Changing the American Model of Medical Education

[FedSquarewall]

So after four years of undergrad, I'll be receiving a useless piece of paper in a few weeks. It's not that I didn't learn anything, on the contrary I learned and matured more in one year of college than all four years of HS. That being said, what a waste. Very little of what I learned will be useful in medical school or medical practice. And don't get me started on Mickey Mouse BS classes needed for most school's general requirements. It was a growing experience for sure, albeit, a costly, largely academically useless, and in my eyes, a glorified "weeding out process." My question is simple, how would you change medical education in the United States structurally?

From what I've heard from some research, practicing doctors, residents, and a few medical students I know:
A) Current US System (In most cases 4+4):
Pros: 1) Weeds out most of those who couldn't handle the load in college. 2) Produces more "rounded applicants" (different experiences) 3) Room for scientific exploration.
Cons: 1) Extra Cost 2) Extra Time 3) Useless Classes 4) Even more Useless General Classes 5) If unsure of a specialty, not a whole lot of time for electives before match.

B) The system used by most of the world (i..e Europe, China, etc) (6 years post high school, 3 years basic sciences, 3 years clinical sciences)
Pros: 1) Reduced Time 2) Reduces Cost 3) More Structured Time 4) More time to explore specialties
Cons: 1) High School isn't the best judge of students academically. 2) Locked in at a very early age 3)Little time for exploration outside the realm of medicine

C) Accelerated Programs (2/3 + 4)
Pros: 1) Reduced Cost 2) Reduced Time 3) Many of the mickey mouse classes have been removed.
Cons: 1) Middle of the road outside experience 2) Some accelerated programs (from what I've heard) have lower standards than the usual weed out process and produce a mixed bag of students. 3) Like A, If unsure of a specialty, not a whole lot of time for electives before match.

Perhaps the current system is the best of many long roads and some of my generalizations about the paths are misguided/wrong. I'm just trying see see what the general consensus is out there.

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[Boolean]

Relevant research

 

[FedSquarewall]

Relevant research

Interesting read, I forgot about the aussies using a 4 and 4 as well sometimes.
I think my 4 years of undergrad were useful, just not practical or "time well spent."

 

[pluto101]

If you think reading literature and studying foreign languages was a literal waste of time, then I really feel sorry for you. I double majored in humanities and sciences, and I'm a much better person for it.

 

[FedSquarewall]

I agree that it gives people a plethora of experiences to draw from, but with that mindset why don't we require phd's so we can all be "independent thinkers." I read in my spare time a lot and I'm decent with Spanish and Vietnamese (spent a lot of time with my best friend's families) I don't need a 4 year degree to tell anyone that. In the end, we could always just add something more to say, "that experience/degree/traveling would make me a better person," but It's just not a practical, straight forward approach. That and its costly in time and money.

If you think reading literature and studying foreign languages was a literal waste of time, then I really feel sorry for you. I double majored in humanities and sciences, and I'm a much better person for it.

 

[Holmwood]

I've been talking to this with someone just last night! In the end, I belive the US model is better.

Time:

National Taiwan University's model: 8 years post-highschool (It was 7 years, but they changed it to 8 years from 2013)
UK model: 5-6 years post high school
US model: 8-9 years post high school

The Taiwanese model in this sense doesn't deviate from the US model. So you may think that the UK model trumps the US model, but look at the residency length.

UK model: 5-7 years post medical school? (4-7 years fellowship?)
US model: 3-7 years post medical school (2-3 years fellowship)


Conclusion: The time till training is over is approximately the same for all. .. Although if you were doing additional fellowships, the UK system will lag behind. Not sure about taiwan's residency length though.

Content:

While I don't know much about the UK model, the Taiwanese model does mandate hospital volunteering within its training. . . But what you learn is mostly pre-determined for you. The US model allows 4 years to do whatever you want in terms of studying and extracurriculars. You can learn new languages, learn new research techniques, expand upon your humanities, start clubs/organizations, etc.

Flexibility:
With the US model, you can bail out of pre-med whenever you want. Think about the attrition rate of pre-meds here in the states, and you would be wondering if overseas counterparts are miserable being "stuck" with their pre-med education. If they wanted to switch to another major, they would have to start all the way from the beginning.

 

[FedSquarewall]

I've been talking to this with someone just last night! In the end, I belive the US model is better.

Time:

National Taiwan University's model: 8 years post-highschool (It was 7 years, but they changed it to 8 years from 2013)
UK model: 5-6 years post high school
US model: 8-9 years post high school

The Taiwanese model in this sense doesn't deviate from the US model. So you may think that the UK model trumps the US model, but look at the residency length.

UK model: 5-7 years post medical school
US model: 3-7 years post medical school

Total time to board certification:
UK: 11 years minimum
US: 11-12 years minimum

Conclusion: The time till training is over is approximately the same for all.

Content:

While I don't know much about the UK model, the Taiwanese model does mandate hospital volunteering within its training. . . The US model allows 4 years to do whatever you want in terms of studying and extracurriculars. You can learn new languages, learn new research techniques, expand upon your humanities, start clubs/organizations, etc.

Flexibility:
With the US model, you can bail out of pre-med whenever you want. Think about the attrition rate of pre-meds here in the states, and you would be wondering if overseas counterparts are miserable being "stuck" with their pre-med education.

I agree to an extent, it's just looking back after 4 years and I don't think it was all necessary. As for GME, its my understanding that in many other countries it's no where near as time intensive as the US, hence the longer length. I may be wrong.

 

[Holmwood]

I agree to an extent, it's just looking back after 4 years and I don't think it was all necessary. As for GME, its my understanding that in many other countries it's no where near as time intensive as the US, hence the longer length. I may be wrong.

I editted my post too late. : (

Look at the fellowship length for UK that I posted.

 

[FedSquarewall]

The attrition rate is what I would find concerning about a 6 year model. So many people I know "were going to become doctors!"

 

[Holmwood]

The attrition rate is what I would find concerning about a 6 year model. So many people I know "were going to become doctors!"

Yeah. I saw only 3 pre-meds at last meeting a week before AMCAS primaries open. But we had two rooms full of them during freshman year... : /

The weeding out process should start earlier, for sure. That means pushing high school students to develop a mindset for their future career earlier through mandatory volunteer work/internships. Currently, people start deciding their careers at junior year in college... But even then, the teenage me sure did not want the same thing as 21 year old me even with relevant experience. . . So it's difficult to say.

Having a 3 year graduation with less gen-ed coursework would not be a bad idea though. Though I can't say the length of training is the immediate turnoff. From what I heard former pre-meds say, "I still want to be a doctor, but I just don't have the brains" (in response to low academic performance in introductory courses, presumably). That's an issue I think people who have taken post-bac/SMPs can answer better than me, I believe.

 

[Aloft085]

I don't think that anyone should be selected for a medical program straight out of high school. That being said, I also think that a four year degree is excessive. I would like to see more three-year options, and perhaps eventually two-year options. Also, I have no earthly idea why many medical schools still give students the summers off. Christ, we're not going back to the farm for two months. Give the kids a two week break instead, and graduate them a half year earlier. The same applies for undergraduate schools.

Ultimately though, I think medical schools are unlikely to take many students without degrees as long as entry is so competitive. Hell, many candidates need to get post-bacc's or masters degrees in order to get accepted. So we're really going in the other direction here. We really need to clear up the bottlenecks in medical school enrollment. Increase residency spots, and medical schools will follow with increased class sizes. That will ultimately lower the degree requirements for incoming students.

Also, med students and physicians really need to be raising a fuss about the highway robbery interest rates we're being charged on our student loans. With medical school graduation rates of over 95%, we're really being fleeced at 7% interest. We're essentially subsidizing students in less lucrative fields, at the cost of hundreds of thousands of dollars to us. Likewise, you have to pay off those loans with after-tax income. So a student that borrows $200k is going to pay around $400k over the length of the loans, with that requiring around $600k in pre-tax income (33% estimated effective tax rate). Ridiculous.

 

[karayaa]

I don't have stats at hand, but I've noticed that non-trads are becoming the new norm at many medical schools, which means an additional 1-3 years of life/research experience.

@FedSquarewall

Very little of what I learned will be useful in medical school or medical practice.

How do you see medical practice? From my perspective, anything that improves my ability to learn, understand information, solve problems or interact with people is useful for practice.
I think college is full of such opportunities - but not everyone takes advantage of them.

 

[FedSquarewall]

I worked almost full time since I was 16. Others may be able to spend time getting involved with campus life. I was not one of them.
I'm not saying these experiences aren't useful. Just that their a product of the ultra competitive process that has become medical school admissions and that they aren't necessary to become a good physician.
To add I would say that on my interviews so far it has been 50/50 nontraditional vs finishing up college split.

 

[Mad Jack]

The 4+4 system is more conducive to selecting the most qualified and motivated physicians. We lose 95% of people along the way, which really does a good job of sorting the chaff from the wheat.

 

[Porkloins]

Being forced to pick your discipline/profession at 17 years old is just not a good idea imo. At that age very few people will really have the proper conviction and motivation needed for a career in medicine. Importing the European system to the US would probably just lead to a bunch of bright high school students applying to med school because their parents want them to, and a bunch of burned out physicians in the decades following.

 

[Holmwood]

I worked almost full time since I was 16. Others may be able to spend time getting involved with campus life. I was not one of them.
I'm not saying these experiences aren't useful. Just that their a product of the ultra competitive process that has become medical school admissions and that they aren't necessary to become a good physician.
To add I would say that on my interviews so far it has been 50/50 nontraditional vs finishing up college split.

I'm all for competitiveness since you want the best of the best to deal with human lives. It's the same reason we have ridiculous requirements for pilots, I presume.

But I do agree that not all of the qualities adcoms look for are essential for being a good physician... in the short term. In the long run, however, there's more concern about burn out and character reversals that lead to patient abuse, profiteering, and suicide. The hope is that positive life experiences can help safe guard against burn out and character reversals in the future, but I argue that routine psychiatric evaluations and counseling can also provide comparable results.

And I agree with @Porkloins about the burn out.

 

[FedSquarewall]

Being forced to pick your discipline/profession at 17 years old is just not a good idea imo. At that age very few people will really have the proper conviction and motivation needed for a career in medicine. Importing the European system to the US would probably just lead to a bunch of bright high school students applying to med school because their parents want them to, and a bunch of burned out physicians in the decades following.

This is probably very true. I just feel like 4 years was too much. I knew going in and at 2 and 3 years i knew as well. Just feel like after my prerequisite classes i was ready to move on.

 

[Holmwood]

This is probably very true. I just feel like 4 years was too much. I knew going in and at 2 and 3 years i knew as well. Just feel like after my prerequisite classes i was ready to move on.

It took me until the end of sophomore year to figure it out as well. But for my brother, it took until the beginning of senior year to decide that medicine wasn't right for him. . .

It certainly wasn't the hospital volunteering, academics, or length of training that made him switch though!

 

[FedSquarewall]

I guess everyone is different and has entirely different situations. Possibly an option to apply after prerequisite classes w/o a bs (or accelerated affiliation agreement) would have been a nice option. The basic prerequisite classes seem to be the ones "weeding out" anyway. However, it seems like most people so far are fine with the status quo so perhaps I'm the n=1.

 

[Lucca]

I plan to respond to this in more detail later but here are some initial thoughts:

It's not just about the higher education system in these countries, it is also about health care delivery systems and primary and secondary education systems. We cannot think about "importing" or adapting other systems if we don't address the incongruities in those systems as well. (i.e. European high school grad =/= US high school grad, payment structure, debt structure, etc. etc.)

The medical education system is facing an identity crisis: on the one hand it needs to address the needs of the population (the distribution of physicians, shortage of primary care providers, maintaining the public health, etc.) but seems to value academics and research more highly because academic and research structures are the pillars which keep the medical education system afloat.

My personal opinion:

US system is best. I do not feel the same way you did about your undergrad, in fact I feel like four years is not enough time to learn everything that I want to learn and I am more bitter about middle and high school being a total waste of my time.

My proposed solution:

Greater diversity in the types of medical schools for serving different purposes. We have this now to a degree but they all seem to have the same cookie cutter requirements and this is largely unacceptable. BS/Md might be the best route for someone, primary care physicians should be able to go straight into their own medical education and then residency with less time in college (this excludes academic primary care, at least in my opinion).


I'll add more later, for now I have a paper I should be writing.

 

[Goro]

So demonstrating to Adcoms that you're smart and can handle difficult coursework is useless? Must be, because you describe yourself as a medical student when you haven't even enrolled yet.

As a Bio major who went into research, I took exactly the same coursework that the pre-meds did, and here I am as a faculty member. So a career in research, industry, as a lab tech...those won't take a Bio major or someone was was doing what pre-meds do?

So after four years of undergrad, I'll be receiving a useless piece of paper in a few weeks. It's not that I didn't learn anything, on the contrary I learned and matured more in one year of college than all four years of HS. That being said, what a waste. Very little of what I learned will be useful in medical school or medical practice. And don't get me started on Mickey Mouse BS classes needed for most school's general requirements. It was a growing experience for sure, albeit, a costly, largely academically useless, and in my eyes, a glorified "weeding out process." My question is simple, how would you change medical education in the United States structurally?

From what I've heard from some research, practicing doctors, residents, and a few medical students I know:
A) Current US System (In most cases 4+4):
Pros: 1) Weeds out most of those who couldn't handle the load in college. 2) Produces more "rounded applicants" (different experiences) 3) Room for scientific exploration.
Cons: 1) Extra Cost 2) Extra Time 3) Useless Classes 4) Even more Useless General Classes 5) If unsure of a specialty, not a whole lot of time for electives before match.

B) The system used by most of the world (i..e Europe, China, etc) (6 years post high school, 3 years basic sciences, 3 years clinical sciences)
Pros: 1) Reduced Time 2) Reduces Cost 3) More Structured Time 4) More time to explore specialties
Cons: 1) High School isn't the best judge of students academically. 2) Locked in at a very early age 3)Little time for exploration outside the realm of medicine

C) Accelerated Programs (2/3 + 4)
Pros: 1) Reduced Cost 2) Reduced Time 3) Many of the mickey mouse classes have been removed.
Cons: 1) Middle of the road outside experience 2) Some accelerated programs (from what I've heard) have lower standards than the usual weed out process and produce a mixed bag of students. 3) Like A, If unsure of a specialty, not a whole lot of time for electives before match.

Perhaps the current system is the best of many long roads and some of my generalizations about the paths are misguided/wrong. I'm just trying see see what the general consensus is out there.

 

[FedSquarewall]

I think people are mistaking me for being malicious towards the current system. My intention was not to inflame. I'm sure that life experiences make many people into better doctors and the current system makes some of the best doctors in the world. I just think that perhaps the last two years of my life could have been better spent (I.e. In medical school). This is probably my own mistake for not going into one of the existing 2/3+4 programs. I just wanted to get a general feel for what other users thought of the current system.
I made this in pre-allo and concentrated on the period before medical school. I have an acceptance and besides handing in two manuscripts, my college career is over, so changing my status to med student seemed acceptable. If not I'll change it back. I never made any statements that I had any experience as a current med student.

 

[bhog]

There are a couple of schools in Canada who accept applicants who apply in their third year of undergrad and don't require them to graduate. Other schools (ex. McMaster) have 3 year medical programs by running year-round. It's a model that's worked pretty well for them.

 

[Aloft085]

...I am more bitter about middle and high school being a total waste of my time.

I definitely agree with this sentiment. Our secondary schools provide absolutely atrocious education for the top 10% of students, since the focus is on the average Joe and eliminating achievement gaps. If I can afford it, I might send my future kids to private schools.

 

[FedSquarewall]

I definitely agree with this sentiment. Our secondary schools provide absolutely atrocious education for the top 10% of students, since the focus is on the average Joe and eliminating achievement gaps. If I can afford it, I might send my future kids to private schools.

+1.
Two of my younger siblings are home schooled. Two college classes every semester on top of their normal school work and this is at zero cost (I think our district pays for it). Probably the way to go for lower ed if one has the motivation for it.

 

[alpinism]

After completing undergrad and most of med school, I still think having a 4 year undergrad (bachelor's degree) is useful for producing more well rounded and mature students. In addition, it does help to weed out some of the potential applicants who would have failed out of med school (no matter how great they did in high school).

That being said, half of the pre-req's were useless in my opinion, especially physics and ochem (interesting classes but not very relevant to medicine). On top of that, the current M1 curriculum at most schools has very little to do with medicine itself and doesn't belong in medical school.

If I had any say in the matter, I'd like to see a 4+3 system whereby the pre-reqs are kept the same length but changed include half the M1 courses* while keeping the gen biology and gen chem sequence:

1 yr gen biology (1 and 2)
1 yr gen chemistry (1 and 2)
1 medical biochemistry course*
1 medical genetics course*
1 medical microbiology course*
1 medical immunology course*

You could still major in whatever you wanted but you have to take these 8 courses.

Med school would then be 3 years with a 1.5/1.5 year basic science/clinical curriculum.

M1 Anatomy/physiology/epidemiology then start pathology/pharmacology
M2 pathology/pharmacology then rotations
M3 rotations

organ systems curriculum
no mandatory PBL or CBL sessions
optional small group review sessions
4 hours of lecture per day in the morning
2 afternoons per week is clinical skills where you’re in the hospital with real patients learning and practicing the history and physical exam.

benefits:
1. save a year of tuition
2. start residency a year earlier
3. more relaxed med school curriculum since you've already done half the M1 courses
4. keep M1 to M2 summer break for research or vacation
5. Same level and depth of med school education
6. "test phase" semester during undergrad to see if you can handle the "med school" courses before getting into 50K+ of debt.
7. If you decide to do something other than med school, you can still use those pre-reqs for PA or pharmacy school.

 

[wjs010]

Our system is best because it gives young, naive, clueless college kids time enough to sort of figure out if they might wanna go into medicine. But yea, how about talking about changing the quality of primary and college education in the US

 

[Lucca]

After completing undergrad and most of med school, I still think having a 4 year undergrad (bachelor's degree) is useful for producing more well rounded and mature students. In addition, it does help to weed out some of the potential applicants who would have failed out of med school (no matter how great they did in high school).

That being said, half of the pre-req's were useless in my opinion, especially physics and ochem (interesting classes but not very relevant to medicine). On top of that, the current M1 curriculum at most schools has very little to do with medicine itself and doesn't belong in medical school.

If I had any say in the matter, I'd like to see a 4+3 system whereby the pre-reqs are kept the same length but changed include half the M1 courses* while keeping the gen biology and gen chem sequence:

1 yr gen biology (1 and 2)
1 yr gen chemistry (1 and 2)
1 medical biochemistry course*
1 medical genetics course*
1 medical microbiology course*
1 medical immunology course*

You could still major in whatever you wanted but you have to take these 8 courses.

Med school would then be 3 years with a 1.5/1.5 year basic science/clinical curriculum.

M1 Anatomy/physiology/epidemiology then start pathology/pharmacology
M2 pathology/pharmacology then rotations
M3 rotations

organ systems curriculum
no mandatory PBL or CBL sessions
optional small group review sessions
4 hours of lecture per day in the morning
2 afternoons per week is clinical skills where you’re in the hospital with real patients learning and practicing the history and physical exam.

benefits:
1. save a year of tuition
2. start residency a year earlier
3. more relaxed med school curriculum since you've already done half the M1 courses
4. keep M1 to M2 summer break for research or vacation
5. Same level and depth of med school education
6. "test phase" semester during undergrad to see if you can handle the "med school" courses before getting into 50K+ of debt.
7. If you decide to do something other than med school, you can still use those pre-reqs for PA or pharmacy school.

This seems pretty solid to me. A lot of schools have managed to condense pre-clinicals to 1 year (Duke model) and then tacked on a research year. I feel like that research year could be totally removed for people A) Not interested in research and/or B) Competitive enough for what they want to do that they don't need it on their application.

 

[Holmwood]

This seems pretty solid to me. A lot of schools have managed to condense pre-clinicals to 1 year (Duke model) and then tacked on a research year. I feel like that research year could be totally removed for people A) Not interested in research and/or B) Competitive enough for what they want to do that they don't need it on their application.

Pre-clinicals in 1 year seems intense though. @_@

 

[Porkloins]

I definitely agree with this sentiment. Our secondary schools provide absolutely atrocious education for the top 10% of students, since the focus is on the average Joe and eliminating achievement gaps. If I can afford it, I might send my future kids to private schools.

Or you could move to an upper-middle class suburb with a great public schooling system. Often private schools = schools for rich kids, not schools for smart kids. We're no Sweden, but we've definitely got plenty of great public schools in this country.

 

[Lucca]

Or you could move to an upper-middle class suburb with a great public schooling system. Often private schools = schools for rich kids, not schools for smart kids. We're no Sweden, but we've definitely got plenty of great public schools in this country.

I agree that we have some great public schools, but I'm going to have to strongly disagree on the suburb thing. The best high schools in this country are early college, dual enrollment schools, or prep academies. Some of these schools are public charter schools. Really, they are the only ones that are worth it. Suburbia is hell on earth and I feel that whatever they might learn in school is undone by the disaffection, aparhy, anxiety, isolation and depression brought on by living in the suburbs. I know that isn't the case for everyone but it was for me. After being educated in a country that is WAY WORSE OFF than the US (Im an inmigrant) and in a very poorly performing middle school in a poor neighborhood in the US AND then a very highly ranked high school in an upper middle class neighborhood, I can confidently say that the US public school system is a pile of garbage at every level and is not worth a fraction of the tax dollars we pay for it.

Now that I'm in college I see how much farther ahead in maturity, time management skills, interviewing and networking skills, research skills, course credit, etc. kids from early college and prep school programs are and I become very bitter about my secondary education. My high school prepared me well for college-level classes so I perform just as well as them but they are miles ahead in other respects and often have a lot more flexibility with how they want to build their degree plans since they have such an enormous head start (some seem to have 60-100 course credit hours as first semester freshmen).

 

[RedPhys]

At least in my experience (Latin America), schools with a system where you go in straight from high school ends up producing a ton of people that fail out of their first year (or second, or third). As my father tells me, it would be something like 250 M1s -- 100 M2s -- 50 M3s -- 25M4s... So, in essence, people end up wasting more time, I think, than if they just did their undergrad to solidify their commitment to go into medicine.

I personally wasn't really even really into medicine until the combination of shadowing experiences and advanced coursework (e.g. Biochemistry) showed me all about medicine, in both service and science. I guess I could have gone into medicine straight out of high school if I were back in Latin America, but I certainly would have gone into it for the wrong reasons. Also, college provided me experiences I could have never even dreamed of, so (personally) I think college can provide an invaluable four years.

 

[Cyberdyne 101]

This seems pretty solid to me. A lot of schools have managed to condense pre-clinicals to 1 year (Duke model) and then tacked on a research year. I feel like that research year could be totally removed for people A) Not interested in research and/or B) Competitive enough for what they want to do that they don't need it on their application.

I wish more Duke students would give us feedback on their curriculum. We've had a few med students post about the 1.5 year pre-clinical structure, but I have yet to see much about the 1 year format. Perhaps more information will soon be available especially since Vanderbilt and Harvard have transitioned to a similar framework.

 

[G_Marker]

The nice thing about the US model is that it gives teenagers and young adults some time to sort out their true ambitions. An enormous amount of students in my class started out as premed, but many of them changed their minds and chose completely different paths. On the reverse, many students (myself included) were completely unsure about whether or not they wanted to be physicians, but the pre-med coursework, along with clinical experiences, convinced them that medicine was their calling. I can't imagine making such an important life decision at such an early age. What's more, if you're a superstar who is 100% certain of their dream to be a physician, you can apply for to a combined undergraduate/MD program. The big downside I see in comparing our model to the European model is the price tag.

 

[Lucca]

I wish more Duke students would give us feedback on their curriculum. We've had a few med students post about the 1.5 year pre-clinical structure, but I have yet to see much about the 1 year format. Perhaps more information will soon be available especially since Vanderbilt and Harvard have transitioned to a similar framework.

They don't give us feedback because they are too busy studying lol.

 

[Cyberdyne 101]

They don't give us feedback because they are too busy studying lol.

Yeah, it's clearly not a "lifestyle curriculum" lol. Well, at least for the first year.

 

[Blue Blood]

If US secondary education wasn't such a joke and medical education was heavily subsidized, then a european system might work in the US.
That said, our HS education system sucks (read some posts from incoming freshman on here, they're delusional)
In addition, political gridlock will not let any reform happen in either secondary education, medical education, and funding for both, at least not anytime soon.
1) School years need to be expanded.
2) School days need to be expanded (it's 5-7 hours at most places, which is a joke )
3) Schools need to not be afraid to fail kids!
4) More technical avenues have to be open for kids that aren't book worms like all the users here.
5) Some kind of regulation has to be placed on universities. It does not take 50k to educate someone. It does not take 25k. If community colleges can survive with county level subsidizing and 2k tuition a university can as well.

 

[Aloft085]

If US secondary education wasn't such a joke and medical education was heavily subsidized, then a european system might work in the US.
That said, our HS education system sucks (read some posts from incoming freshman on here, they're delusional)
In addition, political gridlock will not let any reform happen in either secondary education, medical education, and funding for both, at least not anytime soon.
1) School years need to be expanded.
2) School days need to be expanded (it's 5-7 hours at most places, which is a joke )
3) Schools need to not be afraid to fail kids!
4) More technical avenues have to be open for kids that aren't book worms like all the users here.
5) Some kind of regulation has to be placed on universities. It does not take 50k to educate someone. It does not take 25k. If community colleges can survive with county level subsidizing and 2k tuition a university can as well.

The only proposal that I really agree with here is expanding the school year. All schooling should be year-round, no matter the level. I took summer classes every semester in college, and it both helped me finish faster and keep the knowledge fresh. There's no point in sitting on your @ss for 2-3 months, or working some minimum wage job, while waiting for school to start back up.

I don't think expanding school hours is really a solution. I can't sit and listen to lectures all day, and neither can most of you. Private study time is how most college/medical students actually learn, and it's going to be the same for high school students. You just have to find a way to get them to actually do the studying.

 

[deleted390966]

If US secondary education wasn't such a joke and medical education was heavily subsidized, then a european system might work in the US.
That said, our HS education system sucks (read some posts from incoming freshman on here, they're delusional)
In addition, political gridlock will not let any reform happen in either secondary education, medical education, and funding for both, at least not anytime soon.
5) Some kind of regulation has to be placed on universities. It does not take 50k to educate someone. It does not take 25k. If community colleges can survive with county level subsidizing and 2k tuition a university can as well.

I only agree with this part of your post. I don't agree with expanding school year or school day. Increasing the level of HS education is necessary to be on par with Europe and Asia, though.

 

[Blue Blood]

The only proposal that I really agree with here is expanding the school year. All schooling should be year-round, no matter the level. I took summer classes every semester in college, and it both helped me finish faster and keep the knowledge fresh. There's no point on sitting on your @ss for 2-3 months, or working some minimum wage job, while waiting for school to start back up.

I don't think expanding school hours is really a solution. I can't sit and listen to lectures all day, and neither can most of you. Private study time is how most college/medical students actually learn, and it's going to be the same for high school students. You just have to find a way to get them to actually do the studying.

1) It doesn't have to be lecture, could be some organized activity. Lets be honest, most HS kids, including myself did not do JackS*** after school let out each day unless we had a sports activity. I'm just advocating for structure, something inner city schools need desperately.
2) I know people who I graduated HS with who can't write a normal sentence, square a number, ect. These people should have been held back. Teachers will give you the C- just to pass you, at least in my area's HSs.

 

[Blue Blood]

I only agree with this part of your post. I don't agree with expanding school year or school day. Increasing the level of HS education is necessary to be on par with Europe and Asia, though.

Summer learning loss is a real problem with tons of statistics to back it up. We're one of the only nations in the world with such a short school year. Many nations have 220 to 240 day school years.

 

[GavinThePremed]

I agree that it gives people a plethora of experiences to draw from, but with that mindset why don't we require phd's so we can all be "independent thinkers." I read in my spare time a lot and I'm decent with Spanish and Vietnamese (spent a lot of time with my best friend's families) I don't need a 4 year degree to tell anyone that. In the end, we could always just add something more to say, "that experience/degree/traveling would make me a better person," but It's just not a practical, straight forward approach. That and its costly in time and money.

You need College to show you that Medicine is what you're really after. In India and other Asian countries they churn out doctors like it's nothing, massive amounts of saturation in certain parts of the county. I'd rather have a select group of well-read, hardworking physicians than a huge bunch who're immature and weren't allowed to grow up devoid of this career. Teenagers in Medical School? Kind of nuts.

 

[Aloft085]

You need College to show you that Medicine is what you're really after. In India and other Asian countries they churn out doctors like it's nothing, massive amounts of saturation in certain parts of the county. I'd rather have a select group of well-read, hardworking physicians than a huge bunch who're immature and weren't allowed to grow up devoid of this career. Teenagers in Medical School? Kind of nuts.

I kind of wonder if third world physicians end up with a medical knowledge level similar to US nurses. Maybe that's not the case, but it seems like a similar level of education.

 

[GavinThePremed]

I kind of wonder if third world physicians end up with a medical knowledge level similar to US nurses. Maybe that's not the case, but it seems like a similar level of education.

I don't want to knock IMGs, but there's such a variety. I've heard Australian graduates are basically equal to American graduates. But, at the hospital I volunteered at, it wasn't uncommon for some of the Pakistani graduates that worked with us (Apparently Pakistan churns out like a crazy number of doctors annually) to have failed their USMLE multiple times before starting a residency. One of the guys I worked under landed a residency after 20 years, failing the USMLE time and again. That's got to say something.

That being said, you can't say a Chinese Graduate = Pakistani Graduate = British Graduate = Colombian Graduate. I'm sure there's varying levels of efficacy based on the level of program present in each country.

 

[WingedOx]

Don't knock your years of liberal arts education. I learned more about life on 3rd year rotations from Kafka than from any pre-clinical science course.

 

[RedPhys]

I kind of wonder if third world physicians end up with a medical knowledge level similar to US nurses. Maybe that's not the case, but it seems like a similar level of education.

Some of the best doctors I've gotten to work with are FMGs (that re-did their residency in the states).

 

[emflem]

Don't knock your years of liberal arts education. I learned more about life on 3rd year rotations from Kafka than from any pre-clinical science course.

Yeah, but if you wake up and think you're a giant cockroach, it's Seroquel for you.

 

[Aloft085]

1) It doesn't have to be lecture, could be some organized activity. Lets be honest, most HS kids, including myself did not do JackS*** after school let out each day unless we had a sports activity. I'm just advocating for structure, something inner city schools need desperately.
2) I know people who I graduated HS with who can't write a normal sentence, square a number, ect. These people should have been held back. Teachers will give you the C- just to pass you, at least in my area's HSs.

I was one of those low-income at-risk students that failed a few classes in high school, in spite of my IQ in the top 99th percentile. I don't think making students stay at school longer is the answer. There's only so much bllsh*t that I'm willing to sit through in a day, and teachers at lower-income schools tend to be quite poor. I don't like being shepherded along like a livestock animal from class to class, expected to just listen and say little for hours on end. That's not how human beings learn, and that's why no one does it that way in higher education. Some medical schools still do long daily lectures, and universally it is always a top complaint of students.

A popular model these days is combined high school plus university education, where students do 2 years of intro courses at their local high school, and then the next two years at their local community college. It seems to work pretty well. The only issue I see with it is in having young impressionable HS students exposed prematurely to the drinking and sex culture of college. But that could be rectified with greater scale, increasing the percentage of other high schoolers in the college classrooms.

Let's discuss one of the bigger issues with high school education in poorer communities, however. It's money. Many poor high school students come from troubled families, and they end up trying to work jobs and live on their own while in high school. They're basically already adults at this point, sometimes legally. However, unlike college, high school provides no opportunity for financial aid. Students are expected to be 100% supported by their parents. If they're not, then what? Well, they mostly end up dropping out, due to being unable to both work enough to support themselves and continue making passing grades in school. Many high schools in areas like Chicago have drop-out rates as high as 50%.

Another issue: class scheduling. Only in high school (and professional school) do you fail an entire year for failing a single course. What happens if you fail a single course in college? Well, you retake the course! Does it add an additional year to your degree? Of course not. You might just take an extra class one semester, or take a class over the summer. Worse case scenario, you take an additional single semester, adding a mere 4-5 months to your education. Many or most high schools require an entire year to be retaken, which is frankly ridiculous. So how do you fix this problem? Schedule high school courses more like college courses. I went to one high school that did this, and it was great. Classes only lasted one semester each, and could be moved by a year or two in order to accommodate an individual's schedule. Fail freshman English? No problem, you can take it sophomore year, and then take sophomore English junior year.

That brings up another point: high school education is primarily attendance based, rather than knowledge based. With the rise of online and distance learning, this should change. There should also be far more flexibility to test out of certain subjects, and perhaps move on to college earlier. Anyway, this conversation could go on forever.

 

[Aloft085]

US system is best. I do not feel the same way you did about your undergrad, in fact I feel like four years is not enough time to learn everything that I want to learn and I am more bitter about middle and high school being a total waste of my time.

Greater diversity in the types of medical schools for serving different purposes. We have this now to a degree but they all seem to have the same cookie cutter requirements and this is largely unacceptable. BS/Md might be the best route for someone, primary care physicians should be able to go straight into their own medical education and then residency with less time in college (this excludes academic primary care, at least in my opinion).

I strongly agree with the two paragraphs above.

 

[RedPhys]

A popular model these days is combined high school plus university education, where students do 2 years of intro courses at their local high school, and then the next two years at their local community college. It seems to work pretty well. The only issue I see with it is in having young impressionable HS students exposed prematurely to the drinking and sex culture of college. But that could be rectified with greater scale, increasing the percentage of other high schoolers in the college classrooms.

The models where I have seen this is at mainly commuter schools. I think in those cases, it has worked pretty well. Traditional campuses, in my experience, are in more remote places (unless it is a very urban school like Columbia or NYU), and thus do not lend themselves to work with such programs.

I think it's a great idea for those who HS is not too challenging, or wish to go above and beyond during HS. I was able to take advanced math and CS courses my last two years of HS because our county had a program with the local colleges, but I imagine being in a more formal 'final 2 yrs of HS in a combined program' would have been better.