual. Going to Yale for med school will not make you study (it might even make you not - they have no tests). Going to UCSF for residency will not make you study. Education is ENTIRLY STUDENT AND RESIDENT DEPENDANT - not institution dependant. High tier places will not MAKE you better in any capacity, only you can do that. Only you can learn from your mistakes and study. The thing is that the high tier places generally attract people who can do just that, but it's certainly not limited to Name places.

There's nothing in the water in New Haven, otherwise we'd have a smarter president.

btw, I'm at a relatively high tier place in neurology and have been consulted for clear syncope seizures several times (though not by cards).

Thus, if I were looking at med schools today, my top 4: price, price, price, location. But then again, spending that money on a boat, learning how to fix cars, or going to grad school in uselessology. It'd have prevented me from taking call on X-mas, right?

Summertime -- please save your posts and reflect on them sometime after you've finished residency and see if your views still hold at that time.

-James

Interesting discussion. I am fourth year MS on my way to a surgery residency. I am really happy at my school and my time in medical school was great and I learned a ton. My decision to come to my school was pretty much random. I really don't have much in the way of advice for how to find the correct school for you. Perhaps a combination of feelings on visiting, the reputation of the school, and the importance of debt to.

I only include school reputation because, regardless of what others are saying, it does make a difference. Only because big academic centers have big names and big names write your letters of rec for residency. Ultimately, that is the value of a brand name institution for medical school. If you want to be a researcher as well as a physician, going to a place with big NIH money translates to more opportunities to explore your interests. In the end, that is another important thing about choosing a med school, finding a place where your interests can be pursued and expanded.

I think for the rare individual who is out there applying to med school and already knows what he/she wants to go into, it seems reasonable to explore that department at whatever medical schools he/she is looking at. going to a place that is strong in your field of interest can only help you, because going to school there gives you the inside track to stay or could set you up with fly letters when you decide to leave.

Not much of a system I know, but still I would like to emphasize that prestige does matter, but it is pretty much irrelevant if you are not comfortable in the place you are at or you are taking on more of a financial burden than you really want to.

I feel you can get an excellent medical education at a "mid-tier" medical school. I would suggest if you are planning on going to a "mid-tier" medical school you would consider how much debt you are going to be in when you get out. According to US NEWs when I was deciding where to go to medical school Georgetown actually ranked below Cincinnati and Ohio State; yet not so much a bargain with twice the tuition and much higher living expenses. That being said, I think it would be probably foolish to turn down Harvard or Wash or Hopkins if they said yes. Keep this is mind though: if you will be in debt nearly 300,000 bucks this is going to make a serious impact on your specialty choice. If you are not ready to probably say no to primary care then your should think long and hard about the pressure you will have to pay off loans during and after residency. If you have an idea what specialty you might want to go to look into what the highly regarded places are in these forums and consider that when applying.

dcw has is right - it is the INDIVIDUAL who will make the most out of their training that will be the best physician.

Many med schools graduate people who stay at their same school for residency. So, students- look at your interns from your own school and see if you can catagorize them as ALL awesome or ALL losers. Look at your chief residents, now, and do the same. I bet you can't do it - some are great, some are weaker. Why? It's not the training alone - it's the person with great organizational skills, management skills, compassion, teaching skills, many other things we all need to work on regardless of where we train, that will make us the kind of physicians we all hope to be.

yes, we need to look for schools and programs that provide a variety of learning opportunities, increasing levels of responsibility, and great teachers - but it is true that lots of places have that, not just the "top25" schools or residencies.

without question, residency is more important.