A change in attitude

[Sage880]

---

Members do not see this ad.

For the last 3 years, I've been a pretty big fan of the Irish medical schools. I've argued with those who discouraged students from attending and even called them trolls. student.ie is one that comes to mind but there have been others.

Anyway, they can take this post as an apology. The first 3 years of Irish medical school are fine.... but you can learn pre-clinical medicine in a cave if you want. You don't have to go to Harvard - there's nothing magical about it. The only variable is how hard you work and I did very well - no thanks to my medical school.

But the clinical years..... now you're much more dependent on a medical school that has a clue to provide learning opportunities. I haven't had any real bad experiences. It's just that the Irish medical schools whole philosophy toward teaching clinical medicine and training doctors is so broken and poorly done there's not even a list of things that need to change.

So, if I could do it all over again, I would not have come here. I would have stayed in Canada and re-applied over and over again until I got in. As a back up, I would have headed to the Caribbean (since pre-clinical year teaching just doesn't matter) and done my clinical years at hospitals on the mainland US.

I'm not a troll - go back and read some of my previous posts in this section. I fought against exactly the kind of things I'm saying right now. But I was wrong.... this education is at best sub-par. Do yourself a huge favor and seriously reconsider filling out an application to an Irish medical school.

 

[cheezer]

Yikes

 

[Tyerat]

I am guessing you wanted to come back to canada which is why you went to Ireland. But I have always wondered if the chances of coming back to canada are better if you graduate from irish schools compared to caribbean schools. I am canadain and currently going to apply and was also contempleting the same question, would europe be a better option or caribbean if i wanted to come back to canada but wouldnt mind working in the states. Please let me know what you think.
Thanks.

 

[Unch]

As I'm a year behind Sage880 at the same school (and just about to formally start in the hospitals this coming Tuesday), I can assure all that Sage is no troll.

But I was struck by what he wrote and can't help but respond. I think I know some of the specific criticisms he would level if asked but would like to appeal to him for details for the benefit of other SDNers. Really, those were pretty damning words and I think it begs a more fleshed-out critique. There's always the argument that "it is what the individual makes of it" and certainly that must still be true to a degree. But what aspects seem insurmountable and would warrant regret of such magnitude.

I guess another way of phrasing this request is to ask for a synopsis of some constructive suggestions to those of us in or entering the morasse of Irish clerkships. If we are here and do have to navigate this system, surely there are some better ways to make the best of it. Any sage advice from Sage?

 

[Sage880]

Well, I could go into about 50 different specific problems with the education but I won't. For better or for worse, I still have two more years of medical school in this country and I'm determined to make the best of it. I really didn't even write this to bitch - I just suddenly feel really bad about the advice I've been giving to people about the Irish medical schools and wanted to retract that.

I'm not trying to "put down" or demonize the Irish system. It's not like it will make you a horrible doctor. It just won't make you an especially good one and we will all be pretty far behind the North American students when we graduate. I'm not sure exactly how much of a handicap that will be in the end but I don't imagine it's insignificant.

I'll compare the two systems.

For pre-clinical, students at good American schools get some of the best teachers in the world who are masters at what they do. They are experts at lecturing on their topic and can explain things simply, accurately, and interestingly for their students. I'm sure a couple of the instructors aren't super-stars but I think that the majority are pretty good.

Here, the pre-clinical teachers are mostly full time. Most of them have no teaching in education at all but a couple are very, very good. Things you take for granted at home like, "teachers understand what makes a good test" are luxuries here. But, in the end, a blind-monkey can teach pre-clinical medicine. You basically have to show up to find out which text book the monkey is grunting about and then go read it yourself. So none of this really matters that much in the end for pre-clinical years.

Then you start the clinical years....

What do you want from your clinical years in medicine? Medical school teaches you that you can memorize anything given to you. So again, I can spit back facts from Robbins with the best of US students. But more important is just getting "real world" exposure to things you should be learning in clinical years. Seeing patients in medicine, examining wounds in surgery. Making sure you've at least seen every major condition or scenario in a specialty at least once.

At US medical schools, every student rotates through the major clinical rotations and is part of a medical team. That team understands that every student needs to cover certain things during that rotation and it's their job to ensure that the student has an opportunity to see the majority of things that they will need to know about that specialty. In addition, the students have shelf exams at the end of that rotation further ensuring that they have learned all the things they need to know. There's continuity to the whole process where the instructors understand what the students know and what they need to know. You can confidently hire a US grad and, based on the fact that they've passed the surgery shelf exam, know that they've got some amount of knowledge pool that you can build on.

Needless to say, that's not how it works in Ireland....

Even for lectures, we basically just have random doctors who are asked to come to tutorials at the last minute and talk to us about something or other. They have no idea who we are even or what we really know and were just asked to do something 5 minutes before our lecture started. They're not all like that, but a lot of them are. Because of this, we basically get the same tutorials over and over again. I have had the "classifying anemia" lecture about 13 times. I'm not kidding. Really??!!? You can break anemia down into macro/normo/microcytic and whether there's reticulocytes present or not?!? Fascinating!! But do we ever have a lecture on management for these patients? No, we do not. I have seen the final year lectures in hematology and they are the EXACT SAME THING as we receive in 3rd year. Lectures on treatment and management are seen as too advanced for medical students it seems. You know why fifth year is so hard at the Irish medical schools? Because you don't do **** all during years 1-4 unless you take it on yourself to read textbooks yourself.

But, in the tradition of clinical medicine, hopefully I will learn everything else I know when I rotate through a specialty. Remember, if I was in the US I'd be attached to a team for a while who would have certain learning objections for their students and expect certain things from me. I'll tell you what my schedule was last week:

Every day I had one hour with a random team that agreed to take a couple medical students at the last minute. Through magic eight-ball scheduling, I was with Infectious Diseases, Renal, Respiratory, GI, and Hematology. I have no responsibilities of course. Basically we're supposed to show up and tag along for an hour and learn something. Of those 5 days, a doctor only showed up for 3 of them..... and that's a fantastic week compared to last year. The other two days you get dressed up, head to whatever hospital you're assigned to that day. Wait around at a nurse's station for 40 minutes paging their intern or other members of their team and trying to not get in the way of hospital life. For the three days someone did show up, we took two group histories with the doctor present (one each day! A PE and someone with a nephrotic syndrome) and had a 30 minute lecture on "classifying anemia" on chairs in the middle of a hallway the third day. Worth getting out of bed for? You be the judge.

People try and make the best of it the days when no one shows up. Since that's about half, it's better to do something to make getting out of bed worth while. You can ask the nurses for a list of their patients and go take a history and do a physical exam on a patient or two. That's what the Irish medical system prides itself on - how well their students can take a H/P because they practice it constantly for three years at the expense of everything else. Do you want to know a secret though? Something the Americans have figured out? TAKING A HISTORY AND DOING A PHYSICAL EXAM IS JUST NOT THAT HARD! I had to type that in caps for emphasis because so many people here disagree with that statement.

And then when people do show up to teach you, they have no idea who you are or what you know. They just know they have to do something with you for an hour so they just talk about or show you whatever they feel like that day. Things like, "classifying anemia" or "how to take a respiratory history" are taught dozens of times but 98% of the rest of medicine you will never have any exposure to clinically. American medical students see 100's of wounds, the complete management of medical patients with countless conditions, learn the nuances of dealing with the whole rainbow of medical diseases. But hey, I can take a really kick ass respiratory history. Yay me!

Magic eight-ball scheduling says next week I will be going to 3 different hospitals over 5 days for one hour each day. I am assigned to Geriatrics, Rheumatology, Cardiology, Cardiology (at another hospital!), and GI. If someone from the team shows up, I will do my best to learn something. But I will probably just be taking more histories on patients who've had a heart attack.

If I had to sum up the last year and a month of Irish medical school I would say this: low yield. It's not that it's bad, it's just that we get to do and see maybe 5% of what US students do during their clinical years. So do yourself a favor and go somewhere where you'll be exposed to everything. Because trying to make up that 95% that I'm falling behind every day compared to US students is one giant pain in my ass right now.

 

[Unch]

Thanks Sage,
I guess I asked for it. "Ouch" is all I can say. Can I still transfer out of here?!

 

[khl31]

whilst I had a rather similar experience to sage880 over here in the UK, i personally choose to see it as a good rather than bad thing.

how so? well - if we are so poorly supervised, it means that we have more time to go seek opportunities for ourselves, and because so few things are organized, and so few students are either motivated and/or savvy enough to go seek their own destinies, consultants tend to be very appreciative and supportive of the few that do. (I speak from personal experience - turned up in theatre one day, asked if i could stay and watch. reply was "are you supposed to be here?" "no, but i'm interested in _____" "keen and interested. good. want to scrub and assist? you can close, i'll teach you." so i'm a surgical groupie, and knife-happy. sue me. 😛)

yes, you might feel as if you're not getting your money's worth of teaching, but think of it as such - you get to forge your own destiny instead, and you stand head and shoulders above the unwashed masses in the eyes of your seniors if you choose to do so.

hang out in the theatre/ward of your chosen interest, and be seen, not heard. make your presence felt by the decrease in the doctors' workload - offer to help them any way you can, and they'll help you any way they can. trust me, if you're patient, this will work within a fortnight of trying. most students make the error of trying this for maybe a day or two and then giving up.

and although it sounds like an official line used as an excuse, this particular one does hold true the world throughout - you don't learn medicine from textbooks, you learn it from patients. hang out in theatres and wards keeping your eyes open and being generally helpful pays off. viewing work as scut is an unhealthy attitude - if you can't do it better than the person who's supposed to be doing it, and if you're supposed to know how to do it, then you've got more to learn! if you're cheerful on the wards, and not grumpy because you feel as if you're not getting what you're "entitled to", your presence will be that much more welcome.

from observing my fellow medical students and having gotten to know some of my seniors (SHOs, reg's, consultants) quite well, they usually let time do the work - they'll ignore students who turn up because they're supposed to, and these quickly lose interest and will go away. Students who *want* to be there, and are a useful pair of hands, are always, *ALWAYS* enthusiastically received (i believe the technical jargon for describing these is "worth teaching"), even when the doctors are running around tearing their hair out. the merits and morality of the situation might be debatable, but that is the way it is. i don't know whether it is fair or not, but frankly, that's the way it is and there's no use running to mummy to cry about it, because your consultant's not going to care, is he/she now?

i have no personal experience with american doctors, and so it would not be fair to pass comment on them. but i must say i've heard both good and bad things. some are brilliant at what they do, others... well... less so. friends returning from electives in america speak of horror stories where patients get referred from A&E to radiology for CT Abdo for ?acute abdo when there's a MASSIVE strangulated hernia protruding from the abdomen. and when the doctor was quizzed, reply was... "er... i didn't look." (There are of course many stories of cool things seen in the US too, to balance these)

moral of the story - you have to WANT to be a good doctor, no system can make you one. and you can be a good doctor coming from any system, though admittedly some systems give you more opportunities than others, such as the Irish/British one! 😛


p.s. apologies for the long post that sounds rather rant-ish to me. it's been a long week in the hospital, i'm essentially working on 2 firms at the same time at the moment 😉

 

[khl31]

ooh, i'm on a roll now and feeling garrulous, so here goes... (BTW, i'm not picking on anyone or hoping to troll/start flamewar... guess i'm just venting to a ?receptive audience)


the "art" of history taking. after a year of consultants hammering into me that history taking is an art, i've only really started to appreciate it these past 2 or 3 weeks. i guess it's one of those things that you need to have a certain amount of background before you appreciate how great someone is (clinically😉).

what do i mean? have you ever had the situation where a medical student does an exhaustive clerking in an outpatient clinic, asks every question in the book he/she can remember, and writes 4 sides worth of a single clerking, and comes up with a long beautiful DDx? and then the consultant comes along, looks bored about 15 seconds into the spiel, cuts the student short, turns to the patient, and asks a *single* question which rearranges the DDx TOTALLY? i had that happen to me many times these past 2-3 weeks, and probably even more before without realizing. but now, i'm beginning to have a vague idea of what i'm looking for, and what each question probes, and so i appreciate the directness, the insight, offered by a good consultant's single question.

on a related note. a close friend of mine is an oncology registrar now (fairly senior resident for those across the pond). we once had a discussion of one of the most loaded, and discerning medical terms used in patient notes. "Well". he tells me when different people write that, he assesses the background of that "well". a junior's "well" = "this patient did not crash or die in front of me, and will not crash or die within 2 minutes of me leaving him/her; all bets are off as of 2:01". a consultant's "well", on the other hand, implies that "this patient has been thoroughly questioned/examined for most conditions, including some rather obscure ones, and i have no reason to think he/she has any of them".

with insights from people who have come before, as illustrated above, i'm beginning to appreciate the deep undercurrents that lurk beneath the seemingly innocuous actions and notes of senior doctors. it has taken me some time to understand this, but now i see why the junior doctors are in awe of some of these white-haired, bespectacled, wrinkly, croaky and creaky consultants parkinson-ing it up and down the hallways. 😳

 

[Unch]

Utterly awesome, khl31. Thanks.

I confess that another friend who finished in Ireland about two years ago (and still raves about it) said similar things, namely that it IS all here for the taking and that too few actually have the right flavour of perseverance to make it happen for them as individuals. As the friend said, they (the reg/consultant/SHO etc) mostly treat you like sh** initially and that if you're sincerely interested enough (and lack a chip-on-shoulder... which many "youth" don't) that they come on in spades when they see you still hanging around on the third/fourth/fifth day. I'm sure Sage has tried all this and that it's not as easy as it sounds. But the farther I get and the more I see (and I'm, er, not exactly young), the more I agree that EVERYTHING boils down to people. That is to say, there's always room to put your personal stamp on the interactions with people that form your clinical experience/elective/residency...

A slightly relevant digression: Last year I was a mock patient for an upper year OSCE and the examiner at my station was a very senior clinician. She didn't even acknowledge me for the first 20 minutes, even though we were sitting feet apart at the same table. I took this as a personal challenge and tried an approach or two to draw her out and see if I could actually enagage her in some dialog (not for any purpose, per se, other than to disabuse myself of the reflex tendency to dismiss her as an arrogant cow). I managed to learn a fair bit about her and her fellowship in the US, her perceptions on some interesting differences between medicine here and there etc. And perhaps i got on her radar a bit for when I cross paths again on a clerkship. Only later did I learn that she's noted for her prickly personality but is highly respected as an uncannily good diagnostician and can be a superb teacher if handled "carefully".

Anyway, I'm going in circles on all this. I'm up. No, I'm down. I'm somewhere inbetween. I guess, sigh, I'll be okay. Today is my semi-annual "crisis-of-faith" (which is pretty good since I had them weekly in first year).

 

[Sage880]

khl31, I'm not saying that there's nothing to take out of Irish medical school. Yes, I know how to make the best of it and by being enthusiastic, working hard, and getting to know a team I have gotten some good teaching eventually. Like you said though, you have to hang around for a couple days before anyone will really even talk to you.

But our rotations change quickly and we're off to a new team. New people to get to know and new people to ignore us for the first couple days. More hurdles to jump - more egos to stroke. All those "couple days" add up during the year to a WHOLE lot of low yield days. Every couple of days my buddy back home sends me an email about his week and they see in a week what we're lucky to get in a semester. EVERY single day we put in "hanging around" and waiting for them to accept you is time lost!!! In other countries they are actually on a structured curriculum where they are making the most of almost every day and learning something. We can't even just "go to theater" or hang out with whatever team we want to as you suggested. Because, since we're almost doctors and professionalism is what the expect of us *sarcasm*, we actually have attendance cards that need to be signed by whatever team we're supposed to be with. So not only is the curriculum organized by monkeys apparently, they actually enforce us sticking to it for forth and fifth year. You can't even do an away rotation. No attendance in third year but that's only because most teams actually asked us to not show up because they were so busy they didn't want to teach us or have us in the way. I actually think I got more out of third year because I was actually free to do my own thing. Because even when people do show up this year they aren't really following any curriculum and we just get some random tutorial by a doctor.

Aside: again, it's not horrible across the board. Some teams are amazing and some rotations are incredibly high-yield. Anesthetics, for example, in third year is great. But not even most, the MAJORITY of them are bad. Bad in terms of being really, really repetitive at best. Someone posted a story about toughing it out and getting in good with a surgery team and getting an opportunity to scrub in and maybe even close during a surgery - a real success story in Irish medical school. Every student in a US program gets to do that. Countless numbers of times. They're EXPECTED to do those things. They have that in their curriculum. That's a really good example to see the difference in both the programs and people's attitudes and expectations.

And I knew people were going to focus on the whole "H&P's just aren't that hard to learn how to do". I really thought about not putting it in there. I don't mean to imply that I'm a master at them by any means. In fact, it definitely is one of my weaker points. I do realize that it is a life-long skill I will be cultivating for the rest of my life. I'm just saying that while I'm doing that for 3 years of clinical medical school I could be actually learning medicine throughout the day as well instead of standing around trying to page my team for hours or attending lectures and tutorials where the professor attendance rate is at best 70%.

I'm not trying to argue with anyone about this. If you think North American kids would be better off coming to Ireland to train instead of Canada, the US, or the Caribbean then we'll just have a difference of opinion. But talk to anyone from Ireland who's even done an elective in the US and I think they will 100% agree that there is NO comparison between the pace and the volume between the two countries' medical school programs. If you do your clinical rotations in North America you will see 20 times what you see here. So if you can't get into a mainland school, go to the Caribbean so you will do your clinical rotations in a US hospital. Your education will be vastly superior to the one you receive at an Irish medical school. I will still do whatever I can to make the best of my next two years but I 100% believe that any student trying to make a decision where to attend should learn from my mistake and consider this advice.

 

[deutsche106]

Hi, sage880,

Can I ask you which Irish medical shcool are you attending right now? Are all Irish med schools are like the way you described? (I'm currently thinking about applying there)

Thanks a lot!

 

[Sage880]

I think all the schools have pretty much the same set of problems. I've gotten PM's from people from every Irish medical school except Galway expressing their frustration as well. Also, some of the old "trolls" of this forum pretty much had the same message - although maybe stated a little more harshly. RCSI has an army of people bashing it on the forum and I believe student.ie graduated from UCD? It might have been RSCI though.

I'd post comments from current students at Trinity and UCD that were sent to me but obviously if they sent comments via PM instead of responding to this post they don't want their negative comments posted publicly.

 

[Sage880]

Guys, I think my message is being lost a little bit here after I just read another couple question PM's I got. I'm not trying to crap on the Irish schools. If you don't have any other options then coming here is better then nothing. You will graduate, you will match into at least FM in Canada or the US if you're from there, and you will be able to practice medicine fairly competently.

I'm not even saying the Irish are bad doctors. Most are great. The difference is, they start school early and they have more of their training AFTER medical school. They learn things during their intern year that US students do during their second year of medical school. So, if you go through the Irish system and work for 4 years or so after school you will have caught up a lot more to the US programs. But for those of us who want to go back to the US or Canada after we graduate medical school then we are at a disadvantage. It's just frustrating because Irish medical school is soooo easy and slow paced. People call it "Club-med" up until the very last year.

I'm just saying don't lie to yourself about what the experience will really be like. And don't kid yourself that the Irish schools are a better choice then something like Ross in the Caribbean. Being able to do your clinical years at a US hospital is a HUGE advantage for you. I don't want to tell anyone not to come here, I just want them to take a long hard look at their chances of re-applying back at home or exploring the other options like the Caribbean or maybe even Australia. Because honestly, that's what I would do if I had a chance to do it all over again. I am making the best of it and I love Ireland and will always remember my time here. But career wise, I have to be honest to myself if I'm to be giving advice to other pre-meds making these decisions about their future.

 

[deleted21609]

Yeah. Sage has come to realize the sad truth.

I'll repeat what I'm sure I've said many times. If you can get into medical school in NA, it is a huge mistake to go to IRL. If you can't get in in NA, it's probably better to try again than to go to IRL. If you absolutely have no other choice then you can go to IRL and become a doctor, but medical school will be subpar and you should plan on spending one to two years working after medical school just to catch up with the new grads in NA. Problem is that you may not be able to get a job, and you probably don't want to stay there for that long. I always though that IRL was better than Caribbean, but I might have been wrong about that. At least Carib students do serious rotations at US hospitals with a wide variety of diseases, and are involved in patient care. In IRL, you follow around a medical team, in NA, you are a part of the team. In NA, you write notes that go in the chart, present the same patients every day, make plans for the patients, and are asked about &/or taught about the important things you should learn from that patient. In IRL, you follow around a team, you may or may not be able to hear the discussion (but you are not a significant part of it), and you go home. You can try to squeeze some education out as discussed above, but many of the house staff will not be receptive or interested in your education.

 

[leorl]

I'm not as extreme as student.ie, but having gone through a lot of crap last year, I will admit to be disillusioned by the schools. The same problem(s) happen in each school so one is not better than another in this regard.

You may remember me posting that one day I will post all the issues I had with my school...I still haven't found time but will at some point.

Ultimately, I still have enjoyed my experience here and have met some of my best friends for life. I will say that all the **** that happened last year did basically ruin 4 years of happiness here and I was really really angry that they could do that to me, and furious that a school would actually create a students vs. administration environment. Although heightened in my year, we are not the first class to feel this way - it's been going on for years, just very hidden...for the same reasons why we felt we had to hide it. Medicine is a very political world. Anyway, I'll explain more hopefully soon. I've always supported study abroad - but last year made me really question my decision to come here and question my decision to go into medicine. However, I still maintain that I made the right choice for me and do not regret coming.

With regards to training - I don't agree that coming here makes you a subpar physician. I think it depends what you get out of it and your own personal attitude towards work and clinical ability. I don't mean this to sound like bragging, but when doing electives back home, I was told that I was one of the best rotating students they'd had (this is in multiple rotations). This was a surprise to me because I felt I was just acting naturally. But it isn't that hard to pick up the work ethic needed in US electives, or the way to do admissions, soap notes and just general jobs. You don't need to have years of US clinical experience to pick that ability up. Working here, I've also been told (just today in fact), that I am the team's best intern. Our jobs are very similar to what they do in the US, although we have more ****work here. The praises aren't particular to me, and many of my colleagues who have done electives back home have been told that they are outstanding. It's not how good a student that counts, it's a combo of your knowledge plus your attitude...and often, attitude wins. Clearly, something in the Irish system can produce good physicians in both a US and UK/Irish medical setting.

Where I feel the downfall of the Irish system lies is obviously with USMLE preparation. That is the weakest part of my application (and of others in my class applying for the Match this year). But as I said before, I'm not the best student and also, being away from the NA setting will make you a bit naive regarding what's needed to prepare, no matter how much advice you get. Obviously, some are able to get fantastic scores...I'd like to know what their trick was - only, I'm pretty sure it's because my studying wasn't completely focused, and theirs was.

 

[Sage880]

Where I feel the downfall of the Irish system lies is obviously with USMLE preparation.

That's funny because I think that's one of their stronger points compared to any other non-us school. The one thing I will say about UCC is that path is taught (well, was taught - they just changed the curriculum and I think there's less path now) very, very well. Even though the pharm department pissed me off with their general "student unfriendliness" and hostility, I'll admit that pharm was taught quite solidly. So even Irish friends who did absolutely no extra study passed step 1 quite easily. I'd say most of the north Americans beat the US mean. All that I've heard did but I guess if someone did badly maybe they'd keep it quiet so my view of the results might be skewed. Also, people could just be outright lying about their results.

But yes... I have heard success stories like yours leorl from people going back home for residency and electives. I guess I'll see next summer for myself when I do mine. I can't believe we'd have the same base as the people I know who are in school back at home but maybe that clinical exposure is a little overrated and good old hard work and a good attitude help fill in the gaps. I guess the real test is where we all end up matching. There's no freaking way I would stay here for my intern year (I don't know how you do it leorl) so I will be starting the application process next year. Are you going to stay in Ireland or return to the states? Any idea on what specialty you're thinking of?

 

[leorl]

i'm trying to Match now for EM. If I stayed here, I'd probably pursue orthopedics but that's going to take 10 years.

I stayed here for 1) MONEY. However, this might change if they actually enforce EWTD which I really cannot see happening and 2) Irish qualification for full medical council registration which would then open EU med registration should I wish to return in the future. Since I'm interested in international medicine, this is a possibility in my life. 3) My best friends are here and wasn't quite ready to just leave last year.

Glad UCC prepares you well...they were changing things in Trinity and in our year, our pathology was really poorly taught and there lies the difficulty. None of the people in my year did very well on the USMLE (both Irish and US), but that could be particular to us too. Many of us are very involved in other things and might have been naive regarding the preparation. I did meet someone from UCC who failed Step 1 and had to retake, but honestly...failing Step 1 once doesn't seem that uncommon (ie. 1-2 of a class per year, depending on circumstances). But my school might have gotten things better with path after our year (they hated our year because we made things hard for them...we were so pissed off with our path "teaching" that they received daily complaints and actually some students sent them some really really rude emails) because some of the students in the year below us scored really well. They are swots though.

 

[VeerTheTIGuy]

having done basic precepting clerkships for the past couple summers in the US, and having seen and heard what US med students have to do, all I can say is that I hope schools in the UK are more like the US system than they are the Irish (although from what I've heard about Manchester, I seriously, seriously doubt it).

However I agree with the whole "get out what you put in" philosphy, especially since a lot of UK students (especially those from the UK originally) aren't as 'into it' as we are, leaving room for us to step forward and excel (not trying to put them down, but if they're not going to step up, I sure as hell will).

I definitely do not like the "gunshot/magic 8 ball" assignment approach, either. My sister (currently a 4th year at Leeds) has already been on a Urology rotation, a GU rotation (wtf how are those different?), and renal (alright seriously, what's the point?) she has yet to cross above the diaphragm! From what I understand at Manchester, however, they split the 3rd yera into above and below diaphragm (not actually called that, but its a simple way of describing it), and you stick with teh same team for 7 weeks (one block medical, one surgical). But like many of you above have said, doing H&Ps all day is essentially useless if you don't do the DDx, order the labs/imaging studies, etc, and then FOLLOW UP on the patient. I understand that the UK and the NHS are moving towards a more GP-centered approach, but just because a majority of the docs only see their patients once doesn't mean we shouldn't learn how to follow up on the patients. From what I understand, we aren't expected to "pre-round" like most US students, and take a more 3rd-party approach, rather than being the closest person involved in the patients care, knowing each and every detail of their story. If I can change this (or at least pretend I am in the US and do this anyway, I will). Just wondering, do they allow you to write orders/order images, etc, if you get a co-signer?

And what about pagers/being contacted? Say you're on a team with a patient who is here for one complaint, and say they're not on DVT prophylaxis (compression stockings, enoxaparin/heparin, etc). All of a sudden, they develop acute SOB😱. Who gets called? The Consultant/Attending? The Registrat/Resident? The House Officer/Intern? Or you? Who is going to order their stat CXR, D-Dimer, and CTA? (I may be being optimistic here, but in the US, when an inpatient has a serious problem, things are done fairly quickly). Are you attached at the hip with one of the above team members? What about if this happens at night? I know that if it were a US student, maybe you're on-call and have to cover the team's patients for anything that goes wrong...In essence I'm asking, how much responsibility do they give you? And if you ask for more, will they let you? I know many of you are Irish students, so I'm not expecting much in terms of UK hospitals, but I'm assuming they're very similar.

Oh boy, I've seemed to have gone way off track...ohwell! Very interesting discussion so far, thank you...

 

[leorl]

In the UK/Ireland, students do not follow patients at all. With my students, I have tried to assign them patients...but this becomes difficult with their schedules and the fact that there's a high turnover in Orthopaedics and therefore nothing really to follow. I think there is use in practicing H&Ps in the beginning anyway, to practice how to tailor histories. But usually what I'll do is then get them to think about what they'd like to do afterwards and I have to say I have been impressed with their thinking. I did find it difficult to do when I did my ICU rotation in the US, but that's because those guys had pathologies that I'm still not expert about. It's up to the person you're attached with whether they will let you order and agree to co-sign. In most cases I can't see why not...I do, it lessens the amount of writing and crap I have to do.

In an emergency situation what usually happens is the intern gets called first and gets the ball rolling. Intern realizes...oh crap, something serious is going down and calls the SHO, who depending on experience will call the Reg or instruct the intern to call the reg. In some hospitals, whole teams carry the arrest bleeps so if someone arrests then the whole team gets notified simultaneously. If this happens to a patient that you're covering, then yeah..you'd feel comfortable ringing your senior and being like...get down here now!. The trickiness comes when you're on call and you're covering patients you aren't familiar with and have higher ups who you're also not familiar with, with all parties trying to do as little as possible 🙂. And just for the record...you aren't going to get a stat CTPA here at 2 am.

Students will have no contact except observational ...anywhere. This is for legal/insurance reasons. Even in the ICU, in an arrest situation...you would be given smaller jobs (like chest compressions maybe) or examining a certain system. All the ordering/imaging/drugs are handled by certified physicians.

 

[VeerTheTIGuy]

In the UK/Ireland, students do not follow patients at all. With my students, I have tried to assign them patients...but this becomes difficult with their schedules

crap. that was what I was afraid of.

If this happens to a patient that you're covering, then yeah..you'd feel comfortable ringing your senior and being like...get down here now!. The trickiness comes when you're on call and you're covering patients you aren't familiar with and have higher ups who you're also not familiar with, with all parties trying to do as little as possible 🙂.

Now when you say 'covering', what do you mean? As in anything going wrong you get paged for? And i'm assuming this is in final year maybe? Or not at all during school?

And just for the record...you aren't going to get a stat CTPA here at 2 am.

Well then what, empirical Heparin therapy? jeez...lol. Oh well, I knew I was being optimistic.

Students will have no contact except observational ...anywhere. This is for legal/insurance reasons. Even in the ICU, in an arrest situation...you would be given smaller jobs (like chest compressions maybe) or examining a certain system. All the ordering/imaging/drugs are handled by certified physicians.

I'm sorry...what?! Do you mean only in the ICU, or in total? As in you're never anywhere without a supervisor? Please elaborate, that first sentence just threw me for a loop lol

Sorry for all the questions!

 

[PTgirl]

I need some positive input from the Trinners on this forum, please!!! This is the last thing that the incoming 1st year Med students want to be reading!

 

[eg77]

I need some positive input from the Trinners on this forum, please!!! This is the last thing that the incoming 1st year Med students want to be reading!

I second that...this is very hard to digest since my ticket to Dublin is booked for Sep 28th. Really worrying as it's too late to change anything now. 🙁

Regarding Ross or St. george's in Carrib. Wouldn't you say that their acceptance policies are really easy? I don't know of one person who got rejected from there. This automatically worries me cause I associate an easy admission process with bad training. Not sure why but it's just a gut feeling. No offense to the carrib students but this is just my thoughts...no facts to back this up. This is why I invested in Ireland; the admission cycle seemed more reasonable. Any thoughts?!?

 

[Coccinelle]

I second that...this is very hard to digest since my ticket to Dublin is booked for Sep 28th. Really worrying as it's too late to change anything now. 🙁

Regarding Ross or St. george's in Carrib. Wouldn't you say that their acceptance policies are really easy? I don't know of one person who got rejected from there. This automatically worries me cause I associate an easy admission process with bad training. Not sure why but it's just a gut feeling. No offense to the carrib students but this is just my thoughts...no facts to back this up. This is why I invested in Ireland; the admission cycle seemed more reasonable. Any thoughts?!?

I know of a few people who were rejected from Ross & SGU, it seems that they are getting more competitive as of late. I went to visit a Carib school and it seems that the education is not sub par, but like everywhere else it's what you put into it that determines how much you get out of it. They seem to be more targeted for USMLE prep which i think is one of the main factors separating them from the Irish schools.

p.s. if anyone changes their mind about going to Ireland, i would be happy to take their place. 😀

 

[leorl]

Hey, we realize this thread would be discouraging...hence the title. It's not great going into first year having reservations, but honestly...the stuff that's been said in this thread, I wish I knew before I came here. It wouldn't have changed me coming here, but I could have planned better.

I've done this in the past before and people have expressed interest in it - when you guys are here, I can meet you all somewhere and chat to you about what to expect here, give you some pointers so you can start off right. And answer some questions you may have.

Everyone has positive experiences here too...but as with everything, the negative ones are the ones you remember 🙂. I've had a fantastic time here and did really love Trinity, which was one of the reasons I got so angry when Trinity admins dicked us over. I've gotten to do things here that I never will be able to do again. But as we've said over and over, you have to get involved.

No place is going to be perfect. Being here is just the same as anywhere else, only you'll have more obstacles to face since you're eventually going to go back into a different system. But know that medicine is tough...everywhere. You will not end med school thinking you're in cloud 9. It's a very humbling experience as well. No matter how good or how smart you are, everyone does/says things that are completely stupid. That's just medicine, and it's universal. But ultimately, you knew that this is the only thing you wanted to do...otherwise you wouldn't have gone into it.

 

[leorl]

VeertheTIGuy:

Well, you have your own patients and then you "cover" other patients when you're on call (ie. they're not your patients but you do necessary tasks for them). That includes anything going wrong. This is while you're working, not during school. NOTHING about the clinical years is similar to what US students go through...you do NOT do call, you are NOT attached specifically to a team. What you do during final year is basically on your own...attend tutorials, lectures and then go see any patient on any team anywhere in the hospital with signs or pathologies that you can practice with. You have no responsibility for any patients.

When you are a student as I just said, you do not do any tasks regarding patient care. You just take histories and practice exams for your finals. You also learn theory and literature. Therefore, there is no supervision except in your own tutorials. When you're an intern, supervision is on a team basis. For instance, in the team I'm working with now, interns run the wards and much of it is unsupervised. If we have problems, then we'll ring our seniors. Or if we're learning a new technique, then we'll be with our seniors. When you're on call, you are unsupervised but you also have seniors you can call should you run into problems. On some teams (more medical), the senior and junior member of the team are almost always together. It just depends what team it is and how they run things.

 

[VeerTheTIGuy]

VeertheTIGuy:

Well, you have your own patients and then you "cover" other patients when you're on call (ie. they're not your patients but you do necessary tasks for them). That includes anything going wrong. This is while you're working, not during school. NOTHING about the clinical years is similar to what US students go through...you do NOT do call, you are NOT attached specifically to a team. What you do during final year is basically on your own...attend tutorials, lectures and then go see any patient on any team anywhere in the hospital with signs or pathologies that you can practice with. You have no responsibility for any patients.

When you are a student as I just said, you do not do any tasks regarding patient care. You just take histories and practice exams for your finals. You also learn theory and literature. Therefore, there is no supervision except in your own tutorials. When you're an intern, supervision is on a team basis. For instance, in the team I'm working with now, interns run the wards and much of it is unsupervised. If we have problems, then we'll ring our seniors. Or if we're learning a new technique, then we'll be with our seniors. When you're on call, you are unsupervised but you also have seniors you can call should you run into problems. On some teams (more medical), the senior and junior member of the team are almost always together. It just depends what team it is and how they run things.

THanks for you response, but I've gotten some info from some clinical students at Manchester (where I'm headed in a couple years) and they say things very different to what you did - so I guess it is pretty different in the UK than Ireland.

 

[Unch]

Well, I'm going to weigh in here again. I took the bait initially (against my better judgement) and followed along with the criticisms but I have a bit more to add.

My comments hinge on the long view versus the short view. I keep returning to the ups and downs of medical school (any medical school anywhere) in the here/now versus one's ultimate goals and the end result of a medical degree. The real questions are (a) whether Irish training is up to par and (b) whether one can achieve one's prefessional goals with an Irish degree. After that, the "quality" of the degree is pretty subjective as is one's experience along the way. We can have an emphatic dialog about the nuances but i think it's patently clear that Irish degrees are well-respected worldwide, meet international standards and offer all reasonable professional opportunities.

Nonetheless, the "quality" and comaprative issues linger and I'm as guilty as anyone for my recurrent crises of faith. So after Sage880's post that started this thread, I contacted a few friends who graduated from Irish schools (TCD and UCC) in the last couple of years. I forwarded Sage880's post and got their responses. They're not a large sample but they are grads of Irish schools who are in excellent/commpetitive US and Canadian residency programs and can accurately and honestly assess the Irish programs, transfer issues and salience of the Irish training in NAmerica.

To begin with, both didn't disagree with Sage880 per se but had strong reactions to his interpretation of the reality here. Acknowledging that there's a lot to be frustrated about here along the way, neither has felt even remotely handicapped in their NAmerican residencies. On the contrary, both feel at least as well trained in medicine, equally trained in path and pharm, much better trained in history taking and physical examination and maybe a bit less well-trained in therapeutics/management. The last is, perhaps more easily remedied later while the former (basic clinical skills) is probably harder to remediate later. Rather than ramble, here are some bulleted gleanings from their responses. There was a lot but these are just a few highlights I remember.

• Irish clinical training is much less time-intensive in that we aren't expected to be on call (read scut work in the US/Canada) so we have much more time to study and sleep
• the final med year in Ireland (a whole year of unflinching bedside teaching) is invaluable
• Irish schools might not necessarily give quite as much exposure to esoteric/rare pathlogies (seen best in large patient populations) but they teach the basics very well indeed
• lifelong benefits of experiencing a different medical system and stitching that into a NAMerican career
• Best, at some reasonable point, just to commit to the program you're in. There might be somewhere better but isn't there always?

So I guess all this is to say that every school can be bumpy along the way and i certainly don't hear my NAMerican friends unerringly praising every aspect of their med school years. But in the end, everyone i know personally who trained in ireland has become a physician and they've all gotten good residencies in Canada or the US. Are they as good as they'd be if they went to a NAmerican school? My bet is that they'll be better since they'll have had school in one system and residency in another. I wouldn't trade my training here, even if I have some crappy clerkships. If I were recently-accepted and worrying about having made a mistake, I'd lose the fear which can so often linger and color the whole experience and concentrate on the fact that I'm going to emerge well-trained and with great options.

 

[deleted21609]

I also have a bit more to add. If the questions are whether Irish training is up to par and whether one can achieve one's prefessional goals with an Irish degree, the answers are no and maybe.
Claiming that Irish degrees are well-respected worldwide is a basically meaningless statement. Most people worldwide don't know or care about Irish medical education.
It is definately a myth that Irish grads are better trained in histories and physical exams. You would also be mistaken to think that these skills are all that difficult to obtain. Excessive time is spent on performing physical exam maneuvers that are frankly not necessary in the practice of modern medicine. If you have ever look at the pretest and posttest probabilities of physical exam maneuvers, then you'll know what I'm talking about. Much of what you are learning is useless in that it makes no meaningful difference in your differential diagnosis.
Did you just say 'call - read scut work'? You either have never taken call or don't know what scutwork is. I'm no fan of call, believe me!, but decisions made on call are the most independent you will make. One of the hardest things to do, I thought, is to move from carrying out someone else orders to making decisions for yourself. Call forces you to make this change in outlook. The stuff about more time to read and sleep as an Irish medical student are true and kinda nice.
I haven't noticed any benefit whatsoever of experiencing a different medical system. I mean it was great life experience for my personal life to go to Ireland for years, but I don't think you really benefit in your career.

"they've all gotten good residencies in Canada or the US" is just wrong. Many do, many don't.

 

[Sage880]

Unch, I know we've talked about this outside this forum but I want to say this again. My goal with this isn't too crap on our program and spew negativity. I have caught myself doing that lately but even as I'm doing it I realize it's wrong. I think we're both committed to being here and will try and make the best of it. I really shouldn't act so negative around the third years who are now starting some clincal medicine. I'm not doing myself or them any favours by crushing their spirit.

This thread is 100% for the fact that I feel really bad about the advice I've given out on this forum. I've strongly encouraged people to come to Ireland and that's what I want to retract.

So honestly, if you were giving advice now to new students, would you tell them to apply?

My feelings are this: If they were American, I would tell them they're stupid to consider it. I just think the Caribbean is a better idea. I hadn't realized that Canadians cannot practice in Canada with a degree from the Caribbean though so for Canadians who have honestly tried to get into medical school at home, it might still be the best option - I don't know. Of course I have friends here now so it taints my decision. But just from a medical school point of view, if I was making the choice again I'd really consider trying to re-applying to Canada (actually "apply" for me - I never bothered to apply to Canada because I was in a rush to start med school) or take a good, hard look at the Australian schools. Maybe the grass isn't any greener down under but I think it would be worth considering.

"It is definately a myth that Irish grads are better trained in histories and physical exams. You would also be mistaken to think that these skills are all that difficult to obtain."

I actually really believe that as well. Although you will almost be crucified here in Ireland for even suggesting that.

 

[leorl]

Based on my experiences... I really do think Irish grads are better trained to recognize clinical signs. But US grads eventually pick up the same skills (well, some of them), just as we eventually adapt to the US way of doing things when we go back.

I think ultimately, I would still have come here. But then, my circumstances are slightly different in that I knew I wanted to come here even before applying to med school (did a JYA at Trinity). However, if I could do it again... I definitely would change the way I did things, and definitely would like it if Trinity changed the way they did some things. And I'm still bitter that Trinity made me really pissed off last year. But...c'est la vie. There is always something in life that could have been done differently. You just have to make the best of what you have at the current moment.

Which speaking of... I said it earlier, but I always offer to talk to first years (and other undergrads) and try to give my experiences / answer questions that you may have about what to expect and even stupid stuff (like how come the streets change names every time there's a bend or where to get Jones New York Cream Soda).

It seems like some of you are coming to Ireland this week. If people would like to meet up Saturday, I'd be up for it (I think I'll have my applications to residencies done by then). Apart from that, I actually move to Ballinasloe (near Galway) for 3 months. I'll be back at weekends but I have call one in four so I'll only ever get the whole weekend off if I'm on call on a Thursday. Anyway, we can arrange something.

 

[slomustang]

Hmmm, interesting discussion. I rarely contribute to these forums, but as a recent Trinity graduate, I feel compelled to share some of my thoughts... if only for the sake of the incoming students. I remember how I felt before coming to Dublin in 2001. 9/11 had just happened and I was not at all sure I wanted to leave the life I knew in the US for what was largely an unknown quantity. I recall that I'd purchased a student travel ticket and had to take advantage of the $25 change fee about 3-4 times before actually getting on the plane. That was the scary part. Now, in my second year as a resident in internal medicine at a fairly well-respected university program, currently working on my application for subspecialty fellowship, those all seem like distant and trivial memories.

My first piece of advice is this... be prepared for a bit of an adventure. Personally, it was one of the primary reasons for my wanting to study abroad in the first place. As the other posters have indicated, medical school in Ireland has its share of ups and downs.

I would agree that the clerkship portion of medical student training in Ireland generally leaves much to be desired, particularly when compared to the system one might expect in the US. I won't rehash the particulars, as they have already been addressed, but the bottom line of what's lacking in Irish training is real, hands on experience on the wards. Nevertheless, I am not convinced that makes a huge difference in the long run. As a resident working with US medical students, I suspect that their training gives them an advantage over similar Irish-trained students only over the first few months of internship. That is because even the best medical students here only manage to cover the basics of any specialty. To become truly proficient, you really need to have the responsibility of an intern or resident for your learning to be substantial. What may be more critical is the lack of both a specified curriculum for each subject and an corresponding examination in real time, the way that US students take shelf exams. By the time you do final med in the Irish system, it may be too late to change the course of an individual who is not meeting the minimum requirements. But now I'm getting off-topic...

If asked to reassure American students coming to Ireland for medical school, I would recommend the following... (I can't personally comment on the Canadian experience, but most of my Canadian friends have been pretty content with their placements.)

First, if you are dead set on doing derm, ortho, plastics, ophtho, rad onc or any other of the most competitive specialties, you would probably be best served by going to a medical school at home. Otherwise, be prepared to be really exceptional if you want to match in the US. I'm not saying that it can't be done, because apparently it has in the past. Even radiology and possibly EM or general surgery are pretty tough to do, but to a lesser degree. I knew going in that I would most likely be doing internal medicine, so that was working in my favor from the beginning. IM, peds, family, OB/GYN should be no problem if you take care of your boards.

Next, take every opportunity to do clinicals in the US. I did four elective months in the US... 2 in internal medicine, 1 in radiology and one Sub-I in ICU which I believe really helped when internship started. These experiences most likely also helped in getting a residency position.

When I take full stock of my experience... and I'm not sure I've had enough time to reflect, I think it boils down to this: what you do, what you learn, and where you end up depends mostly on you. Of all the individuals I have encountered in this business, some of the most brilliant, hardworking and talented have come from Ireland. In my class alone, there are at least a dozen people who I would put up alongside anyone I have ever worked with... 250+ board scores and all the rest. One of this lot, a good friend of mine, recently matched in IM at what would be considered our nation's best hospital... but he's a genius. Leorl probably knows who I'm talking about (btw leorl, I was just back for the Electric Picnic and other things... drove through Ballinasloe on our way from Galway to Dublin. I hate to break it to you, but that place is nowhere near Galway! One hour commute, at least... j/k.)

In all, I truly enjoyed the experience I had in Ireland. The friends I made are some of the best a person could have. And what could be better than having friends on pretty much every continent on the planet? The educational experience is not without its frustrations, but the farther away I get from it, the less it seems to matter. In some ways, I feel like I have a more well-rounded education (albeit with less practical experience) than some of my US-trained classmates, and that may have to do with the final year. Maybe I'll let you all know if my foreign degree negatively impacts my fellowship application, but I have a feeling it plays less of a role the further you go on in your career. However, I'm sure there are some who would disagree.

Best of luck with med school and your future careers.

 

[Arb]

Things are already in place for changes. Not sure about your school.

 

[leorl]

Hey slo, yeah, I do think I know who you're talking about and Trinners would too. Brilliant guy in all respects. Incidentally, I was in A&E during my finals (dislocated shoulder) and he was doing his intern rotation in AE then and was like "OOO can I watch them relocate you?" I was like..."GO AWAY!" hehe. Apparently I was goofy from the fentanyl cuz I guess I said something funny and they were all laughing at me. That's my parting memory of genius-boy.

Eh, I don't mind Ballinasloe. It might be in the middle of nowhere...but 1) you get to go home at 12 on your call night! 2) You don't start until 8:30! 3) you finish at 6 for the most part! 4) NOT AS MUCH SOCIAL CRAP! I will be battling the horse fair traffic on Sunday. Apparently they just line the A&E floor with those who come in and put them all in recovery position.

 

[Kaptain Krunch]

Hey Sage, I vaguely remember PMing you a few years ago.

Sorry to hear that UCC is pissing you off.

Don't know what year you are in now but if you're in 4th year, accept that it is a total waste of time.

Final med can be a fantastic learning experience depending where you are are:

Limerick: Fantastic for every specialty apart from Obs+Gyn
South: B. Creedon is good for clincial skills
Mercy: Never was there as a student but there as a doctor.
CUH: Evil nurses, good if you want to scub in.
Tralee: Spent a week there, nothing special

My main advice is to do outpatients AS MUCH as possible. It is the best learning opportunity for all of the specialities.

By the way, never met you (as far as I know). PM me if you're working in the Mercy.

 

[Sage880]

Hey Sage, I vaguely remember PMing you a few years ago.

Sorry to hear that UCC is pissing you off.

Don't know what year you are in now but if you're in 4th year, accept that it is a total waste of time.

Final med can be a fantastic learning experience depending where you are are:

Limerick: Fantastic for every specialty apart from Obs+Gyn
South: B. Creedon is good for clincial skills
Mercy: Never was there as a student but there as a doctor.
CUH: Evil nurses, good if you want to scub in.
Tralee: Spent a week there, nothing special

My main advice is to do outpatients AS MUCH as possible. It is the best learning opportunity for all of the specialities.

By the way, never met you (as far as I know). PM me if you're working in the Mercy.

Yes, in forth year. The mornings are hit and miss depending on what rotation we're on but I've just accepted that the afternoon classes are a total waste of time. I've been to two good ones so far this year. At least I'm learning to read the schedule to see who the lecture will be and what topic it is ahead of time.

Thanks, I'll remember that about outpatients. Definetly won't miss those mornings. I've heard Limerick was excellent for students but I'm not sure we'll be going there anymore. I heard a rumor that we won't be anyway. Not sure why but it's too bad.

On the plus side, I'm a lot more relaxed then I was in third year. Having some friends from home come to visit, going out more. Have accepted it now and just trying to enjoy it since the summer should be busy with board exams and electives. Go club med!

 

[Resident101]

As someone who graduated from an Irish med school. I can only state that the clinical teaching was superb. I find myself to be a much more capable physician in a competitive IM residency.

 

[Arb]

For those considering going to Ireland, bear in mind that things are constantly changing. Even second years will have different experiences. The curriculum will be different and organization of clinicals will be as well. The incoming UCC students will have different experience from Sage.

 

[deleted50478]

..

 

[Sage880]

I don't think the problems with the Irish medical system will be fixed with the curriculum change. The changes aren't drastic enough and I'm not even sure they're in the right direction. And at UCC, most of the changes are for the pre-clinical years I think - making them more system based instead of subject based - so from what the year below us is going through it looks like more of the same clinical teaching wise. But I guess time will tell!

I think the biggest thing they could do to fix the clinical years is start having exams at the end of each rotation. Maybe it's too simple but I think it would help. At the very least it would give doctors in the departments an idea of what we're supposed to be seeing/learning about. And again, not all rotations are bad. Some departments really have a structure and set learning objectives for the students that the doctors are aware of. It seems like such a small thing to me but it makes a night and day difference. The rotation I'm on now actually is great for that and I'm learning loads. Makes me dread the next poorly organized rotation even more though.

 

[Bateman]

I'm back and you can all suck my cock! Some of you SDN re-treads will remember me! I used to all over this site like an ugly date, however I was deemed to be too critical of the Irish schools and I got booted. Hey man, no harm by me. I have spent the last 3 years on a massive cocaine and gin bender. Unlike you ass licking hacks, I did my med school, residency and fellowship in the USA - so you better believe I have reason to celebrate.

Soooooo, it looks like many of you have pulled your heads out of your asses and realised there is a reason why me and the rest of the boys at the Yale Club thinking that IMGs are only suited to shining shoes and driving cabs.

Let's start with LEORL: All that hard work got you... NOWHERE!!! You crashed and burned on your USMLEs and now you are an intern in Ireland. Congratulations! You have achieved NOTHING! You have posted on this site over 5000 times, repeatedly stating that Irish medical education is great and that you would secure a residency position in the USA. I guess things didn't quite turn out that way. An intern in Ballinisloe is a long way from an American academic centre, isn't it? I bet your parents are so proud of the way in which you have turned $500,000 of tuition into jack ****. Maybe you should have spent more time studying for the USMLE and less time offering useless advice on this forum. Don't blame the Irish schools for poor USMLE prep. Everyone who writes the USMLE is responsible for their own studying. If you can't do well on the exam, it tells you somethingabout the grey and white matter between your ears, not the school you attended.
Speaking of advice, do you think that it is time to call it quits with your SDN bull****? You have failed to prove that you are nothing more than another IMG with a degree worth less than the paper it is printed on. You are applying for the match this year! Whoopee ****! In the unlikely event that you are accepted, it will have taken you seven years to achieve what American medical students do in 4. Also, you will start over as a PGY1. Half a million bucks in Ireland well spent! Don't worry about the match too much, as you will likely spend the rest of your life stuck in Ireland.

I'd like to take the time to diss the rest of you, but it is simply too easy and I have a kilo of cocaine and half a dozen ***** to get through before dawn. Please allow me to offer a generic "your mother was great last night" to all the IMGs reading my post. As always, the Yale Club is looking for new shoe shine boys and fluff girls for our Friday night benders. IMGs are welcome to apply.

Eat **** IMGs!

yours in all manner of superiority,
Dr. Patrick Bateman FACS

 

[THX]

I'm back and you can all suck my cock! Some of you SDN re-treads will remember me! I used to all over this site like an ugly date, however I was deemed to be too critical of the Irish schools and I got booted. Hey man, no harm by me. I have spent the last 3 years on a massive cocaine and gin bender. Unlike you ass licking hacks, I did my med school, residency and fellowship in the USA - so you better believe I have reason to celebrate.

Soooooo, it looks like many of you have pulled your heads out of your asses and realised there is a reason why me and the rest of the boys at the Yale Club thinking that IMGs are only suited to shining shoes and driving cabs.

Let's start with LEORL: All that hard work got you... NOWHERE!!! You crashed and burned on your USMLEs and now you are an intern in Ireland. Congratulations! You have achieved NOTHING! You have posted on this site over 5000 times, repeatedly stating that Irish medical education is great and that you would secure a residency position in the USA. I guess things didn't quite turn out that way. An intern in Ballinisloe is a long way from an American academic centre, isn't it? I bet your parents are so proud of the way in which you have turned $500,000 of tuition into jack ****. Maybe you should have spent more time studying for the USMLE and less time offering useless advice on this forum. Don't blame the Irish schools for poor USMLE prep. Everyone who writes the USMLE is responsible for their own studying. If you can't do well on the exam, it tells you somethingabout the grey and white matter between your ears, not the school you attended.
Speaking of advice, do you think that it is time to call it quits with your SDN bull****? You have failed to prove that you are nothing more than another IMG with a degree worth less than the paper it is printed on. You are applying for the match this year! Whoopee ****! In the unlikely event that you are accepted, it will have taken you seven years to achieve what American medical students do in 4. Also, you will start over as a PGY1. Half a million bucks in Ireland well spent! Don't worry about the match too much, as you will likely spend the rest of your life stuck in Ireland.

I'd like to take the time to diss the rest of you, but it is simply too easy and I have a kilo of cocaine and half a dozen ***** to get through before dawn. Please allow me to offer a generic "your mother was great last night" to all the IMGs reading my post. As always, the Yale Club is looking for new shoe shine boys and fluff girls for our Friday night benders. IMGs are welcome to apply.

Eat **** IMGs!

yours in all manner of superiority,
Dr. Patrick Bateman FACS

Haha! Psychotic pefection.

 

[Arb]

The changes are quite noticable I think, even in the clinical years. For example, at UCD, you're in the hospitals 3 months earlier now. According to a 4th year friend, there's a new guy/department handling all the organization issues too so changes will be made to make things more efficient. Here's to hoping things get even better. As for pre-clinicals, the curriculum is completely different. I can see a shift towards more USMLE type testing. Granted, it's a small shift but maybe they will incorporate a bit more of it.

Again, I'm not sure how UCC will adjust. I figure all Irish schools are looking for ways to improve. It is apparent though that they take our suggestions into account.

 

[deleted21609]

The changes are quite noticable I think, even in the clinical years. For example, at UCD, you're in the hospitals 3 months earlier now. According to a 4th year friend, there's a new guy/department handling all the organization issues too so changes will be made to make things more efficient. Here's to hoping things get even better. As for pre-clinicals, the curriculum is completely different. I can see a shift towards more USMLE type testing. Granted, it's a small shift but maybe they will incorporate a bit more of it.

Again, I'm not sure how UCC will adjust. I figure all Irish schools are looking for ways to improve. It is apparent though that they take our suggestions into account.

Sounds like they are fixing something that wasn't a problem. Adding three clinical months is nothing. There were plenty of clinical months already. The problem is with the quality of those rotations.

If they really wanted to improve things, you'd do anonymous evaluations of your instructors and there would be consequences to the instructors for poor performance. If you suck, you fail. If they suck, or don't even show up for lectures, nothing happends. That's a big part of the problem.

 

[Arb]

Like I said, apparently there is a department in charge of that now. It remains to be seen if things improve and how long it will take but the step has been made.

 

[irish trained]

Thanks all for such an excellent series of posts! Especially Sage 880's #5 and the ones that responded directly to this. I graduated from an Irish school about 4 years ago and could have written very similar posts back then. I laughed out loud a couple of times, but also said to myself "damn, hasn't changed a bit!" Much of what people say, both pro and con, is true. I myself spent many, many mornings wandering around the hospital, looking for something, anything, to do/learn. The school was quite easy, though, and I got to live a good life outside of it! It is also true that a good education was there for the taking, if you were a go-getter you could learn a lot, and not have the pressure of working yourself too much. But, let's face it, most students are not like this (I certainly wasn't). Both sides are partly right, but the determining factor for me (the one that Irish schools are most guilty of) is that the foreign students are paying a tremendous amount of money for a service, that service being the teaching of medicine. In any other business/field/education, it would be preposterous to pay such sums yet receive so little.
OK, enough said about that. I did really enjoy living in Ireland, and I thought that the education, while substandard (especially clinical), was not a disaster. I definitely would not delay med one year if that was my only option. You get through it, and can do well on the USMLE (I passed all of mine no problem, not great scores, but I was shooting for FP anyway). Start of US residency was a small shock, at the time I thought that I had caught up to the other residents after 3-4 months, but I now think it took more like 6. However, if you work hard, things usually work out, and by 12 months I was probably one of the top 2 or 3. All history now, you get through these things, get your education, and are eventually qualified to work in both the US and the EU (just to clarify something said above, you can do your residency in the States and still get full Irish med council registration---I did it this way).
And, while you are still over there, take a closer admiring look at the semi-socialized medicine---you will miss this and other aspects, once you are back in the States and worried about train wrecks, defensive medicine, and lawsuits. Not pretty.

 

[profstudent]

i was hoping someone could comment on the level of difficulty of irish medical schools. many of you seem to say it wasn't so bad. i assume the material is more or less the same as US MD/DO programs, so was it "easy" because it was spread over 5 years? it's weird b/c US grads seem to secure solid residencies despite the "easy" curriculum and not-so-great clinical years.

 

[Unch]

The material, books, and everything else content-wise is the same. Irish schools can be characterized by, perhaps, an inconsistently busy schedule along the way but stiff exams at the end. And since we're tested twice on each set of material (progressive assessment = end-of session final) and then finals at the end of the year, I feel I really know the material. I don't think anyone would argue that the core science is subpar here (well, maybe on this forum someone would) and if you are reviewing for the steps anyway, there won't be any substantial gaps at the end of the day as compared to NAMerican grads.

I guess I'd say that it's the scheduling and organization here that lacks at times but the bottom-line science abd rigor is plenty sufficient.

 

[profstudent]

how hard was it to adjust to this new way of evaluation, in which the final is worth close to 100% of your grade?

also this is random, but do any of you currently studying in ireland happen to have a blog so that those of us can read about your experiences over there?

 

[Unch]

As a rule of thumb, finals are worth anywhere from 50% to 70% depending on the course. That's not so hard to get used to. Rather, it's the fact that they create exams with the aim of a class average around 55%-60%. And they give zero feedback in most cases, even if it's an essay exam. That certainly irks me... to have 70% of a pharm mark be based on three final exam essays (comprising the whole exam) and then never having the opportunity to review your exam in detail. Even if you make an appointment to see the lecturers, they'll sit there with your exam and give general comments but won't show you your paper or indicate where you went wrong.

This is all pretty much the standard in European universities, though, so I wouldn't fault the school of medicine per se. Just the way that it is.

 

[deleted21609]

What's hard to get used to is what you get points for in answering an essay question. They don't expect you to answer the question as best you can. They expect you to write everything you know that is remotely related to the general subject mentioned in the question. I started off with the background of getting points for answering questions and losing points for getting off topic, but that's not how it is in Ireland. Some people actually write essays that aren't at all related to the question if they don't know much about the subject of the question, and they get points for writing something. Bottom line: essays in Ireland are not about answering the question, they are a race to put as many words as possible on paper in the available time. They are graded on volume as much as on quality. Be prepared to answer accordingly.