A Crisis of Trust Between U.S. Medical Education and the NBME

[Matthew9Thirtyfive]

the people who need three years were going to need three years in the current system anyway. I still think people will average 18 months give or take 6 months. But who knows what the match will have to incorporate going forward.

Edit: I dont think Medical schools give special dispensation for finishing UG earlier, so I dont think residencies will have to give special dispensation for that question either. People will have to fill the other time with research to stay on schedule so it will be ok.

But there needs to conversations about changing the structure of medical school and not just changing step 1 to p /f . that was merely a symptom of the way our healthcare system and medical education is structured.

Yeah I was thinking more about the people who take longer. Since currently taking 5 years is looked at as a bit of a red flag.

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[Lawpy]

Interestingly, Stanford is 2 years and now optionally 3 years. Key Features

Yeah thats a problem imo. The real value of med school is spending a lot of time in clinical years and having more flexibility with aways, research, electives etc.

Preclinical can be revamped to focus very heavily on things like clinical skills learning and useful case based PBLs.

 

[Neopolymath]

Are medical students adults that learn in their own ways or do they children that need to be taught a specific way?
Is the goal to train people to be self directed life long learners or people who need to be spoonfeed information.
Are school lectures high quality or are they 10 year old slides that the instructor reads in a monotone.

This whole premise is non-sensical.
If medical students are adults and they know what works for them, and are able to find the information, memorize it and apply it appropriate for in house exams and board exams these people should not be complaining, rather they should try to learn from the lessons that can be learned from third party sources and zanki.


Now on to the specifics
"They downgrade other topics and activities (e.g., understanding disease mechanisms; enhancing critical thinking and clinical reasoning; improving physical examination, interview, and communication skills; understanding the psychosocial context of illness; undertaking early clinical experiences and community engagement; volunteering; maintaining physical and emotional health and healthy relationships) as they, instead, elevate Step 1. "
1. Underlying disease mechanisms are learned as is evidenced by mastery of content for both in house and board exams.
2. Critical thinking, see above.
3. Physical exam is learned quickly and efficeintly in year 3.
4. Interview- see above.
5. Understanding psychosocial context, learned and actually applied during in house and board exams, and takes like an afternoon to learn this
6. Early clinical experience? what purpose will it serve?
7. Volunteering , maintaining physical and emotional health. Most students do this and them taking part of the external parrallel curriculum does not mean that they wouldnt ignore this if they were fully invested in the home curriculum.

This article just shows how far medical educators are willing to go to put down students who are doing what they find is the best way to learn and apply the material. Rather than say we as educators have failed them in not providing the best way to gain this information. They are doubling down on their superiority of curriculum without any evidence that their curriculum or way is superior, provides better physicians , or generates better outcomes.

I said this to a preclinical dean in school and I thought their head was going to explode. It was hilarious. They are so out of touch AND maintain an untenable position when they spout their BS opinions. It's comical now that I'm a 4th year and it was terrifying about 1 month into school when I realized these people were stupid but still somehow driving the proverbial bus.

 

[Neopolymath]

These people are like carriage builders after the advent of the automobile making up reasons why the automobile is worse. They are trying to advance their position by changing the system. but that only works for so long.And it doesnt address the intrinsic existential issues they have. Either adapt or be relegated to obsolescence. These people fail to see that and refuse to change.

How about if a curriculum gave you anki cards for the lectures, or gave you in house picmonics or sketchy equivalent, or provided you with in house q banks. Sat down with you after a practice exam and gave feedback. or god forbid actually sat down with you after a standardized patient encounter and provided feedback. Had built in questions after the lecture after you watch a video remotely?

I also maintain that I wouldn't watch Dr. Ryan or Sattar himself lecture in person because it is not 2x speed and I can't pause/take a break/rewind. Preclinical education is outdated in presentation and content. There is no coming back because PBL is a terrible waste of time too.

 

[Neopolymath]

Crazy to me that undergraduate students can learn objectively harder topics on their own like organic chemistry, modern physics, etc etc. But for some reason med school microbio is completely unlearnable without TBL.

I never went to a single physics class in undergrad and ended with an A. Imagine if I said that to a preclinical faculty clutching their pptx files haha

 

[Matthew9Thirtyfive]

I never went to a single physics class in undergrad and ended with an A. Imagine if I said that to a preclinical faculty clutching their pptx files haha

I got an entire math degree without going to class.

 

[slowthai]

I just have to say that the unrelenting infantilization and plain disrespect of med students just drives me nuts. I'm a grown adult paying multiple hundreds of thousands of dollars for this degree and you're telling me that you have a problem with the way I learn? Just get out of my face, lol

 

[slowthai]

I also maintain that I wouldn't watch Dr. Ryan or Sattar himself lecture in person because it is not 2x speed and I can't pause/take a break/rewind. Preclinical education is outdated in presentation and content. There is no coming back because PBL is a terrible waste of time too.

This is what I've always said. I mean, even the godly Goljan, I would still skip his classes. Hurt me a little to say that, but it's the truth.

 

[Matthew9Thirtyfive]

This is what I've always said. I mean, even the godly Goljan, I would still skip his classes. Hurt me a little to say that, but it's the truth.

We have had some world renowned people come lecture. I skip them and watch them at home. No ragrets.

 

[penpenclown]

Lecture videos at 2-3x is one of the greatest blessings God has bestowed upon man.

 

[Lucca]

Our 3 year pre-clin option is essentially M2 at half-speed to fit in a year-long research project along class. A minority of students choose this option for a variety of reasons. Others just do a separate research year at another point. It’s a bit of a quirky thing I don’t think fits into the symptomatology of bloated preclerkship education.

That said, I don’t think there’s a reason for preclinical to be 2 years and would prefer it to be 1 year long with an option to decelerate for QOL / exploration / research reasons.

I’m still staunchly in agreement that making Step 1 p/f is more than a “symptom patch” because the logic of step 1 performance is so core to Med student behavior during preclinical. But it’s not worth having this discussion for the tenth time here.

The classes I have found most valuable in medschool so far have been elective courses with active clinical components / patient-centered learning and the “practical” courses. E.g. A class where you round with residents and they are there entirely to teach you about the case and help you practice your skills with the patient in a setting with no grades or evaluations, all around a fun and useful experience even with I only retain half of what I learned. Maybe 1% of that will be useful for step 1 (maybe more of it will be useful for s2ck).

I also enjoy learning from podcasts like the Curbsiders, cpsolvers, curious clinicians. Podcasts are not efficient methods of delivering knowledge or very content/volume dense in general, but I’ve found that I retain information much better from them than from lecture. Listening to a podcast about clinical trials, or how a drug actually works vs how people are taught it works will provide me with zero extra points on step 1 but will probably be valuable in the long run to have at least seen this content somewhere and theoretically be able to remember or review it in the future. I’m not suggesting anyone get their entire education from podcasts but in a high tech world it’s one of many resources.

As someone who actually enjoys research and wants to do it for a career, I’ve spent a lot of time on it during preclin. Has been worth my while, productive, probably good for my career in the long run. Zero points on step 1.

I’ve had great practice summarizing and presenting cases to residents and attendings thanks to volunteering in our clinics in a setting with no grades or evaluations but plenty of opportunities for constructive feedback. Maybe a patient here or there will recall some pathophys fact for me on Step 1 but certainly low yield compared to dedicating the same number of hours in a clinic shift to Zanki.

In the current/previous climate doing any of the above things I mentioned is penalized rather than rewarded. A sensible human being shouldn’t of course study for step at the cost of everything else but that’s actually what some people do and while I wouldn’t necessarily make the identical argument about med Ed in the paper I would agree with the conceit that this phenomenon impoverishes and disincentivizes learning. If ppl in this thread are really as passionate about letting adult learners learn medicine their own way then they should, I think, agree with at least that. The current/previous system was just another form of using a strict incentive structure to reward a very narrow approach to self-directed learning and penalizing most others that did not take step 1 to be at the core.

 

[slowthai]

In the current/previous climate doing any of the above things I mentioned is penalized rather than rewarded. A sensible human being shouldn’t of course study for step at the cost of everything else but that’s actually what some people do and while I wouldn’t necessarily make the identical argument about med Ed in the paper I would agree with the conceit that this phenomenon impoverishes and disincentivizes learning. If ppl in this thread are really as passionate about letting adult learners learn medicine their own way then they should, I think, agree with at least that. The current/previous system was just another form of using a strict incentive structure to reward a very narrow approach to self-directed learning and penalizing most others that did not take step 1 to be at the core.

It's sensible to study for step 1 at the cost of everything else if step is the most important thing at this point in one's career and one is aiming high (to be able to match into a very competitive specialty and/or location)

When you say that the system disincentivizes "learning", I assume you're talking about those non-step activities. Every activity you listed can be done to varying degrees all while preparing intensely for step. You just need to be good at time and energy management.

I always come back to this; the main issue here is that of competition. Because it is so great, people will do whatever it takes to make it to where they want to get to. If research was weighted the most, people would be saying screw step, I have to pump up these pub numbers. If it was about having the most clinical experience, people would be spending all of their time in the hospital from day 1 of M1.

Personally, it doesn't really matter to me what is the most important. All that matters to me is how I'm going to acquire the thing that programs are looking for.

 

[libertyyne]

Our 3 year pre-clin option is essentially M2 at half-speed to fit in a year-long research project along class. A minority of students choose this option for a variety of reasons. Others just do a separate research year at another point. It’s a bit of a quirky thing I don’t think fits into the symptomatology of bloated preclerkship education.

That said, I don’t think there’s a reason for preclinical to be 2 years and would prefer it to be 1 year long with an option to decelerate for QOL / exploration / research reasons.

I’m still staunchly in agreement that making Step 1 p/f is more than a “symptom patch” because the logic of step 1 performance is so core to Med student behavior during preclinical. But it’s not worth having this discussion for the tenth time here.

The classes I have found most valuable in medschool so far have been elective courses with active clinical components / patient-centered learning and the “practical” courses. E.g. A class where you round with residents and they are there entirely to teach you about the case and help you practice your skills with the patient in a setting with no grades or evaluations, all around a fun and useful experience even with I only retain half of what I learned. Maybe 1% of that will be useful for step 1 (maybe more of it will be useful for s2ck).

I also enjoy learning from podcasts like the Curbsiders, cpsolvers, curious clinicians. Podcasts are not efficient methods of delivering knowledge or very content/volume dense in general, but I’ve found that I retain information much better from them than from lecture. Listening to a podcast about clinical trials, or how a drug actually works vs how people are taught it works will provide me with zero extra points on step 1 but will probably be valuable in the long run to have at least seen this content somewhere and theoretically be able to remember or review it in the future. I’m not suggesting anyone get their entire education from podcasts but in a high tech world it’s one of many resources.

As someone who actually enjoys research and wants to do it for a career, I’ve spent a lot of time on it during preclin. Has been worth my while, productive, probably good for my career in the long run. Zero points on step 1.

I’ve had great practice summarizing and presenting cases to residents and attendings thanks to volunteering in our clinics in a setting with no grades or evaluations but plenty of opportunities for constructive feedback. Maybe a patient here or there will recall some pathophys fact for me on Step 1 but certainly low yield compared to dedicating the same number of hours in a clinic shift to Zanki.

In the current/previous climate doing any of the above things I mentioned is penalized rather than rewarded. A sensible human being shouldn’t of course study for step at the cost of everything else but that’s actually what some people do and while I wouldn’t necessarily make the identical argument about med Ed in the paper I would agree with the conceit that this phenomenon impoverishes and disincentivizes learning. If ppl in this thread are really as passionate about letting adult learners learn medicine their own way then they should, I think, agree with at least that. The current/previous system was just another form of using a strict incentive structure to reward a very narrow approach to self-directed learning and penalizing most others that did not take step 1 to be at the core.

Enjoyment aside. There are many things like early clinical exposure that people may find value in , but frankly wont matter come year three because your peers will quickly catch up with you. There are 3-7 years of residency time where you will hone clinical skills and patient interactions which matter a whole lot more than some clinical class you will take.

There is currently a lifetime earning differences of 3+million dollars between competitive specialties and primary care, not to mention the prestige difference. When people are focused on maximizing their chances of obtaining any specialty they want, they are not acting in bad faith or trying to cheat the system. They are trying to optimize their application. If currently it is Step 1 , they will go crazy on step 1, if it becomes step 2 they will go crazy on step 2. If it is research people will take multiple research years.

The problem is not Step 1, it is merely a symptom of the inequity in outcomes. If earning differentials and prestige equalized people would probably not be so wound up about this. But then the question becomes would students exert such effort on learning the material ? Probably not. Does a system where mastery of preclinical and clinical material is rewarded create better physicians or does one where clinical skills and research is rewarded? I dont know the answer , and anyone who claims to know is full of it. IMO mastery of the material does matter and probably matters more initially compared to other skills that students will have a lifetime to refine and practice.

 

[Matthew9Thirtyfive]

Our 3 year pre-clin option is essentially M2 at half-speed to fit in a year-long research project along class. A minority of students choose this option for a variety of reasons. Others just do a separate research year at another point. It’s a bit of a quirky thing I don’t think fits into the symptomatology of bloated preclerkship education.

That said, I don’t think there’s a reason for preclinical to be 2 years and would prefer it to be 1 year long with an option to decelerate for QOL / exploration / research reasons.

I’m still staunchly in agreement that making Step 1 p/f is more than a “symptom patch” because the logic of step 1 performance is so core to Med student behavior during preclinical. But it’s not worth having this discussion for the tenth time here.

The classes I have found most valuable in medschool so far have been elective courses with active clinical components / patient-centered learning and the “practical” courses. E.g. A class where you round with residents and they are there entirely to teach you about the case and help you practice your skills with the patient in a setting with no grades or evaluations, all around a fun and useful experience even with I only retain half of what I learned. Maybe 1% of that will be useful for step 1 (maybe more of it will be useful for s2ck).

I also enjoy learning from podcasts like the Curbsiders, cpsolvers, curious clinicians. Podcasts are not efficient methods of delivering knowledge or very content/volume dense in general, but I’ve found that I retain information much better from them than from lecture. Listening to a podcast about clinical trials, or how a drug actually works vs how people are taught it works will provide me with zero extra points on step 1 but will probably be valuable in the long run to have at least seen this content somewhere and theoretically be able to remember or review it in the future. I’m not suggesting anyone get their entire education from podcasts but in a high tech world it’s one of many resources.

As someone who actually enjoys research and wants to do it for a career, I’ve spent a lot of time on it during preclin. Has been worth my while, productive, probably good for my career in the long run. Zero points on step 1.

I’ve had great practice summarizing and presenting cases to residents and attendings thanks to volunteering in our clinics in a setting with no grades or evaluations but plenty of opportunities for constructive feedback. Maybe a patient here or there will recall some pathophys fact for me on Step 1 but certainly low yield compared to dedicating the same number of hours in a clinic shift to Zanki.

In the current/previous climate doing any of the above things I mentioned is penalized rather than rewarded. A sensible human being shouldn’t of course study for step at the cost of everything else but that’s actually what some people do and while I wouldn’t necessarily make the identical argument about med Ed in the paper I would agree with the conceit that this phenomenon impoverishes and disincentivizes learning. If ppl in this thread are really as passionate about letting adult learners learn medicine their own way then they should, I think, agree with at least that. The current/previous system was just another form of using a strict incentive structure to reward a very narrow approach to self-directed learning and penalizing most others that did not take step 1 to be at the core.

I listened to the Cribsiders episode on T1DM on my way to a patient encounter and the patient ended up being a T1 diabetic in DKA lol.

 

[7331poas]

In the current/previous climate doing any of the above things I mentioned is penalized rather than rewarded. A sensible human being shouldn’t of course study for step at the cost of everything else but that’s actually what some people do and while I wouldn’t necessarily make the identical argument about med Ed in the paper I would agree with the conceit that this phenomenon impoverishes and disincentivizes learning. If ppl in this thread are really as passionate about letting adult learners learn medicine their own way then they should, I think, agree with at least that. The current/previous system was just another form of using a strict incentive structure to reward a very narrow approach to self-directed learning and penalizing most others that did not take step 1 to be at the core.

hard disagree. research is absolutely rewarded, even with a scored step 1. They both serve the same purpose: increase an applicants probability of matching.

I agree that your example of having residents teaching students is fun, but in my experience it is usually just wasted time because I did not have the level of knowledge needed to properly comprehend clinical "pearls" as an M1.

Step 1 makes students more focused on taking a test for sure. But you will always have students focusing on something. if these tests are scored, then students will try and score high. if programs look at my research output, then I will just try and put out more papers. If programs only see my grades, then I am firing up my oven every night and making pastries.

The problem is not Step 1, it is merely a symptom of the inequity in outcomes. If earning differentials and prestige equalized people would probably not be so wound up about this. But then the question becomes would students exert such effort on learning the material ? Probably not. Does a system where mastery of preclinical and clinical material is rewarded create better physicians or does one where clinical skills and research is rewarded? I dont know the answer , and anyone who claims to know is full of it. IMO mastery of the material does matter and probably matters more initially compared to other skills that students will have a lifetime to refine and practice.

That and the more practical point that no one will want to do general surgery if they are going to get paid equivalent to a medicine trained doctor with a 5 year training pathway.

 

[Lucca]

Enjoyment aside. There are many things like early clinical exposure that people may find value in , but frankly wont matter come year three because your peers will quickly catch up with you. There are 3-7 years of residency time where you will hone clinical skills and patient interactions which matter a whole lot more than some clinical class you will take.

There is currently a lifetime earning differences of 3+million dollars between competitive specialties and primary care, not to mention the prestige difference. When people are focused on maximizing their chances of obtaining any specialty they want, they are not acting in bad faith or trying to cheat the system. They are trying to optimize their application. If currently it is Step 1 , they will go crazy on step 1, if it becomes step 2 they will go crazy on step 2. If it is research people will take multiple research years.

The problem is not Step 1, it is merely a symptom of the inequity in outcomes. If earning differentials and prestige equalized people would probably not be so wound up about this. But then the question becomes would students exert such effort on learning the material ? Probably not. Does a system where mastery of preclinical and clinical material is rewarded create better physicians or does one where clinical skills and research is rewarded? I dont know the answer , and anyone who claims to know is full of it. IMO mastery of the material does matter and probably matters more initially compared to other skills that students will have a lifetime to refine and practice.

It is far more spurious in my opinion to say no one will try to learn material if it doesn’t translate to earning more money or scoring higher on a test. Everyone considers it sure but it’s certainly not the most important or even an important factor for many outside the SDN/Reddit groupthink (although you’ll get no disagreement from me that it is a driver of competition). And how valuable are the sacrifices for this knowledge? Will an Ortho resident who scored a 260 have as much useful, clinically relevant knowledge of physiology and medicine as an IM doc who scored a 210 at the same stage of training? If you’re asking “what produces better doctors?” and thinking “Exams” then I think that’s just willfully ignoring what outcomes are actually valuable.

“Mastering content” is great but in the modern age I think the core fundamentals everyone needs can easily be taught in a single year of organ blocks.

Let’s also be real here: no med student is “mastering” anything regardless of their Step score. Medical school provides an incredibly shallow level of knowledge across the immense expanse of human biology, but put your best second year Med student fresh off STEP 1 in a room with a solid grad student studying liver biology and my money is 9/10 the grad student understands liver biology in better detail and depth than the med student. And that’s ok. That’s not the kind of “mastery” that’s required for Step 1 or being a physician. That kind of integrative knowledge is not terminally developed by the time people take step, it develops throughout med school and more importantly residency. But in the previous/current meta beyond Step 1 little else matters. It truly makes no sense even using this other yardstick.

I speak for myself but I’m perfectly motivated to learn without the need for high stakes exams. If the idea in this thread is “let people learn how they learn as long as they learn” why must I be forced to learn the “Step 1 to match Derm/Ortho” way if I can meet every bar of competency? Just because a handful of very small specialties (I have absolutely no interest in other than maybe ENT/NSG) happened to have set the Meta game for all of Medicine?

 

[slowthai]

I speak for myself but I’m perfectly motivated to learn without the need for high stakes exams. If the idea in this thread is “let people learn how they learn as long as they learn” why must I be forced to learn the “Step 1 to match Derm/Ortho” way if I can meet every bar of competency? Just because a handful of very small specialties (I have absolutely no interest in other than maybe ENT/NSG) happened to have set the Meta game for all of Medicine?

They didn't set the meta game; the number of spots available in these specialties (and highly sought after programs in non-competitive specialties) caused this. You can do whatever you want, but if you want to maximize your chances at ENT or nsg, you're going to have to play the game. It's all about the risks you're willing to take. If you're fine with doing things your way but having an objectively lower chance at making it into your specialty of choice, fair enough, but a lot of people outside of SDN/reddit totally reject that.

 

[Matthew9Thirtyfive]

They didn't set the meta game; the number of spots available in these specialties and (highly sought after programs in non-competitive specialties) caused this. You can do whatever you want, but if you want to maximize your chances at ENT or nsg, you're going to have to play the game. It's all about the risks you're willing to take. If you're fine with doing things your way but having an objectively lower chance at making it into your specialty of choice, fair enough, but a lot of people outside of SDN/reddit totally reject that.

That's a bit of a false dichotomy. It's not "BUFAPS and be competitive or don't BUFAPS and you won't be as competitive." If you do things differently but are still able to meet all the competencies, you will still be competitive. There are people in my school who are in the top quartile and even the top 10% who don't use the standard UFAPS. They watch lectures, make their own cards if they even use flashcards, etc. These people will still crush step and be very competitive even though they didn't follow the roadmap.

So you don't have an objectively lower chance at making it just because you don't do what is considered the standard. You will only have an objectively lower chance if you are objectively less competitive, and people who do BUFAPS can still be at the middle or bottom of the class.

 

[slowthai]

That's a bit of a false dichotomy. It's not "BUFAPS and be competitive or don't BUFAPS and you won't be as competitive." If you do things differently but are still able to meet all the competencies, you will still be competitive. There are people in my school who are in the top quartile and even the top 10% who don't use the standard UFAPS. They watch lectures, make their own cards if they even use flashcards, etc. These people will still crush step and be very competitive even though they didn't follow the roadmap.

So you don't have an objectively lower chance at making it just because you don't do what is considered the standard. You will only have an objectively lower chance if you are objectively less competitive, and people who do BUFAPS can still be at the middle or bottom of the class.

But that's not even what I said at all. I didn't even mention BUFAPS. I've said it before on here that you don't have to do what other people do just because everyone says it's necessary; you just have to do what works for you. If that's doing the exact opposite of what a lot of us do: attending class, using no boards resources other than UWorld, waiting until dedicated to start preparing for step, etc then do it. I reject dogma and I've always said that there are multiple ways to do things.

When I said "do things your way", I was specifically referring to refusing to play the game to maximize your chances in the match. You will be less competitive if you don't meet the criteria that programs are looking for, and that is the risk you will be taking.

 

[Matthew9Thirtyfive]

But that's not even what I said at all. I didn't even mention BUFAPS. I've said it before on here that you don't have to do what other people do just because everyone says it's necessary; you just have to do what works for you. If that's doing the exact opposite of what a lot of us do: attending class, using no boards resources other than UWorld, waiting until dedicated to start preparing for step, etc then do it. I reject dogma and I've always said that there are multiple ways to do things.

Then what are you even arguing, lol. His post was saying that if you don't follow the map the people trying to match into those top specialties have set out, but you still meet all the benchmarks, then what's the problem? Seems like you agree with that, or am I misunderstanding your post?

When I said "do things your way", I was specifically referring to refusing to play the game to maximize your chances in the match. You will be less competitive if you don't meet the criteria that programs are looking for, and that is the risk you will be taking.

I didn't read his post to mean you wouldn't be doing things like getting research, etc.

 

[slowthai]

Then what are you even arguing, lol. His post was saying that if you don't follow the map the people trying to match into those top specialties have set out, but you still meet all the benchmarks, then what's the problem? Seems like you agree with that, or am I misunderstanding your post?



I didn't read his post to mean you wouldn't be doing things like getting research, etc.

I may have misunderstood his post, but he seems to be against the fact that you have to meet these marks to be competitive. When he mentioned "meeting every bar of competency", I thought he was just talking about in general, like passing the steps, passing clinicals, etc. My point is that being competent is not enough if you want to make it into these competitive places.

 

[Matthew9Thirtyfive]

I may have misunderstood his post, but he seems to be against the fact that you have to meet these marks to be competitive. When he mentioned "meeting every bar of competency", I thought he was just talking about in general, like passing the steps, passing clinicals, etc. My point is that being competent is not enough if you want to make it into these competitive places.

Yeah we just read it differently, cause I agree with you there.

 

[NicMouse64]

They need to raise the score required to achieve a Pass on Step1. If I went into clinicals with just the basic science knowledge needed to pass step 1 I would be so f***ing lost. And that is what is going to get incentivized. I'm glad I worked and pounded in those concepts that were tested on step 1. Sure there was a lot of extraneous BS on the exam, but there was also a lot of fundamental science that is important. I do wish they focused more on things like PEEP or respiratory formulas rather than genetics, but hey, what do I know.

Part of me worries that the loss of a well rounded pre-clinical phase where you have to work your a** off to know a sh** ton to do well or even decent on step 1 before you start your clinical years will result in medical students having even less of a clue when they start 3rd year. I have no idea what is going on right now, but that's more due to the clinical intricacies (using an emr, knowing brand names versus generics, actually visualizing a JP drain/PICC line/central line/etc.) than it is due to knowledge gaps.

 

[manwelio]

I totally agree with this guy, just spot on. Preclinical curricula are so much better than boards resources. They actually teach you how to understand medicine while boards resources just teach you how to guzzle down information. It's such a shame that students purchase such expensive resources instead of getting their money's worth with these world class medical school curricula.

Wild guess here but isn't that what they were taught to do for MCAT success? I'm not shocked they're repeating "what already worked for them" with another test instead of participating in a different kind of learning process that possibly they've never participated in before.

 

[slowthai]

Wild guess here but isn't that what they were taught to do for MCAT success? I'm not shocked they're repeating "what already worked for them" with another test instead of participating in a different kind of learning process that possibly they've never participated in before.

Yeah, I was mocking the author's nonsensical take.

 

[manwelio]

Yeah, I was mocking the author's nonsensical take.

But I mean it literally, you've got all these people who prepared for medical school by cramming with a Kaplan book. I'm not shocked that people in medical school continue to feel more familiar with a study guide than they do with their professors. I remember the 10-year-old prof notes from undergrad. Only it wasn't even a PPT, it was the prof reading hand-written (pencil) notes that were so old and smudged he would actually say, "Oh I can't read that part. Anyway..." I didn't learn from him, I learned from the damn textbook. The dirty secret of higher education is that the teachers don't really teach, it's the texts they pick for students to read. I guarantee the last time anyone had a really good _teacher_ was like elementary or middle school.

 

[Eye-eye]

or god forbid actually sat down with you after a standardized patient encounter and provided feedback.

Is this not something most schools do? Most of my SP encounters had a debrief either with just the SP or with a whole group of people who were watching the encounter.

 

[Matthew9Thirtyfive]

But I mean it literally, you've got all these people who prepared for medical school by cramming with a Kaplan book. I'm not shocked that people in medical school continue to feel more familiar with a study guide than they do with their professors. I remember the 10-year-old prof notes from undergrad. Only it wasn't even a PPT, it was the prof reading hand-written (pencil) notes that were so old and smudged he would actually say, "Oh I can't read that part. Anyway..." I didn't learn from him, I learned from the damn textbook. The dirty secret of higher education is that the teachers don't really teach, it's the texts they pick for students to read. I guarantee the last time anyone had a really good _teacher_ was like elementary or middle school.

My school has some fantastic professors. There are a few really bad ones, but most are decent and we have some amazing ones.

 

[Matthew9Thirtyfive]

Is this not something most schools do? Most of my SP encounters had a debrief either with just the SP or with a whole group of people who were watching the encounter.

Mine does too. We have a one on one feedback session with the SP, then we present to the attending like we’re presenting on clerkship, and then they give us feedback on the encounter and the presentation. We also have a couple students give us feedback.

 

[Neopolymath]

Mine does too. We have a one on one feedback session with the SP, then we present to the attending like we’re presenting on clerkship, and then they give us feedback on the encounter and the presentation. We also have a couple students give us feedback.

That's what we do too aside from students don't give us feedback.

 

[Matthew9Thirtyfive]

That's what we do too aside from students don't give us feedback.

Just to be clear, the only thing that actually matter for our grade is the attending. The rest is just to help put things into context for us so we can get better.

 

[Eye-eye]

That and the more practical point that no one will want to do general surgery if they are going to get paid equivalent to a medicine trained doctor with a 5 year training pathway.

Can't disagree with that more. If I had to choose between the two at the same pay scale, I'd definitely choose getting to perform surgery over rounding for 12 hours a day.

 

[Eye-eye]

Just to be clear, the only thing that actually matter for our grade is the attending. The rest is just to help put things into context for us so we can get better.

Oh, they weren't graded for us; this was in M1-M2. We never used SPs after that, and only a couple clerkships had a specific patient encounter that was to be formally graded by the attending (though we got feedback from attending and peers for those when they occurred). Basically all the rest of our grade was cumulative clerkship evals, i.e., 100% random grades.

 

[Matthew9Thirtyfive]

Oh, they weren't graded for us; this was in M1-M2. We never used SPs after that, and only a couple clerkships had a specific patient encounter that was to be formally graded by the attending (though we got feedback from attending and peers for those when they occurred). Basically all the rest of our grade was cumulative clerkship evals, i.e., 100% random grades.

Yeah, I'm talking preclerkship. We have an SP encounter every block, and we are graded by the attending on our encounter, presentation, and our H&P. It's pass/fail.

 

[m2regen]

At Stanford, despite a faculty with 8 Nobel laureates and extensive clinical facilities

Another problem with this statement is that it assumes having Nobel laureates on faculty implies a high quality of teaching, as if the Nobel prize is given for teaching...

Also, not every university can have Nobel laureates on staff. Using this as a reason to discredit the parallel curriculum implies that they favor having variation in medical school education quality. In training physicians for the workforce, it's disingenuous to promote having better medical education depending on where you go to school. Medical education should adhere to standard, and it's just arrogant and ridiculous to assume that your school can lecture better than OME, Pathoma, etc.

This is just another instance (just like Step 1 P/F) of entitled individuals who are afraid to compete, so they try to undermine attempts at a level playing field at the expense of everyone else.

 

[7331poas]

Can't disagree with that more. If I had to choose between the two at the same pay scale, I'd definitely choose getting to perform surgery over rounding for 12 hours a day.

Good for you. Most hospitalists do not work 12 hours a day. And the work during residency is much less intense.

 

[Matthew9Thirtyfive]

Good for you. Most hospitalists do not work 12 hours a day. And the work during residency is much less intense.

What’s your point? He’s just saying not everyone would do the “easier” job if the money was the same.

 

[7331poas]

What’s your point? He’s just saying not everyone would do the “easier” job if the money was the same.

Okay ill rephrase. "A significant decreased in surgical applicants will occur" if pay became equivocal between surgeons and medicine.

 

[Matthew9Thirtyfive]

Okay ill rephrase. "A significant decreased in surgical applicants will occur" if pay became equivocal between surgeons and medicine.

Hmm. Not sure. Most of the people I know who are going into surgery or who are surgeons would be miserable in IM.

 

[NicMouse64]

Hmm. Not sure. Most of the people I know who are going into surgery or who are surgeons would be miserable in IM.

and vice versa. You couldn't pay me a million dollars a year to go through that grueling 5 year residency. F. That.

 

[Mass Effect]

Wow you'd think with 8 Nobel laureates they could create a curriculum that students would find useful

Even if they did, it wouldn't matter. The ship has sailed on students trusting the curriculum. Most students pick up their board materials before orientation and ignore their own curriculum from day one.

 

[slowthai]

The most useful preclinical curriculum would be no curriculum. This would be my ideal situation:

1. Only NBME exams, no crappy in-houses

2. No lectures

3. No small group, PBL, or any other similar wastes of time

4. No mandatory anything

5. Pairing with a serious research mentor in your field of interest

It's a win-win for everyone. We don't have to listen to some mediocre lecturers and they can focus on their research/clinical practice.

 

[Lawpy]

The most useful preclinical curriculum would be no curriculum. This would be my ideal situation:

1. Only NBME exams, no crappy in-houses

2. No lectures

3. No small group, PBL, or any other similar wastes of time

4. No mandatory anything

5. Pairing with a serious research mentor in your field of interest

It's a win-win for everyone. We don't have to listen to some mediocre lecturers and they can focus on their research/clinical practice.

does this include shortening preclinical to 1yr?

 

[slowthai]

does this include shortening preclinical to 1yr?

That's one thing that I'm ambivalent about honestly. The upside is having extra clinical/research time (Duke/Vandy/Michigan). The downside is going at such a crazy pace. I think I would prefer step to be after clerkship in that case. Otherwise, I'd go with a 1.5.

 

[m2regen]

The most useful preclinical curriculum would be no curriculum. This would be my ideal situation:

1. Only NBME exams, no crappy in-houses

2. No lectures

3. No small group, PBL, or any other similar wastes of time

4. No mandatory anything

5. Pairing with a serious research mentor in your field of interest

It's a win-win for everyone. We don't have to listen to some mediocre lecturers and they can focus on their research/clinical practice.

Yes, I agree that the main value of having faculty is to help you understand the practical value of that pathophysiology. Since the content is already lectured on well, I think medical schools should take the money they would save on faculty to provide access to these lectures.

The challenge is figuring out how to best implemented this as uniformly as possible among all medical schools. I guess theoretically LCME (or whatever accrediting body) has power to choose official partners and develop a minimum curriculum by committee. I think the majority of medical students use Pathoma, OME, and UWorld, so that should cover most of the information you need to function in clerkships. On top of that OME is free...

 

[7331poas]

Hmm. Not sure. Most of the people I know who are going into surgery or who are surgeons would be miserable in IM.

And 100% of general surgeons would not be happy at all in any other specialty? IR, EM, ophtho etc etc?

 

[slowthai]

And 100% of general surgeons would not be happy at all in any other specialty? IR, EM, ophtho etc etc?

So you don't consider ophtho to be surgeons, huh?

 

[Matthew9Thirtyfive]

And 100% of general surgeons would not be happy at all in any other specialty? IR, EM, ophtho etc etc?

You’re moving the goalposts.

Most of the surgeons I know or people going into surgery would do it even if the pay were the same. In fact for many of the people I’m talking about, the pay won’t be that much different from their medicine colleagues because we all make the same base pay in the military and the bonuses are not tremendously different compared to civilian world. You might make 30k more as a surgeon for example.

That doesn’t mean they wouldn’t also be happy in another procedural specialty (or even a non-procedural one), but that wasn’t exactly the argument.

 

[Matthew9Thirtyfive]

So you don't consider ophtho to be surgeons, huh?

I know an ophthalmologist who doesn’t think of himself as a surgeon lol.

 

[7331poas]

You’re moving the goalposts.

Most of the surgeons I know or people going into surgery would do it even if the pay were the same. In fact for many of the people I’m talking about, the pay won’t be that much different from their medicine colleagues because we all make the same base pay in the military and the bonuses are not tremendously different compared to civilian world. You might make 30k more as a surgeon for example.

That doesn’t mean they wouldn’t also be happy in another procedural specialty (or even a non-procedural one), but that wasn’t exactly the argument.

Guess we will have to agree to disagree. The people I know going into surgery love the salaries and it is a large motivator.

I think the evidence supports that as well, seeing as neurosurgery is relatively noncompetitive in many EU countries where the pay is equivocal.