How has your M1 year been going?

[Brorthopedic]

I'm surprised to see so much positivity.

M1 sucks. The material is dry and barely applicable. I don't get to see my family nearly enough. I study several hours a day in terms of volume, not difficulty. Any time I take time off to go out or hangout, I can barely enjoy it secondary to feeling guilty for not studying. The studying makes my normal state school undergrad look like a complete joke. Maybe it's because I have a significant clinical background, but I easily see how much useless stuff we're learning. Our professors are sub-par at best. Our tests average from 76 to about 82 without curves, but everyone pretends like they're stress free and getting 100s on every exam, which is more annoying than anything else. There's a large amount of people in my class who love OMM, which I just don't understand. Type A people are annoying as hell. People ask the dumbest questions I've ever heard with the answer literally in front of their face on the slide. The amount of fake altruism I endure is truly nauseating, especially in spite of recent events. I'm passing, but not without having drug my feet.

To be honest, I find that a lot of what I learn is largely applicable to medicine. Even with Biochemistry, a lot of the material I've learned has helped me understand the symptoms of certain diseases as opposed to just memorizing them.

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[DO2015CA]

I'm surprised to see so much positivity.

M1 sucks. The material is dry and barely applicable. I don't get to see my family nearly enough. I study several hours a day in terms of volume, not difficulty. Any time I take time off to go out or hangout, I can barely enjoy it secondary to feeling guilty for not studying. The studying makes my normal state school undergrad look like a complete joke. Maybe it's because I have a significant clinical background, but I easily see how much useless stuff we're learning. Our professors are sub-par at best. Our tests average from 76 to about 82 without curves, but everyone pretends like they're stress free and getting 100s on every exam, which is more annoying than anything else. There's a large amount of people in my class who love OMM, which I just don't understand. Type A people are annoying as hell. People ask the dumbest questions I've ever heard with the answer literally in front of their face on the slide. The amount of fake altruism I endure is truly nauseating, especially in spite of recent events. I'm passing, but not without having drug my feet.

I feel I have days that are like this but even then I realize how cool it is that we are even here.

My view on OMS1 is exactly what multiple faculty have said, "respect the process"

We have to earn it like every physician did before us. Yes it is dull but getting through it is the real battle not the difficulty of the content

 

[Drrrrrr. Celty]

I feel I have days that are like this but even then I realize how cool it is that we are even here.

My view on OMS1 is exactly what multiple faculty have said, "respect the process"

We have to earn it like every physician did before us. Yes it is dull but getting through it is the real battle not the difficulty of the content

Except the process is enormously flawed and need comprehensive revision which is completely faulted by the presence of standardized tests like the USMLE and COMLEX which make it impossible to experiment with curriculum. I mean when it comes down to it and mind you I love Biochem, there are probably like 2-3 lectures that are clinically relevant and the rest are mainly just random factoids that are more useful for development of therapies than their implementation and clinical practice.

 

[PKA<0]

Except the process is enormously flawed and need comprehensive revision which is completely faulted by the presence of standardized tests like the USMLE and COMLEX which make it impossible to experiment with curriculum. I mean when it comes down to it and mind you I love Biochem, there are probably like 2-3 lectures that are clinically relevant and the rest are mainly just random factoids that are more useful for development of therapies than their implementation and clinical practice.

We know all of this biochem so when we're an attending and a pharm rep tells us the drug works on "x" pathway we'll have a slight clue as to what they're talking about.

 

[Drrrrrr. Celty]

We know all of this biochem so when we're an attending and a pharm rep tells us the drug works on "x" pathway we'll have a slight clue as to what they're talking about.

Most doctors I know don't even remember how a hydrogen pump in the stomach works... A pharm rep telling me that it inhibits this enzyme isn't going to do me much good.

 

[PKA<0]

Most doctors I know don't even remember how a hydrogen pump in the stomach works... A pharm rep telling me that it inhibits this enzyme isn't going to do me much good.

Well now I completely disagree with you. What about a patient presenting with pernicious anemia (lack of intrinsic factor)? Knowing that the Intrinsic factor comes from parietal cells and that PPIs inhibit parietal cells. You could solve the patients neuropathy from decreasing their omeprazole. Biochem is very relevant my friend.

The same can be said about any class that we take. I think behavioral medicine is BS, but It my be relevant to the family practitioners and psychiatrists. You're being molded to be over qualified so that you can be a self sustaining, competent physician who looks at problems from multiple angles.

 

[kenjixshadow]

Well now I completely disagree with you. What about a patient presenting with pernicious anemia (lack of intrinsic factor)? Knowing that the Intrinsic factor comes from parietal cells and that PPIs inhibit parietal cells. You could solve the patients neuropathy from decreasing their omeprazole. Biochem is very relevant my friend.

And I completely disagree with you and agree with @serenade. Knowing the biochem factoids isn't clinically relevant, no matter how much you convince yourself otherwise. Knowing i.e. the MOA and the enzyme that is inhibited makes for great intellectual bloviating and in answering pimp questions, but doesn't mean a thing in clinical world. Even in step 1, recent test takers reported that biochem questions appeared from 2-5 questions at the most.

 

[Apoplexy__]

bloviating

This word is just the best

 

[AlteredScale]

And I completely disagree with you and agree with @serenade. Knowing the biochem factoids isn't clinically relevant, no matter how much you convince yourself otherwise. Knowing i.e. the MOA and the enzyme that is inhibited makes for great intellectual bloviating and in answering pimp questions, but doesn't mean a thing in clinical world. Even in step 1, recent test takers reported that biochem questions appeared from 2-5 questions at the most.

What? the USMLE has a HUGE biochem component. What source are you citing that says recent test takers report 2-5 questions at most for biochem?

 

[kenjixshadow]

What? the USMLE has a HUGE biochem component. What source are you citing that says recent test takers report 2-5 questions at most for biochem?

I'm not going through 112 pages 2013 step 1 thread, nor 93 pages 2014 step 1 thread, nor 73 pages of 2015 step 1 thread to find each test taker's experience of regarding to biochemistry and quote them back here. The consensus from many test takers is that biochem is less heavily tested compare to anatomy (recently more tested), pathology, pharmacology, and microbiology. I remember one guy stated 2-5 questions on reddit back in July, so I posted them here. I'd believe them when they say Uworld and FA are enough to prep for biochem.

 

[DO2015CA]

May not be clinically relevant and I doubt we need to know this much damn detail but once we get to clinical practice and we diagnose one of these dysfunctional enzymes it will be easier to appreciate what is happening.

I will not remember any of these steps once I finish my steps but learning it now will make it easier to appreciate what's happening when I read literature from uptodate or some other source when in practice.

 

[AlteredScale]

I'm not going through 112 pages 2013 step 1 thread, nor 93 pages 2014 step 1 thread, nor 73 pages of 2015 step 1 thread to find each test taker's experience of regarding to biochemistry and quote them back here. The consensus from many test takers is that biochem is less heavily tested compare to anatomy (recently more tested), pathology, pharmacology, and microbiology. I remember one guy stated 2-5 questions on reddit back in July, so I posted them here. I'd believe them when they say Uworld and FA are enough to prep for biochem.

Im not asking you to do that so dont be dramatic. I asked where you sourced the fact that you knew that biochem was tested through 2-5 questions on the usmle and your provided me with evidence a la reddit. I wanted to see if you had this sourced as some sort of article or finding through the usmle testing organization.

 

[ortnakas]

I'd believe them when they say Uworld and FA are enough to prep for biochem.

Enough DURING board prep? Probably-- but that's assuming you have a good enough foundation from MS1 and MS2.

May not be clinically relevant and I doubt we need to know this much damn detail but once we get to clinical practice and we diagnose one of these dysfunctional enzymes it will be easier to appreciate what is happening.

I will not remember any of these steps once I finish my steps but learning it now will make it easier to appreciate what's happening when I read literature from uptodate or some other source when in practice.

Exactly this. You also have to learn details because it will make other things make sense later.

Example: I'm a second year and I spent part of my morning reading about leukodystrophies. At this exact moment I'm not able to recite all of the steps of lipid metabolism, but because I studied it last year, I could follow along with that a deficiency of a galactosidase would cause a buildup of galactosphingosine. If I had never had biochem, I could memorize the words, but it wouldn't make a whole lot of sense.

So even though we're not going to be biochemists, it's important to study the details at some point so you have a base of knowledge somewhere in your head.
Edited for spelling

 

[Drrrrrr. Celty]

Again, that's good to know for the soul and usmle. But how relevant is that to actual clinical practice though? I mean honestly, side effects and counter indications are all pretty much listed.

I'm not saying it's relevant, I just think it's not 'clinically' relevant.

 

[DO2015CA]

if you want to be a basic physician not much but that whole "lifelong learner" will require reading papers and being familiar with the biochem will come in handy.

 

[67552931811]

Well now I completely disagree with you. What about a patient presenting with pernicious anemia (lack of intrinsic factor)? Knowing that the Intrinsic factor comes from parietal cells and that PPIs inhibit parietal cells. You could solve the patients neuropathy from decreasing their omeprazole. Biochem is very relevant my friend.

The same can be said about any class that we take. I think behavioral medicine is BS, but It my be relevant to the family practitioners and psychiatrists. You're being molded to be over qualified so that you can be a self sustaining, competent physician who looks at problems from multiple angles.

Growing up around medicine I have encountered exactly 0 physicians who have told me of the importance of the pre-clinical years, especially biochem. In fact, they have all told me the exact opposite. As a side note, during biochem I asked a family member, who is a pathologist (one of the most basic science fields in medicine), tons of questions and his/her response was, nearly every damn time, "I don't remember that. I never use it in practice."

Out of all the classes in medical school, biochem is duking it out for bottom of the totem poll in relevance to clinical practice.

 

[AlteredScale]

Growing up around medicine I have encountered exactly 0 physicians who have told me of the importance of the pre-clinical years, especially biochem. In fact, they have all told me the exact opposite. As a side note, during biochem I asked a family member, who is a pathologist (one of the most basic science fields in medicine), tons of questions and his/her response was, nearly every damn time, "I don't remember that. I never use it in practice."

Out of all the classes in medical school, biochem is duking it out for bottom of the totem poll in relevance to clinical practice.

From what I remember a pathologist isn't really "in practice" in the clinical sense,they aren't prescribing and so the knowledge of biochem is pretty futile for them. Would an academic hospitalist taking care of complex patients need to understand their biochem. I think so.

And since we are basing this off anecdotal evidence, I followed an endocrinologist at Ucsd and he sure as hell knew his biochem. That was a huge staple for his ability to manage his patients and also a huge cornerstone for teaching his medical team.

 

[Drrrrrr. Celty]

From what I remember a pathologist isn't really "in practice" in the clinical sense,they aren't prescribing and so the knowledge of biochem is pretty futile for them. Would an academic hospitalist taking care of complex patients need to understand their biochem. I think so.

And since we are basing this off anecdotal evidence, I followed an endocrinologist at Ucsd and he sure as hell knew his biochem. That was a huge staple for his ability to manage his patients and also a huge cornerstone for teaching his medical team.

Where I used to work a lot of the clinical-basic science integration was done by pathologists. That was probably one of the few places where I'd say biochem was really useful since it was directly implicative for knowing the basics of how to set up studies and knowing what enzymes to deal with.

Honestly, I really enjoy biochemistry. It's my favorite subject. But I think in many regards it does epitomize some what of the disconnect. I mean, know your acid-base cycle, but knowing receptor physiology? Maybe not.

 

[PKA<0]

Growing up around medicine I have encountered exactly 0 physicians who have told me of the importance of the pre-clinical years, especially biochem. In fact, they have all told me the exact opposite. As a side note, during biochem I asked a family member, who is a pathologist (one of the most basic science fields in medicine), tons of questions and his/her response was, nearly every damn time, "I don't remember that. I never use it in practice."

Out of all the classes in medical school, biochem is duking it out for bottom of the totem poll in relevance to clinical practice.

I've already addressed that I think different classes are more important for certain types of doctors.

That's quite a bold statement, saying biochem is the least relevant. My experience growing up around medicine has been different. I'm very close to a pulm/ CC doc and biochemistry was very important in his practice. There is a lot of overlap with biochem knowledge and physiology/ immunology involved.

Endocrinology, especially during development requires an understanding of biochemistry/ genetics. And while we're on the subject of endocrine disorders .... Diabetes. Non-Ketotic vs. ketotic fasting hypoglycemia. No doctor needs to know what's going on there?

Biochemistry is a foundational class and we're going to hit a lot the disorders in many other classes. It may seem rudimentary by the time were done, but it's a learning process.

 

[D4C]

To echo what @kenjixshadow said, biochem was not represented well on the USMLE. I had 4 or less questions on the test itself and actually had more on COMLEX.

@PKA<0 You sure PPIs can cause pernicious anemia? Might want to check on that.

 

[PKA<0]

Where I used to work a lot of the clinical-basic science integration was done by pathologists. That was probably one of the few places where I'd say biochem was really useful since it was directly implicative for knowing the basics of how to set up studies and knowing what enzymes to deal with.

Honestly, I really enjoy biochemistry. It's my favorite subject. But I think in many regards it does epitomize some what of the disconnect. I mean, know your acid-base cycle, but knowing receptor physiology? Maybe not.

To get back on topic, I've really enjoyed first year so far because I try to find relevance in all my classes. I really liked biochem as well. I think people who automatically assume one class isn't important because there's only 4 questions on the usmle are going to have a bad time, and they're selling them self short because they're missing the potential to grow on their knowledge.

 

[asdf123g]

What percentage of your classes are "gunners?" (im assuming everyone here is DO, not MD)

 

[PKA<0]

To echo what @kenjixshadow said, biochem was not represented well on the USMLE. I had 4 or less questions on the test itself and actually had more on COMLEX.

@PKA<0 You sure PPIs can cause pernicious anemia? Might want to check on that.

long term PPI use can exacerbate pernicious anemia.

Edit: Still want to decrease omeprazole. And my point was supposed to be that you were able to realize the patient has pernicious anemia in the first place from biochem knowledge.

 

[Brorthopedic]

What percentage of your classes are "gunners?" (im assuming everyone here is DO, not MD)

That's a hard question to answer. There are some students in my class that look and act like absolute gunners but I would later find out that they're either actually average or far below it. However, I undoubtedly think that there are also a lot of kids that are very quiet but are killing exams.

Overall, my class is great. People are always sharing study materials/study guides for exams.

 

[kenjixshadow]

To get back on topic, I've really enjoyed first year so far because I try to find relevance in all my classes. I really liked biochem as well. I think people who automatically assume one class isn't important because there's only 4 questions on the usmle are going to have a bad time, and they're selling them self short because they're missing the potential to grow on their knowledge.

This generalization can apply to any medical science class. Who is stupid enough to blow off one class just because it isn't high yield on the board? Not SDNers I can tell you that. Ppl here are high achievers. We all want to do well so everything counts. Your original argument was biochem factoids are the necessities to make a competent physician and I asserted that is not true. Just like you, I know the basic mechanism and foundation in the molecular level. Unlike you, I'm not impressed enough to know that one particular enzyme name albeit I know it for the exam then forget about it right after. If I ever need to know it again, I can just google it.

 

[67552931811]

From what I remember a pathologist isn't really "in practice" in the clinical sense,they aren't prescribing and so the knowledge of biochem is pretty futile for them. Would an academic hospitalist taking care of complex patients need to understand their biochem. I think so.

And since we are basing this off anecdotal evidence, I followed an endocrinologist at Ucsd and he sure as hell knew his biochem. That was a huge staple for his ability to manage his patients and also a huge cornerstone for teaching his medical team.

It's not anecdotal experience when it spans years and years of questioning and tens, if not hundreds, of physicians (wide spectrum of specialities). But, you're entitled to your opinion and I respect that. I really couldn't care less about extending myself more to this conversation on the internet.

 

[AlteredScale]

It's not anecdotal experience when it spans years and years of questioning and tens, if not hundreds, of physicians (wide spectrum of specialities). But, you're entitled to your opinion and I respect that. I really couldn't care less about extending myself more to this conversation on the internet.

Im discrediting your experience. I just dont believe that downplaying biochem because its "never" used in clinical practice is an odd way to approach medical practice since its our role to understand the details and not just go through the motions of "only clinical" work.

 

[67552931811]

Retracted: miscommunication.

 

[AlteredScale]

Lol. I don't care. As if you're in a position to discredit what physicians have discussed with me. Haha

lo, dang it. i meant im NOT discrediting your experience. my bad.