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I am currently in my 4th year of medical school. I am here to say that most of what people allow to weigh in on their decision to attend medical school is pretty irrelevant. I base this statement on 1) what I took into consideration 2) what other people I met on the trail into consideration 3) talking to prospective applicants 4) discussions with fellow classmates. This is in large part because most information about schools comes from is from first year students, who really have no idea of what the school is like, sales angles of schools attempting to reel in students etc, and random discussions from people who don't know much more than you do.
What is not important:
1) Impression of students: this is bogus, totally bogus. Every school has a fairly similar mix of a few types and if you think you can tell what students are like by meeting the tour guide and 3 other people you are fooling yourself.
A) Gunners- Every american medical school has gunners. Furthermore, your interview process will not allow you to prove or disprove my theory, as these people generally aren't doing interviews. Also don't let anyone tell you that theres no competition at their school because there is always someone who wants to do ortho at the hosp for special surgery, even at DO schools.
Moreover if you are really worried about dodging the "Gunners" then 90% chance that you are one....my observational experience
B) Slackers- These are the real people I'd be worried about: they tend not to show up to stuff and make everyone look bad.
C) Superstars- Every school has these, good schools have a few more.
D) Everyone else (prob 45-60% of a class)
2) Curriculum- Guys I hear this alot and read this on this board alot....looking back I thought this was a big deal, now I say "who really cares." Here's my breakdown of the issue
A) PBL- you have no background to base your case based learning on...and will not have it until year 2 and probably 1/2 through that (when you start organ system pathology/pathophys). Really how can you expect someone to understand CHF related fluid retention with no prior knowledge of renin-angiotensin and the kidneys...silly
B) lectures vs no lectures- For all practical purposes, you are going to teach your damn selves 90% of the first 2 years.
The reason for this is that most of the first two years really is vocab and getting your mind around a few key concepts so that third year you can actually understand what your residents and attendings are saying. So despite all the hype about new novel ways of learning it boils down to you hanging out with Robbins pathology, a microscope/online slides and a cadaver and figuring it out.
As far as clinical relevant knowledge year 1-2 is more or less the about the same, deal with it. I say this coming from an Ivy so trust me.
3) Quality of facilities- Theres three reasons why this is pretty irrelevant
A) they never show you all the facilities-
B) Does learning in an old building really impact your education
C) When you're trudging in the snow at 4 am to rounds on surgery are you really going to notice or care what the outside of the hospital looks like......highly doubtful
4) extracurricular/social stuff- This is +/-. If you have a passion for playing the violin...can't live without it and are willing to do it despite significant other time committments..this can be a plus
however, do not get the false impression that a medical school class remains this cohesive bunch of social butterflies for 4 years. Generally, everyone is very busy and alot of people are overwhelmed. The attendance at class events dropped preciptiously year 2.
5) early patient contact- I think this is a total sales pitch: To provide an anecdote: It was january of my second year. we were in our physical diagnosis class, having our first group interview with a patient with renal failure and volume overload causing CHF.
so the encounter goes like this.....
A classmate "so what brings you to the hospital today"
patient: "I am having a tough time breathing, it feels like im drowning when I lie flat"
Classmate "that sounds bad"
long silence.
This classmate was a smart guy and ended up being AOA and this was 1 1/2 years into medical school.....
so if thats 2nd year what are you really going to do interviewing patients 1st year.......basically acquire bad habits that you will need to fix later in life. Is it a total waste? no. However do not make this any more than a minor consideration.
Things that are important
1) What is the 3rd year like and how is it structured?:
I almost never hear any real questions or comment from applicants regarding this topic. In the end this is the only real difference between schools, and probably could be the only real question to ask? more specific questions?
a) How are the rotations structured? What is your role on the wards? Do you have a clear role Do you get your "hands dirty" alot, or is it alot of shadowing? This is very important. You really don't learn much by watching people do stuff and if they work you down to a minimal role you will not gain much experience and will suck for several months into internship.
Now I'm not saying you demand the right to cross clamp the aorta during a CABG, but medicine is not a spectator sport and if the school doesn't have a culture of teaching (i.e. alot of patients are private patients, medical students aren't allowed to do anything) it will be a long, boring 3rd year.
2) Where do 3rd year evaluations come from?
Alot of people go in with this attitude "I am here to learn not to get grades." I agree with this attitude 85%. However, using that attitude indiscriminantly is impractical and can lead to some evaulations that you are not too happy with, it happens
You probably can't please everyone equally. This is especially true on surgery and medicine where there is not enough hours in the day.
Thus, the recommendation I make to everyone is to figure out roughly who writes the evaluation and what they expect and make sure you do a really good job on that. I do not recommend kissing up....However, it is really easy at times to get caught up in "which 5 minute presentation do I spend preparing for tomorrow. " This is why if you know who is grading you you can prioritize which person you pull the NEJM articles out for, and who gets the 15 minute before cram session off up-to-date.
Understand however while this happens at all schools (its how the beast works) not all schools do a reasonable job at making this fair or letting you know who is grading you or what you are supposed to do. Thus you should really make an effort to ask questions such as for every rotation do you have an attending directly responsible for evaluating you, or a preceptor (someone not taking care of patients that you are caring for who evaluates your academic abilities and analytic abilities? ideally your grade should come roughly equally from both.
3) Where do the students end up? If you dont want to do primary care, and 75% of school X does. Guess what, you are signing up for 15 weeks of primary care rotations at that school. Conversely, if you want to do general internal medicine or family medicine....and you come to a school that puts out 25 orthopods and 10 neurosurgeons a year.....you will spend alot of time learning about surgeries that you will never perform in your life.
4) How are medical students protected from scut?
If they cannot give you a real answer to this question expect to learn alot about running bloods to the lab and wheeling patients to the CT scanner and very little about managing an MI.
Some schools do a good job of setting up systems to prevent this, however I have also met interns who told me that they failed the surgery shelf because their school was rampant with scut and they didn't learn anything. I think my school did a very good job at scut control, however I have wheeled my share of patients to CT at 2 am.
5) How receptive is the administation to fixing problems and/or disciplining out of line behavior, espcially from residents?
trust me when you have an ID class where the course director is terrible, you will really appreciate it when a new course director is hired the next year.
6) how is the research opportunities at this school?
If you want to end up at an academic program, there will come a time when you will seek papers and if they are not there to be written then you will understand the meaning of this question. If not then forget I mentioned this.
7) how good is this school at focusing on the bread and butter?
This is especially relevant if you are looking at an academic powerhouse type place. Typically alot of times you will find that big tertiary centers tend to be filled with people who A) study esoteric diseases, B) specialize in highly uncommon or speciallized surgeries or diagnostic tests, or C) only doing big commando surgeries on cases people in the community looked at and said no way im touching that.
This is something you may be interested in as an attending or at the end of your residency. However in medical school most of these areas will not be your field and learning the literature on steroid tapers for patients with the CREST syndrome, the signs and symptoms of spinocerebellar ataxia 8 or how to resect a pseudomyxoma peritonei is probably not the best use of time in your only exposure to the area. Its easy to get caught up in that stuff, however good schools recognize the nature of the academic beast and try to make sure that you leave knowing the stages of active labor, how to read an EKG and how to manage childhood asthma.
I hope this helps
mike
What is not important:
1) Impression of students: this is bogus, totally bogus. Every school has a fairly similar mix of a few types and if you think you can tell what students are like by meeting the tour guide and 3 other people you are fooling yourself.
A) Gunners- Every american medical school has gunners. Furthermore, your interview process will not allow you to prove or disprove my theory, as these people generally aren't doing interviews. Also don't let anyone tell you that theres no competition at their school because there is always someone who wants to do ortho at the hosp for special surgery, even at DO schools.
Moreover if you are really worried about dodging the "Gunners" then 90% chance that you are one....my observational experience
B) Slackers- These are the real people I'd be worried about: they tend not to show up to stuff and make everyone look bad.
C) Superstars- Every school has these, good schools have a few more.
D) Everyone else (prob 45-60% of a class)
2) Curriculum- Guys I hear this alot and read this on this board alot....looking back I thought this was a big deal, now I say "who really cares." Here's my breakdown of the issue
A) PBL- you have no background to base your case based learning on...and will not have it until year 2 and probably 1/2 through that (when you start organ system pathology/pathophys). Really how can you expect someone to understand CHF related fluid retention with no prior knowledge of renin-angiotensin and the kidneys...silly
B) lectures vs no lectures- For all practical purposes, you are going to teach your damn selves 90% of the first 2 years.
The reason for this is that most of the first two years really is vocab and getting your mind around a few key concepts so that third year you can actually understand what your residents and attendings are saying. So despite all the hype about new novel ways of learning it boils down to you hanging out with Robbins pathology, a microscope/online slides and a cadaver and figuring it out.
As far as clinical relevant knowledge year 1-2 is more or less the about the same, deal with it. I say this coming from an Ivy so trust me.
3) Quality of facilities- Theres three reasons why this is pretty irrelevant
A) they never show you all the facilities-
B) Does learning in an old building really impact your education
C) When you're trudging in the snow at 4 am to rounds on surgery are you really going to notice or care what the outside of the hospital looks like......highly doubtful
4) extracurricular/social stuff- This is +/-. If you have a passion for playing the violin...can't live without it and are willing to do it despite significant other time committments..this can be a plus
however, do not get the false impression that a medical school class remains this cohesive bunch of social butterflies for 4 years. Generally, everyone is very busy and alot of people are overwhelmed. The attendance at class events dropped preciptiously year 2.
5) early patient contact- I think this is a total sales pitch: To provide an anecdote: It was january of my second year. we were in our physical diagnosis class, having our first group interview with a patient with renal failure and volume overload causing CHF.
so the encounter goes like this.....
A classmate "so what brings you to the hospital today"
patient: "I am having a tough time breathing, it feels like im drowning when I lie flat"
Classmate "that sounds bad"
long silence.
This classmate was a smart guy and ended up being AOA and this was 1 1/2 years into medical school.....
so if thats 2nd year what are you really going to do interviewing patients 1st year.......basically acquire bad habits that you will need to fix later in life. Is it a total waste? no. However do not make this any more than a minor consideration.
Things that are important
1) What is the 3rd year like and how is it structured?:
I almost never hear any real questions or comment from applicants regarding this topic. In the end this is the only real difference between schools, and probably could be the only real question to ask? more specific questions?
a) How are the rotations structured? What is your role on the wards? Do you have a clear role Do you get your "hands dirty" alot, or is it alot of shadowing? This is very important. You really don't learn much by watching people do stuff and if they work you down to a minimal role you will not gain much experience and will suck for several months into internship.
Now I'm not saying you demand the right to cross clamp the aorta during a CABG, but medicine is not a spectator sport and if the school doesn't have a culture of teaching (i.e. alot of patients are private patients, medical students aren't allowed to do anything) it will be a long, boring 3rd year.
2) Where do 3rd year evaluations come from?
Alot of people go in with this attitude "I am here to learn not to get grades." I agree with this attitude 85%. However, using that attitude indiscriminantly is impractical and can lead to some evaulations that you are not too happy with, it happens
You probably can't please everyone equally. This is especially true on surgery and medicine where there is not enough hours in the day.
Thus, the recommendation I make to everyone is to figure out roughly who writes the evaluation and what they expect and make sure you do a really good job on that. I do not recommend kissing up....However, it is really easy at times to get caught up in "which 5 minute presentation do I spend preparing for tomorrow. " This is why if you know who is grading you you can prioritize which person you pull the NEJM articles out for, and who gets the 15 minute before cram session off up-to-date.
Understand however while this happens at all schools (its how the beast works) not all schools do a reasonable job at making this fair or letting you know who is grading you or what you are supposed to do. Thus you should really make an effort to ask questions such as for every rotation do you have an attending directly responsible for evaluating you, or a preceptor (someone not taking care of patients that you are caring for who evaluates your academic abilities and analytic abilities? ideally your grade should come roughly equally from both.
3) Where do the students end up? If you dont want to do primary care, and 75% of school X does. Guess what, you are signing up for 15 weeks of primary care rotations at that school. Conversely, if you want to do general internal medicine or family medicine....and you come to a school that puts out 25 orthopods and 10 neurosurgeons a year.....you will spend alot of time learning about surgeries that you will never perform in your life.
4) How are medical students protected from scut?
If they cannot give you a real answer to this question expect to learn alot about running bloods to the lab and wheeling patients to the CT scanner and very little about managing an MI.
Some schools do a good job of setting up systems to prevent this, however I have also met interns who told me that they failed the surgery shelf because their school was rampant with scut and they didn't learn anything. I think my school did a very good job at scut control, however I have wheeled my share of patients to CT at 2 am.
5) How receptive is the administation to fixing problems and/or disciplining out of line behavior, espcially from residents?
trust me when you have an ID class where the course director is terrible, you will really appreciate it when a new course director is hired the next year.
6) how is the research opportunities at this school?
If you want to end up at an academic program, there will come a time when you will seek papers and if they are not there to be written then you will understand the meaning of this question. If not then forget I mentioned this.
7) how good is this school at focusing on the bread and butter?
This is especially relevant if you are looking at an academic powerhouse type place. Typically alot of times you will find that big tertiary centers tend to be filled with people who A) study esoteric diseases, B) specialize in highly uncommon or speciallized surgeries or diagnostic tests, or C) only doing big commando surgeries on cases people in the community looked at and said no way im touching that.
This is something you may be interested in as an attending or at the end of your residency. However in medical school most of these areas will not be your field and learning the literature on steroid tapers for patients with the CREST syndrome, the signs and symptoms of spinocerebellar ataxia 8 or how to resect a pseudomyxoma peritonei is probably not the best use of time in your only exposure to the area. Its easy to get caught up in that stuff, however good schools recognize the nature of the academic beast and try to make sure that you leave knowing the stages of active labor, how to read an EKG and how to manage childhood asthma.
I hope this helps
mike
