How competent are fourth year med students supposed to be?

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ITT: Random guy on the internet figuratively sh*ts on primary care by saying it can be done by anyone right out of medical school if they can pass Steps 1-3.

The only reason I'm replying to this thread again is because that's a really disrespectful thing to say. I applied to primary care this year. And I don't think badly of DO's. They have a slightly different curriculum and exam system and they do OMM. I wasn't interested in that. Wouldn't mind learning a bit of it at this point, but that doesn't matter now.

Essentially, the regulatory boards are saying nurses and physician assistants can study for 2 or 3 years and then be licensed... Why not someone who studied for 4... and I was using that completion of the total exam series to further the argument for being qualified without a reasonable doubt whatsoever to start pgy-1.

But it's ok. your contradiction is still unfounded.

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Fixed that for you. CS is a slightly more advanced version of the "intro to doctoring" type courses many MS1s take. It was designed to ensure foreign grads speak enough English to train in the US.

I'm aware of what it was designed to do, but a small percentage of US grads also fail it, more than have in the past since they recently changed how they score it. What those students are doing wrong, I don't know, but clearly they're trying to make it more relevant to actual clinical practice and not the 'can you speak English fluently' that it has been in the past.

No, a pass on CS does not mean that you'll be a good resident or attending, but it is one more control in the process.
 
Essentially, the regulatory boards are saying nurses and physician assistants can study for 2 or 3 years and then be licensed... Why not someone who studied for 4...

Totally irrelevant as they are different training pathways with different end goals.

and I was using that completion of the total exam series to further the argument for being qualified without a reasonable doubt whatsoever to start pgy-1.
.

Which is what everyone is disagreeing with. I don't for one second think that passing (or even excelling on) their USMLE exams means someone is qualified "without a reasonable doubt" to start intern year.
 
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It's not just DVs opinion - it's also the opinion of a lot of program directors.

It's not a question of "smart" - it's that IMGs are well known to be in a different prep environment. Basically a prolonged boot camp for the boards. And IMGs are known for taking extended periods of time - often six months or more - to solely study for the USMLE. So, yeah, I'd hope their scores are better

This is a random comparison - but it's kind of like the guy who won the diet dr pepper football challenge (the one where you have to put as many throws through a hoop in under a minute) last year. He practiced for months and perfected a shot put throwing style that was way faster than anyone else. Hell I bet you could have put him against a pro quarterback and he still would have won. Does that mean I want him quarterbacking my team?

Silly comparison but let's run with it anyway. A lot of people play football but there are only 32 starting quarterbacks.

To go a step further: A lot of people are playing for teams no one has heard of, LOL! Someone could think they're a star playing for the Bills but we all know where they'll be when playoff time comes. :)

My point is that we make a lot of assumptions (both good and bad) based upon addresses, scores, breast size, skin color, etc... and not all of them are correct.

I do not doubt US students get a more solid foundation. That being said: Reading about the number of emotional problems (and subsequent support US students receive), I'm not convinced awesome MCAT scores and the luxury of doing ECs are reason enough for people to be exceedingly smug and dismissive.

Additionally, I sincerely doubt a US instructor has the degree of isolation necessary to be unaware of First Aid or adjusting their lectures to emphasize material currently being tested on national board exams.

For me: There are other things to concentrate on, like Step 3 and residency. I only have control over Jake and worrying about what people who wouldn't give me the time of day would be stupid.

I do wish (from a purely selfish point of view) that programs would advertise and be up front with their criteria. It would save offshore students from wasting money on application expenses for interviews. Seems like an exercise in ego. Putting "You have no chance" on websites or communications would me more honest.

Cigar time!
 
I'm aware of what it was designed to do, but a small percentage of US grads also fail it, more than have in the past since they recently changed how they score it. What those students are doing wrong, I don't know, but clearly they're trying to make it more relevant to actual clinical practice and not the 'can you speak English fluently' that it has been in the past.

No, a pass on CS does not mean that you'll be a good resident or attending, but it is one more control in the process.

I took it after they increased the failure rate. I saw little relevance to clinical practice.
 
The only reason I'm replying to this thread again is because that's a really disrespectful thing to say. I applied to primary care this year. And I don't think badly of DO's. They have a slightly different curriculum and exam system and they do OMM. I wasn't interested in that. Wouldn't mind learning a bit of it at this point, but that doesn't matter now.

Essentially, the regulatory boards are saying nurses and physician assistants can study for 2 or 3 years and then be licensed... Why not someone who studied for 4... and I was using that completion of the total exam series to further the argument for being qualified without a reasonable doubt whatsoever to start pgy-1.

But it's ok. your contradiction is still unfounded.

You're right. The thing you said was really disrespectful.
 
You're right. The thing you said was really disrespectful.

no. you know exactly what I meant.

Totally irrelevant as they are different training pathways with different end goals.

Which is what everyone is disagreeing with. I don't for one second think that passing (or even excelling on) their USMLE exams means someone is qualified "without a reasonable doubt" to start intern year.

then what does qualify them. LoRs and other subjective measures? LOL!
 
Hey guys just got here from pre-allo! I have high hopes for this... forum... :whoa:
 
then what does qualify them. LoRs and other subjective measures? LOL!

The obvious. Graduating from medical school...and preferably a US medical school.

A lot of program directors have genuine concerns about the quality of medical training that IMGs receive.
 
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You said I figuratively ****ted all over primary care. Did you not?

NPs and PAs are doing primary care now. Have some self respect. You're a doctor upon graduating your 4th year.

The obvious. Graduating from medical school...and preferably a US medical school.

A lot of program directors have genuine concerns about the quality of medical training that IMGs receive.

Ok. you're so confident, then you accept the bet. If not, then Fold.
 
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Why do you care? Those "tests" are meaningless in terms of practicing medicine....if you "pass" Step 3, I wouldn't assume you'll be a good resident. At all. You do that by doing stuff that matters, which is seeing actual patients and making actual decisions.
THANK YOU. CCS wasn't even added to the Step 3 exam until 1999, which guess what, even now doesn't replicate residency accurately.
 
The only reason I'm replying to this thread again is because that's a really disrespectful thing to say. I applied to primary care this year. And I don't think badly of DO's. They have a slightly different curriculum and exam system and they do OMM. I wasn't interested in that. Wouldn't mind learning a bit of it at this point, but that doesn't matter now.

Essentially, the regulatory boards are saying nurses and physician assistants can study for 2 or 3 years and then be licensed... Why not someone who studied for 4... and I was using that completion of the total exam series to further the argument for being qualified without a reasonable doubt whatsoever to start pgy-1.

But it's ok. your contradiction is still unfounded.
The Board of Medicine has not said this. Nurses fall under the Board of Nursing and medical boards have no jurisdiction over them. A PA receives a PA license under the Board of Medicine. An NP receives a license under the Board of Nursing. They do not receive physician licenses.
 
You said I figuratively ****ted all over primary care. Did you not?

NPs and PAs are doing primary care now. Have some self respect. You're a doctor upon graduating your 4th year.

Ok. you're so confident, then you accept the bet. If not, then Fold.
No, you're not. You're a medical graduate.
 
If a physician subject thinks he or she can practice primary care independently and safely after completing these exams, are you willing to bet your entire career on it that they can't, DV?
Yes, and medical malpractice insurance companies support me on this.
 
No, you're not. You're a medical graduate.
Well no. The day you graduate you are a Doctor. You aren't a licensed physician. You aren't able to practice medicine unsupervised (or possibly even at all if you didn't get a program). But you're a person with a doctorate (i.e. a "Doctor".) Our interns are supposed to call themselves Dr. Lastname on their first day of residency, rightly so.
 
Well no. The day you graduate you are a Doctor. You aren't a licensed physician. You aren't able to practice medicine unsupervised (or possibly even at all if you didn't get a program). But you're a person with a doctorate (i.e. a "Doctor".) Our interns are supposed to call themselves Dr. Lastname on their first day of residency, rightly so.
Yes, I'm being technical. You are officially a doctor by title due to completing the minimum barrier to entry to be eligible for a residency. You learn to be a physician in residency (although medical school serves as a foundation for that). He's referring to unsupervised practice after finishing med school and finishing all the Steps.
 
no. you know exactly what I meant.



then what does qualify them. LoRs and other subjective measures? LOL!

duh? Third year shows way more than some silly multiple choice crap. And LORs with actual comments and substance. For third year, the attending/resident comments about how functional this person is will be WAY better than a pathetic shelf exam. Of course, if you went to a school where you merely shadowed and gotten insta-honors, you wouldn't realize how important it is....on the flip side, the people filling out the comments probably didn't write anything or wrote one word, making the honors something with little substance to work with...Especially from an IMG with rotations that make them weak.
 
THANK YOU. CCS wasn't even added to the Step 3 exam until 1999, which guess what, even now doesn't replicate residency accurately.

In CCS: Congrats! The case is done in 5 mins!

In real life: Congrats! The patient is still here on Hospital Day 5!
 
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In CCS: Congrats! The case is done in 5 mins!

In real life: Congrats! The patient is still here on Hospital Day 5!
I was shocked that I got no reimbursement for those CCS cases. Same for the clinical vignette multiple choice questions. They felt just like seeing real patients.
 
I really need to stop it now. You have 3 yrs of experience on me. I feel bad.
 
wipe that smile off your face. you want another one? ok. this one's the knockout.

http://www.ncbi.nlm.nih.gov/pubmed/16199451

"We analyzed Step 3 scores in association with medical school academic-performance measures, gender, residency specialty, and first postgraduate year (PGY-l) of training program-director performance evaluations."

"significant first-order associations between Step 3 scores and ...PGY-l performance evaluation score"

so.. with that... there may be a correlation

+pity+
 
wipe that smile off your face. you want another one? ok. this one's the knockout.

http://www.ncbi.nlm.nih.gov/pubmed/16199451

"We analyzed Step 3 scores in association with medical school academic-performance measures, gender, residency specialty, and first postgraduate year (PGY-l) of training program-director performance evaluations."

"significant first-order associations between Step 3 scores and ...PGY-l performance evaluation score"

so.. with that... there may be a correlation

+pity+
1) This is ONE study at ONE medical school - which just happens to be WashU in St. Louis a Top 10 medical school which has the highest average MCAT matriculant scores in the nation. So it's not at all surprising they would continue to do well on standardized examinations in medical school.

2) Also look at what the question is actually asking: What Predicts USMLE Step 3 Performance? In other words what metrics can be used to predict USMLE Step 3 score. Not what does the USMLE Step 3 score predict. In other words, this paper is NOT saying that the USMLE Step 3 score can predict residency performance and thus how well one will do when they enter residency. Hence the correlation with performance on USMLE Step 3 by Step 1, Step 2, AOA honor society status in medical school, etc.

The program-director performance evaluation score that you reference comes from a questionnaire that "is a 21-item questionnaire mailed near the end of
PGY-l training to evaluate our graduates’ preparedness for and performance in their residency program. Item responses use a five-point scale: inadequate (1), fair (2), good (3), excellent (4), and outstanding (5). We computed for each graduate a “program-director performance evaluation mean composite score” based on these program-director responses." USMLE Step 3 is usually taken by the end of internship year.

So the program-director performance evaluation score PREDICTED performance on the standardized exam, the USMLE Step 3 score. This does not mean the converse is true, that the USMLE Step 3 score predicts the program-director performance evaluation score. Do you understand now?

 
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you said precisely what I predicted you would say. and I referred to that one cause that is just one other study that shows a correlation with performance. You still have yet to show anything. and yeah, don't waste your time looking for anything.
 
you said precisely what I predicted you would say. and I referred to that one cause that is just one other study that shows a correlation with performance. You still have yet to show anything. and yeah, don't waste your time looking for anything.
Did you even read what I just typed? I'll type it again in big letters with bold:
"So the program-director performance evaluation score PREDICTED performance on the standardized exam, the USMLE Step 3 score. This does not mean the converse is true, that the USMLE Step 3 score predicts the program-director performance evaluation score."

Meaning this study has not said that USMLE Step 3 score predicts residency performance, like you are saying and are confident of. Get it?


This was a paper YOU selected. How could you misinterpret it, so badly?
 
Well no. The day you graduate you are a Doctor. You aren't a licensed physician. You aren't able to practice medicine unsupervised (or possibly even at all if you didn't get a program). But you're a person with a doctorate (i.e. a "Doctor".) Our interns are supposed to call themselves Dr. Lastname on their first day of residency, rightly so.

There are few things that annoy me more than our IM interns not using first names with other residents because they are told not to. Me: "Hi, I'm Jack with Vascular, you guys needed a consult?" IM Intern: "Oh ya, I'm Dr. Gomez, blah blah blah". It is mainly when they have no ****ing clue what is going on that I notice it and am trying to figure out who I need to call to get what is actually going on. I understand wanting to have people use Dr. XYZ with patients, but with other services or to lord it over nursing? That is just asking for it.
 
There are few things that annoy me more than our IM interns not using first names with other residents because they are told not to. Me: "Hi, I'm Jack with Vascular, you guys needed a consult?" IM Intern: "Oh ya, I'm Dr. Gomez, blah blah blah". It is mainly when they have no ******* clue what is going on that I notice it and am trying to figure out who I need to call to get what is actually going on. I understand wanting to have people use Dr. XYZ with patients, but with other services or to lord it over nursing? That is just asking for it.
I think it depends on the nurse. Sometimes being a one first name basis with nursing is good and sometimes it's not. The ones that I know do it with nursing usually do it bc they find them annoying and want to maintain as much professional distance as possible. Yeah, I think it's quite douchey to call yourself, Dr. _____, while calling a consult, and then not properly relate why you're getting a consult or be able to clearly answer the consultant's questions over the phone before seeing their patient.
 
There are few things that annoy me more than our IM interns not using first names with other residents because they are told not to. Me: "Hi, I'm Jack with Vascular, you guys needed a consult?" IM Intern: "Oh ya, I'm Dr. Gomez, blah blah blah". It is mainly when they have no ******* clue what is going on that I notice it and am trying to figure out who I need to call to get what is actually going on. I understand wanting to have people use Dr. XYZ with patients, but with other services or to lord it over nursing? That is just asking for it.

man that's completely douchey
all the residents i've run into so far told us to call them by their first names, even the chiefs
 
man that's completely douchey
all the residents i've run into so far told us to call them by their first names, even the chiefs
I believe he's talking with between services. But yes, the douchiest intern that DOESN'T know what he's doing where you have to call the person above him to figure out what is going on (as mimelim describes above) will latch onto the Dr. _______, like no other.
 
"This patient is coding!! What should we do?!?!?!" - nurse

"Uhhhh..... what are my options?" - me

"THE PATIENT'S TREATMENT WAS NOT PRESENTED IN MULTIPLE CHOICE FORMAT, HOW WAS I SUPPOSED TO KNOW WHAT TO DO?!"- I screamed as they announced my $10 million verdict in court
 
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I think it depends on the nurse. Sometimes being a one first name basis with nursing is good and sometimes it's not. The ones that I know do it with nursing usually do it bc they find them annoying and want to maintain as much professional distance as possible. Yeah, I think it's quite douchey to call yourself, Dr. _____, while calling a consult, and then not properly relate why you're getting a consult or be able to clearly answer the consultant's questions over the phone before seeing their patient.

Ya, I agree entirely. Distance is important when there are any personality issues at play. But, I can tell you that every CVICU/SICU nurse/pharmacist/nutritionist calls me by my first name and most have my cell number. It isn't about being chummy with them. Its about them being able to text me questions or concerns whenever they have them and all of us taking the best care of the patient that we can. We all work better that way. Why use archaic pagers except as a last resort?
 
Ya, I agree entirely. Distance is important when there are any personality issues at play. But, I can tell you that every CVICU/SICU nurse/pharmacist/nutritionist calls me by my first name and most have my cell number. It isn't about being chummy with them. Its about them being able to text me questions or concerns whenever they have them and all of us taking the best care of the patient that we can. We all work better that way. Why use archaic pagers except as a last resort?
My guess is depending on the nurse (the one who calls for EVERYTHING), the last thing you want to give them is your cell phone number, esp. if you're NOT on call that night (yes, there have been incidences even with pagers, of nurses paging people who aren't even on that night).

Edit: Oops, I realized you said texting. I guess it depends on how tech savvy the nurses are.

I do think we've reached in era in which the pager should be officially retired. It's like having this:
upload_2014-9-29_17-49-31.jpeg
 
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My guess is depending on the nurse (the one who calls for EVERYTHING), the last thing you want to give them is your cell phone number, esp. if you're NOT on call that night (yes, there have been incidences even with pagers, of nurses paging people who aren't even on that night).

Edit: Oops, I realized you said texting. I guess it depends on how tech savvy the nurses are.

I do think we've reached in era in which the pager should be officially retired. It's like having this:
View attachment 185852

My experience is that our ICU nurses tend to know what to bug us about. They also just over bug, which is way better than under bugging (from a patient care stand point). Most floor stuff goes to the on-call intern (ie. not me), but I know exactly which nurses you are talking about (can even picture 2 of them in my head right now). I also prefer nurses to call me if I'm not on call if there is an issue than to be stuck without help. I try my hardest to make my service the best in the hospital. Part of that is that we are always reachable, even for the stupid stuff. If the intern isn't calling pages back, that is a problem, especially if they are consults. Our ER docs sometimes text me if they can't get a hold of the on-call resident for 15-20 minutes. If nothing else, it helps me get out earlier because I know about stuff not getting done earlier. It also helps me take better care of our intern, because those texts usually mean that he is getting overwhelmed.
 
My experience is that our ICU nurses tend to know what to bug us about. They also just over bug, which is way better than under bugging (from a patient care stand point). Most floor stuff goes to the on-call intern (ie. not me), but I know exactly which nurses you are talking about (can even picture 2 of them in my head right now). I also prefer nurses to call me if I'm not on call if there is an issue than to be stuck without help. I try my hardest to make my service the best in the hospital. Part of that is that we are always reachable, even for the stupid stuff. If the intern isn't calling pages back, that is a problem, especially if they are consults. Our ER docs sometimes text me if they can't get a hold of the on-call resident for 15-20 minutes. If nothing else, it helps me get out earlier because I know about stuff not getting done earlier. It also helps me take better care of our intern, because those texts usually mean that he is getting overwhelmed.
Wow, you are much more magnanimous than most (all) interns/residents that I know, excluding of course, chief residents - who will have their own reasons. I find more often, that type of thing tends to get abused by hospital staff which is why people don't do it. So during internship (or for some, categorical residnecy), when one is off, you're off -- thank god for being able to link pagers or people would be getting pages long after they've left the hospital.

Nice of you to realize that an intern who isn't answering pages the moment they get them, might just be overwhelmed at the moment. Too often, I think programs wrongfully assume that the intern is "purposefully" not answer pages (yes, I'm sure this happens sometimes, but I don't believe this to be a majority of the cases).
 
Did you even read what I just typed? I'll type it again in big letters with bold:
"So the program-director performance evaluation score PREDICTED performance on the standardized exam, the USMLE Step 3 score. This does not mean the converse is true, that the USMLE Step 3 score predicts the program-director performance evaluation score."

Meaning this study has not said that USMLE Step 3 score predicts residency performance, like you are saying and are confident of. Get it?


This was a paper YOU selected. How could you misinterpret it, so badly?

o'rly.... what do you think is going to happen when we plot that on a graph and calculate an r^2 value? huh? what do you think... is there going to be a correlation? what says you can't reverse extrapolate it to get a predicted PD performance evaluation prior to entering pgy1. I almost want to do a study now just to prove you wrong.
 
My guess is depending on the nurse (the one who calls for EVERYTHING), the last thing you want to give them is your cell phone number, esp. if you're NOT on call that night (yes, there have been incidences even with pagers, of nurses paging people who aren't even on that night).

Edit: Oops, I realized you said texting. I guess it depends on how tech savvy the nurses are.

I do think we've reached in era in which the pager should be officially retired. It's like having this:
View attachment 185852


no. that's still useful to crank you over the head with it when you can't provide any studies to support your argument of refuting someone else's. :nod: :diebanana:
 
wait what do you and southim even do all day... how are you on these boards and not seeing or operating on pts...
 
o'rly.... what do you think is going to happen when we plot that on a graph and calculate an r^2 value? huh? what do you think... is there going to be a correlation? what says you can't reverse extrapolate it to get a predicted PD performance evaluation prior to entering pgy1. I almost want to do a study now just to prove you wrong.
Yup, bc you definitely haven't found something in the decades of research in PubMed on the topic with respect to USMLE Step 3 and residency performance. Based on your misreading of the conclusions of the article you yourself found, you might want to take a course in improving your reading of the medical literature before you set up a study yourself to prove me wrong.

Seriously, just:
upload_2014-9-29_18-16-26.jpeg
 
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