The gradual dumbing down of the M3 and M4 year, not letting students do anything is a problem that is just brushed aside with, "dont worry, youll learn as a resident." AKA 3rd year is a waste of time and money and if it was eliminated, and you moved right onto to internship after M2, I bet you patient outcomes would be the same in most cases. Thats essentially PA school anyway btw.
Med schools do not care if you pay thousands just to shadow. The LCME does not care if you just shadow all day. The AAMC doesnt care if you never do an H and P the entire time you are in med school. Shadowing is a very valuable experience (for them, not for you). Why? Because the school doesnt have to pay your preceptors for anything since having you shadow involves no work whatsoever.
But hey you can always write a fake note on any patient you watch the attending see and then compare it to his note later on. That is a very valuable experience, self grading yourself. I mean it must be valuable since the school admins and hospital admins told me it is. Of course it also has the added benefit of not giving anyone but yourself (the consumer) more work.
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If it has a purpose i would love to know what it is... please dont hold back on me
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When I finished third year, I went right into my M4 IM subi. That month, I worked with a couple third year medical students, a couple of brand new interns, a senior resident, and an attending.
As an M4, I was stunned, absolutely stunned at how much more functional in a hospital environment I was than the M3s. These were smart people, probably with better preclinical grades than I, but at the beginning of third year they knew practically nothing about the day to day tasks expected of a physician. For you to say that M3 year makes no difference just baffles me, and tells me you've had minimal exposure to a student at the beginning of the year compared to one at the end. It's an easy pattern to pick up on as a resident as well, and I've seen it four times over now (that M4 year and my 3 years of residency). M3 year, as ****ty of an experience as it is to go through, is part of what makes the huge gap between the experiences of an actual physician and a PA. Residency is more important of course, but you wouldn't be near as prepared for residency without having that variety of exposures first.
On the other hand, my skills that July were fairly equal to the beginning interns. And they only got worse in the 11 months after that subi when I was doing BS rotations/vacation/interviews before I was a beginning intern myself. M4 is the useless year, though it definitely does a heck of a lot for mental health (and you need time to interview anyway).
I certainly can't speak for every medical school or rotation, but from my perspective...
The purpose of MS3 is get your feet wet in the clinical environment. For most students, they have zero appreciation (even after their "clinical" ECs as a pre-med) for what a hospital rounding service looks like, how a surgeon's practice works, or how an outpatient FM doc does their job. Most only have the vaguest of notions of what a RN, NP, PA, MA, OT, PT, unit secretary, or PharmD do, never mind the individual physician services. I think that a lot of people (Physicians and other groups) under appreciate how long it takes to actually be comfortable in a completely new environment. It is one thing to enter a new environment and learn how to do one specific workflow and learn it well. It is another to need to be able to work in that environment and solve problems as they arise.
MS3 is also the time to start laying the framework for the development of more advanced skills. Every single MS3 should be learning medical communication and documentation. Being able to take a good H&P is a skill and it takes time to develop. Being able to round efficiently and effectively on a large and busy service is a skill and it takes time to develop. That starts as an MS3. Now, if you lack mentors in the form of MS4s, residents and attendings to coach you on how to do those things as an MS3, THAT is a huge problem. If you don't have someone critiquing your communication skills as an MS3, your school is shafting you. It doesn't have to be something formal, but you have to figure out what you are doing right and wrong and MS3 is the best time to get started on it. If you are an MS3 and you are a errand boy, there is something wrong. My expectation of all MS3s on our service is to have a full assessment of the patient. For all MS4s, they have to have a plan. Now, I don't care if it is completely wrong. But, by forcing them to develop those things, it gives me an opportunity to teach them specifically where they went wrong, rather than giving general feedback.
MS3s should also be learning basic procedural skills, suturing, knot tying, lines, etc. I have a big long post elsewhere specifically about this. I had an MS3 with me this weekend who did an entire femoral central line by herself. I was scrubbed in and assisting every step and it was a patient setup for success (intubated, sedated, large vessels, etc), but my comfort with her doing as much as she did was predicated on 2 months worth of basic skill derivation as an MS3 in the ICU and then on the vascular service. I was working with ~30 MS4s at a workshop not too long ago and asked how many had placed a central line as a student, all but 2 said they had. Granted, these are all MS4s going into surgery, so they likely sought those opportunities out, but they also came from 25+ different schools, so clearly those opportunities do exist.
MS4 is a problem because the expectations are so low and there are very few formal rewards after you have already started interviewing. Personally, I did a full ultrasound month where I did the vascular lab studies with the techs and then read the exams with the physicians. I did Cardiology, Nephrology and Neurology in the spring of my MS4, knowing that I was going into vascular surgery. I worked pretty damn hard on those rotations, but they probably helped me take care of patients as much or more than many of my surgical rotations.
and call it "culture"
