Preamble:
It is high time to talk some truth about the Cleveland Clinic Lerner College of Medicine. This doesnt mean airing dirty laundry, rather it means undoing the damage that CCLCMer and his ilk do day in and day out when they use SDN to propagandize for the our medical school. I think that the whole point of SDN, from the interview sections to the blog posts are so that we would have a place to go for balanced views. I know that this post is going to inflame some of the CCLMer style posters and get them frothing, ready to jump the defense of CCLCM to the point of absurdity. But if they sit back for a minute and actually think about what I am saying as opposed to how the post will reflect on their capabilities to land residencies, then I think that we may be getting somewhere on making the school better. However, my prediction is that these folks are going to be true to their past behavior and either attempt to get the post removed or answer the criticisms with their typical credo: we never said that CCLCM if for everyone! Sorry folks, that cop-out doesnt work here. Also, the world beyond CCLCM is subject to the laws of speaking freely and you cannot be remediated by Franco and the MSPRC for that {will explain this more in depth later}. The issues I will discuss are to make a point that some elements of the CCLCM curriculum are for NO ONE and NO ONE should be ever be exposed to these elements. Finally, I will high light beneficial aspects of the curriculum and school. I will address the 4 most important aspects of the training including clinical teaching, research, preparation for exams, the portfolio, and the general environment. This is going to be long so I will break it up and do it over a few days or so. Bear with me.
Conflict of interest statement:
I am a CCLCM student a few years into the system who feels that our administration and the trajectory of the school is going in a somewhat scary direction. I will also attempt to preempt CCLCMer and ilks criticisms.
Discussions about Research:
Positive Point 1:
There is an arsenal of research opportunity available at the Cleveland Clinic. If you are driven enough and you know how to approach PIs and you also are able to imbed yourself in a lab, you can benefit tremendously from the efficiency and money that the Clinic throws into their research facilities. Thus far, I personally cannot complain about access to PIs because I am a very forward person and know how to put myself out there. I also spend a lot of time in the lab pushing my project and my PI has agreed to fund me and/or help me write for a grant. I have some manuscripts that I am writing up. I am thankful to my PI for these opportunities.
Negative Point 1:
Despite these amazing resources, it is the research curriculum devised by the medical school that does the most damage to a students capability to succeed and produce. In the first two years you are expected to produce mock grants. These grants are typically cumbersome and the scrutinies that these mock grants undergo as compared to a PhD program mock grant border on ridiculous. *Remember, CCLCMer will respond to this by saying that this is what makes us better than a typical PhD or MD PhD program and that these amazing scientists scrutinize our mock grants which is a once in a lifetime access line. Be smart, dont buy into his commentary. What he fails to understand is that the system itself is asymmetric, nonobjective, and treats students differently. Some PIs will provide extensive scrutiny of grants and others will shelve the document. This is an issue because the latter folks then are able to utilize the time not spent on cleaning up a mock grant to actually forge connections in their lab or other labs and put themselves on trajectories to working out a good thesis. I was lucky, my PI didnt care at all about the mock grant and this gave me the chance to throw some smattering of words together into a few pages and then focus the rest of my time on producing and preparing myself to apply for actual funding from organizations like Doris Duke or HHMI. Unfortunately, my close colleague had these amazing PIs that CCLCMer will gush about, scrutinizing his mock grant. He had to do 3 revisions and got nothing done over the summer 1 time period. Finally, the amazing PIs are NOT the ones scrutinizing the mock grant. It is often times members of our research committee who have some accolades, but by no means are they the Clinics leading PIs. They do not understand the actual constraints of our time and go into this lock down mode pretending that they are criticizing an R01k application.
Unfortunately, one student who was a 4th year actually had to revise his year 1 (summer 1 mind you) mock grant because someone on the research committee had nothing better to do and decided he would teach this student a lesson in fulfilling obligations after somehow deciding to peep into his research portfolio.
Negative Point 2:
The thesis demands that the committee has in place are hardline to the point of foolishness. One of the class of 2009 had a Heme Onc focused project. One of his committee members moved to California. Towards the end of his thesis work, he offered a rearrangement of his committee with an expert in the field to sit in that investigators place. The research committee refused to accept this change and even threatened to flunk him on his thesis. This is absurd. Once again, CCLCM doesnt know whether it wants to combine a PhD approach with an MD or whether it is new and unique. If it is the former, then by all means keep the requirements as stringent as they ought to be [ though most of my colleagues in MD PhD programs or straight up PhD programs told me that they have much more leeway than this particular students situation!]. However, they claim the latter, in which case they need to get a grip on reality and understand the constraints on medical students in a 5 year program.
Negative Point 3:
The summer 1 and 2 curriculums are horrible at imparting actual working knowledge either on paper or in real lab settings for applied molecular biology or statistics. There were many people in my class who had no concept of what a p value was or for that matter what confidence intervals meant. An equal number of people had never even run an electrophoresis or PCR before. A 3 month long endeavor in biochem or epidemiology and statistics should definitely be better planned and make more sense so these basics are there for each student. *CCLCMer will respond that the requirements are that we have taken biochem prior to admission. Its an absurd response because college biochem/molecular bio covers completely clinically irrelevant material in relation to what med school biochem usually imparts.
These sessions involved taking New England Journal Articles and trying to reproduce their p values and other statistics without even educating folks on the basics of medical research and what these instruments and measures actually meant! At the end of the day, neither summer 1 or summer 2 provide a basic safety net of objectives that each student should know for practical research endeavors or for the USMLE Step 1. Their claim generally is that the Summer 1 biochem/molecular bio stuff will be dispersed into the remainder of the curriculum in an organ systems fashion. This is hardly the case and as one approaches the board, they will find that that miniscule information about lipid rafts are not on the USMLE and the fact that you had to have a whole PBL session about them and read about them was a foolish way to waste a week.
Instead of actually reading basic concepts in medical biochem you are given Devlins book as if a years worth of intense biochem that is not medically focused can be learned in 8-10 weeks. All the while, your primary reading are sets of journal articles. In the end, it all ends up being a big waste unless you are clever enough to preempt and game the system by doing their work just enough to get by and studying what was important on your own.
Discussions about Clinical Care:
Positive Point 1:
You have 4 major teaching hospitals at your disposal to rotate through. You can organize your team during research and other junctures to get clinical exposure at your own pace and actually learn medicine as opposed to being a scut monkey. However, since being a scut monkey is a large part of being a resident physician, you can also learn that stuff in certain scenarios. This is all if you have figured the system out early on.
Negative Point 1:
The CCLCM crew tends to rotate through CCLCM itself and manipulate the system so as to ensure that their Deans letters are formidable magnum opuses. This is done through a log system where the faculty are basically prodded to write lengthy and unusually positive assessments of the students that very often times are inflated. The administration knows this and instead of correcting for it has pandered to it, asking their students to remain within the confines of the Clinic so that their portfolios can be buttressed.
A number of the other centers remain in the classical mode and expect actual work as opposed to functioning like observer-ships. This means that the CCLCM crew can usually be seen at the hospital starbucks or au bon pain gossiping about who got drunk where and when. Many of them hit up the lounge in the afternoon and watch tons of TV. Often times they skimp on writing admissions notes or daily progress notes that most other 3rd and fourth years are writing across the country and rely on presentations alone or finding some obscure research article and distributing it to the team.
CCLCMer at this juncture will interject about the amazing surgery rotation and how hard our colleagues work. Certainly, there are some neat things that you can learn on that rotation and if you are lucky you can get through the whole book Diagnosing the Acute Abdomen. However, remember, a part of surgery/medicine is scut, and scut makes the world go round. When we get to residency, knowledge base alone is not going to save us. Its also about knowing that you have to talk with social work, dial some numbers to get info, and do some grunt work as a future resident. You wont get that experience at your Cleveland Clinic rotation.
In fact, that it is a fellows dominated system remains one the major criticisms of doing a general medicine or surgery residency at the Cleveland Clinic. This has trickled down to the medical student level.
Positive point 1 becomes negated in some senses because if you rotate at Metro your feedback through the filing of logs will not be as inflated as it is at the Cleveland Clinic. As a result, you end up rotating through the Clinic because otherwise, your Deans letter will not reflect your actual work ethic.
Once again, the general retort that the Lerner kids will make is that they work extremely hard and that they read a ton. They have yet to figure out that a large part of clinical training has naught to with reading and much to do with clinical plans and implementing them on the wards. However, come to CCLCM and go on the rounds in medicine, the MICU, or the CCU. Additionally, go on the surgical rounds and come see how much more of an observer-ship it is than a medical school rotation.
- More to come tomorrow!
