An introspective explanation about my optometry posts

[ProZackMI]

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Interesting comments.

I want to emphasize a couple of things. First, while doing well on written tests in professional school involves memorization, being great in the clinic forces one have the ability to apply what is learned. Some people do this better than others - this does come out in clinical rotations and becomes ridiculously obvious in residency. We have all seen the one that aces the tests, but cannot apply it to patients for various reasons (I have found this to be rare in my experiences, however). On the other hand, if one does not know the facts, they do not have a prayer (One cannot use strong interpersonal skills and fake their way through good patient care. You may fake the patient out, but that doesn't count).

Second, I have family members and friends who have taken the DAT, LSAT, OAT, and. The MCAT is a test that not only tests your knowledge base, but I feel one could extrapolate raw intelligence from it as well. For example, the reading section on the MCAT is mentally challenging. I know people that have done very poorly on the reading section of the MCAT and did very well on the LSAT. My point is (and I can only speak for medical school and the MCAT since I have only seen practice DAT and OAT materials), people that do well on the MCAT tend to be able to handle many "mental challenges" - even if the first 2 years of medical school just forces them to sit on their ***** in the library memorizing thousands of pages of notes.

Finally, I have a question for ProZack. I agree 100% that law school is forces one to think. However, I feel that one could predict who does well in law school before classes even start (based on entry LSAT, entry IQ). The people that must study the most in law school don't always do the best. Sure the top 10% of a class probably work hard, but many of the people out on the town regularly (and not in the library) are able to do well with less work than one may think (they rely on raw intelligence, analytical skills, writing). I think law school, medical school, and optometry school (and other professional schools) are all challenging from a time commitment stand point. My question is - could a "natural" get away with less effort in law school compared with other professional schools (ie medical school)?

I'm no expert in testing, but based on my experience in both medical and law school, I would say you can make inferences about a student's potential to succeed in either program based upon undergrad GPA and admission testing scores; however, as with most things in life, you cannot simply make a blanket extrapolation.

For example, in medical school, I knew some folks who did well on the MCAT, but failed out. I knew some folks in law school who did exceptionally well on the LSAT, but failed out. I also knew students who did poorly on the MCAT or LSAT, but did incredibly well in medical/law school. Admission committees extrapolate success potential based on UGPA and scores, but do these factors alone accurately predict ability and skill? No, they do not.

Remember, testing means and averages are based on normative data extrapolated from a narrow pool of applicants, not from ALL applicants. Many minorities and others are excluded from the normative data; this skews the results for certain groups

Also, the people who do well on most admission tests are not always the best people you want as physicians, optometrists, lawyers, etc. Those who test well are not necessarily those with the best clinical skills, bedside manner, or diagnostic skills. Some of the best physicians I know only did moderately well in medical school and did not score high on the MCAT. Some of the worst arrogant pieces of trash I know with MD after their name did well on the MCAT and sucked ass in medical school.

You really can't predict much from grades and test scores in the REAL world. The average Harvard Law grad does not go off and practice real law; they go off and enter politics or academia or high-level government jobs.

In clinical practice, it makes LITTLE difference:

1) where you went to school;
2) what your grades were;
3) what your undergraduate major and GPA was; and,
4) what noted professors you took in professional school

What matters in real practice is:

1) your ability to master the necessary skills to practice safely and competently;

2) your ability to pass licensing exams/boards;

3) your ability to relate to your patients/clients; and,

4) your ability to keep up with current knowledge and information in the field via CME/CLE; and,

5) your adaptability in general to accommodate change in the field, etc.

In medical school, I had a professor who asked the class once: "What do you call someone who graduates bottom of his/her class in med school?" We all scratched our heads and looked around. He answered for us: "You call him doctor, just like the idiot at the top of the class!" In the end, no one cares where you went, what your scores were, what your grades were, etc. I'm not saying these things aren't important, but in reality, they mean very little once you enter school, finish school, or match into a residency.

In response to your last question, I believe anyone who has superior intelligence (which does not necessarily equate to high test scores or good grades; there are many highly intelligent people who do not test well or who do not put forth effort in school, but consistently rank above their peers in raw intelligence) can do well than someone with average intelligence in any academic program. When I was in medical school and later, in law school, I saw some students work their ass off for a B or C, where others were out partying all night, having fun, and still earning high grades. I had two friends in med school who were like night and day. Dan was lazy, took scant notes, and believed in having fun all the time; he graduated with honours. Jen took notes so detailed, they were almost audiographic. She spent almost all of her waking time in the library or labs. She ate, slept, and breathed medicine, but sucked on the tests and failed out after M2. She was not an idiot, but she was not able to pass the tests, whereas Dan could easily do that without even putting forth much effort. I was in the middle; I had to work hard in some areas and could slack in others.

Raw intelligence is NOT directly linked to test scores and grades. True intelligence is not measurable in that manner. Test scores and grades alone are inferential or predictive at best, but not dispositive.

 

[IndianaOD]

Some of the reforms suggested by the AMA Council of Medical Education are:

1) lessen the rigid admission standards into allopathic programs, more like many DO programs.

2) lessen the pre-med requirements (physics, calc, and inorganic chem are not relevant to the practice of medicine) and increase pre-med classes in English, communication, and writing.

3) Reduce the M1 and M2 basic science curriculum and increase the clinical and diagnostic component earlier, thereby forcing true problem-based medicine into every year of medical school.

4) Reduce the residencies in some specialities.

5) Offer 3 year MD degrees with reduced residencies for students going into primary care, like the LECOM model in Pennsylvania (DO in 3 years, FP residency in 2 for a total of 5). This would reduce the stress and financial obligation of medical students.

6) Incentives to get students into medicine and reduce their financial burden. If med students graduated with less debt, perhaps they'd enter MUAs like inner cities and rural areas more and not want to specialize and earn a ton to pay back those loans. Less debt = more altruism = win-win = less need for FMGs and mid-levels.

These are just some of the reforms being tossed around out there. If something does not change soon, in 20 years, psychiatry, IM, FM, PMR, OB-GYN, and many other specialities will be killed off. The doctor of tomorrow will be a nurse, psychologist, and who knows what else. Without reform, medicine will continue to suffer.

So, if you optometrists are questioning your choice of careers, consider all of that. Your opportunities will grow, whereas MDs and DOs will continue to slide into the quagmire of manged care.

Hey, besides bashing everyone else, the AMA actually has some good ideas. I think those listed above would strengthen medicine.

Personally, I think medicine should make a push to shift some of the profits from specialists and "procedures" to primary care. IMO family physicians are getting hosed.

Here in more rural Indiana there are A LOT of FMGs. They may be great docs, but you are right, many cannot communicate as well. Personally, when I moved and was looking for a new family doc for myself and a pediatrician for my son I immediately ruled out FMGs. I definitely am not racist, but feel more comfortable with someone from a US school and upbringing.

On a different topic Zack, why have psychiatrists mainly become med pushers? Is it because you can make more money doing 10 minute med checks compared to 30-60 minute CBT sessions? I actually think psychiatry has forced psychology to expand. It makes more sense to use a combination of therapy and medication in most cases. My sister in law has significant psychological issues and has never gotten anything but med changes from the psychiatrist. Frustrating thing is she is also obese and sedentary and they have never recommended healthy eating and exercise (which I believe can positively affect depressive states).

When I look at the journals, CBT and other strategies are shown to be very effective alone or in conjunction with therapy.

 

[ProZackMI]

Hey, besides bashing everyone else, the AMA actually has some good ideas. I think those listed above would strengthen medicine.

Personally, I think medicine should make a push to shift some of the profits from specialists and "procedures" to primary care. IMO family physicians are getting hosed.

Here in more rural Indiana there are A LOT of FMGs. They may be great docs, but you are right, many cannot communicate as well. Personally, when I moved and was looking for a new family doc for myself and a pediatrician for my son I immediately ruled out FMGs. I definitely am not racist, but feel more comfortable with someone from a US school and upbringing.

On a different topic Zack, why have psychiatrists mainly become med pushers? Is it because you can make more money doing 10 minute med checks compared to 30-60 minute CBT sessions? I actually think psychiatry has forced psychology to expand. It makes more sense to use a combination of therapy and medication in most cases. My sister in law has significant psychological issues and has never gotten anything but med changes from the psychiatrist. Frustrating thing is she is also obese and sedentary and they have never recommended healthy eating and exercise (which I believe can positively affect depressive states).

When I look at the journals, CBT and other strategies are shown to be very effective alone or in conjunction with therapy.

Indiana, it's a complicated answer, but for the most part, psychiatry has become a pill-pushing specialty because of managed health care and predominate idea that ALL psychological problems are endogenous (biochemically intrinsic) and not exogenous (externally caused, like reactive depression, situational anxiety, etc.).

Years ago, most psychiatrists believed that most mental disorders were exogenous and caused by improper learning or socialization or some other maladaptive mechanism, not by a "chemical imbalance" of neurotransmitters in the brain/body. Sometime in the 80s, the pendulum swung the other way and researchers believed that MOST mental disorders were caused by the imbalance of neurotransmitters in the brain/body. Thus, the proliferation of psychoactive drugs that came out of the mid to late 80s and continue to be developed today.

This had a huge impact on the practice of psychiatry. Prior to the 80s, most psychiatrists, after medical school, entered psychoanalysis training or behavioral training during or after residency; most engaged in actual counseling practices that they augmented with psychopharm tx. After the 80s, the therapy aspect was divided up among the social workers, psychologists, and professional counselors (MA-LPCs). Clinical psychology, which was primarily academic and psychometric assessment (e.g., IQ testing, personality testing, etc.), expanded somewhat and moved more into a therapeutic role. SW grew into clinical stuff too.

So, the endogenous theory of mental illness, that became firmly ensconced in the 80s, coupled with the growth of psychology and SW, and the advent of managed health care, placed psychiatry at the "top of the mental health hierarchy" on one hand, but relegated it to a specialized medication review role. Psychiatrists were encouraged to spend less time in therapy and more time writing Rxs, even when we knew the condition was exogenous (i.e., bereavement vs actual depression or situational anxiety due to divorce, employment changes, health problems, etc. -- problems that will change with the passing of time and/or extinction of the situation).

Over time, psychiatry continued to grow into a pill-pushing "industry" and today, it is what it is. As a consequence, most good medical students (MD or DO) do not wish to match into psych and would rather go into a high-paying specialty or a more clinical one such as peds, IM, OB-GYN, FP, etc. Psychiatry is the most non-medical of the medical specialties, in most cases, and most psychiatrists who are not also trained in IM or FM, lose a lot of their clinical knowledge. I know there were some colleagues I worked with who knew less medicine than some PsyD/PhD psychologists I knew, simply because they were mere pill-pushers and never did anything more clinical than take a blood pressure, read a lab, or jot down a script.

The truth is, mental illness is not as simple to break down as physical pathology. Many physical problems have a psychogenic component (like IBD/IBS, PUD, fibromyalgia) and many mental problems have a physical or genetic component (ADHD, Tourette's, schizophrenia, major depression). Medication alone is not effective for many mental disorders where maladaptive behavior and inappropriate learning have taken place. I believe that effective, yet direct therapy aimed at teaching adaptive behaviors, like CBT, in conjunction with psychopharm is the best and most effective way to treat mental illness.

 

[ProZackMI]

Hey, besides bashing everyone else, the AMA actually has some good ideas. I think those listed above would strengthen medicine.

Personally, I think medicine should make a push to shift some of the profits from specialists and "procedures" to primary care. IMO family physicians are getting hosed.

Here in more rural Indiana there are A LOT of FMGs. They may be great docs, but you are right, many cannot communicate as well. Personally, when I moved and was looking for a new family doc for myself and a pediatrician for my son I immediately ruled out FMGs. I definitely am not racist, but feel more comfortable with someone from a US school and upbringing.

On a different topic Zack, why have psychiatrists mainly become med pushers? Is it because you can make more money doing 10 minute med checks compared to 30-60 minute CBT sessions? I actually think psychiatry has forced psychology to expand. It makes more sense to use a combination of therapy and medication in most cases. My sister in law has significant psychological issues and has never gotten anything but med changes from the psychiatrist. Frustrating thing is she is also obese and sedentary and they have never recommended healthy eating and exercise (which I believe can positively affect depressive states).

When I look at the journals, CBT and other strategies are shown to be very effective alone or in conjunction with therapy.

1. I wouldn't go to a FMG for anything. I won't even see an FMG for my dental care. I'm not racist either, but I do not believe these physicians are effective communicators, keep good records, and they tend to have an arrogant demeanor that disturbs me. I'm not saying Americans are superior all the time, but generally speaking, I have had better luck with American-born physicians of any race or gender than FMGs. I recommend to family members to stay clear of the FMGs too.

2. You're right about your sister-in-law. When I was in practice, I was quite frank and direct with my patients. If they abused drugs or EtOH, I told them: "You're a drunk, stop drinking and you'll feel better!" Or I would point out, "You can't afford your blood pressure meds, but you can afford your malt liquor and cigarettes and twinkies?" It pissed m any patients off, but I made my point. I would also point out the Diet Coke fallacy. You know, "You weigh 250 pounds, go to McDs, order 2 Big Macs, large order of fries, but get a Diet Coke. Do you see the flawed logic here?"

If you're fat and unhealthy, depression is a natural result. If you have a physical problem that causes pain, depression is a natural result. If you lose a loved one, depression will follow. If you get canned from your job and have no money, you'll be depressed. These things are understandable, not biochemical. If they persist, it might be endogenous, but before I went off writing a script for an SSRI or TCA or any other antidepressant, I would look at the big picture and see if it's more situational; if so, I'd recommend a therapeutic regimen aimed at correcting the problem situation(s).

The problem with psychiatry today, and allopathic medicine in general (and osteo is not much different to be honest), is that the prevalent idea of the day is "give the patient a pill, that will fix it". Part of this mentality is from managed health care, part of if it from the American "I want it NOW damn it! mentality, and part of stems from the medical model of treat the symptom, not the whole.

 

[LoganNC]

...

 

[eyestrain]

Good Lord, are people actually reading the novels posted here?

 

[IndianaOD]

Good Lord, are people actually reading the novels posted here?

I acutally think this is one of the better threads. Zack's thoughts are reasonable and thought out. I am somewhat similar in that I have seriously considered getting a JD in the future.

 

[DOCTORSAIB]

I am somewhat similar in that I have seriously considered getting a JD in the future.

Is this before or after you go into Dermatology?

I joke, I joke.

 

[qwopty99]

I don't know about you folks, but this is a great post.

 

[qwopty99]

I am somewhat similar in that I have seriously considered getting a JD in the future.

I find the JD an interesting degree.

 

[ProZackMI]

I too considered JD before trying the PhD, and even considered jumping ship to the JD during my PhD studies.


I find the JD an interesting degree. Like you, I'm outspoken and am passionate about what I believe - characteristics that might render someone suitable for a law career.


That said, I recently spoke with a friend currently in law. The amount of reading (old cases) they have to do is ENORMOUS. (Now I'm going to totally botch up the following - I'm sure ProZack is better suited to making the following commentary, but what I got was this:

Some of these cases are dozens (even hundreds) of pages long - and they have to read and compare these things, trying to tease out why different judges made their particular judgments on certain cases, and analyze how each judge interpreted the law differently for that particular case. If that's bad enough, apparently reading these things aren't even interesting!! And it's not that I'm not a reader - I think I'm pretty suited to reading medical-related literature (my room has papers scattered all over the floor), but while I can read multiple 8-9 page manuscripts in a sitting and not be bored at all, the thought of trying to read through a 100-page judgment on some tiny case that occurred in 1896 in the State of Nebraska, just doesn't turn me on. After my friend sent me a few "learning articles" to look at, I realized I probably don't have the stomach to go through law training. And the other problem, is the cost of law school.




ProZack

Just curious. Do you know much about the LLM degree? How tough is admissions at the top schools?

This girl that I know, she graduated from an LLB program from a 2nd-world Asian country. She was apparently accepted to Harvard and Stanford LLM programs (and multiple other top-tiers such as Berkeley, Columbia, NYU, etc.), but is attending NUS (Singapore) this year for financial reasons. I've always known she was bright, but how much of an achievement are acceptances like this? (As an aside, she's absolutely gorgeous and I've been in love with her since the first day I laid eyes on her.)

Thanks in advance.

qwopty99,

Just a few comments to your interesting post. First, what is your academic background? Are you an OD and PhD? Or just an OD who delved into graduate school after optometry school, but never finished? What did you study and what were your goals?

I ask this in order to better answer your questions.

Second, law school is CONSTANT reading and, to use your words, AN ENORMOUS amount of reading! You got it exactly! From day one, as an L1, you read, read, read. Yes, it's mostly the case method of study coupled wtih Socratic teaching. Your basic first year course load is usually:

Criminal Law
Torts I
Contracts I
Property I
Constitutional Law I (or Wills/Estates) or another required

By far, the nastiest and heaviest amount of reading, in L1, is in Torts and Property. OMG, in torts, just one case in intentional torts can span 100's of pages -- especially some of the older cases from the Supremes. Long, dull, and verbose. You really hone your legal skills by sifting through all of the dicta and minutia in order to glean some semblance of comprehension.

Med school, like I'm sure optometry school is/was, was also a lot of reading, but like I said before, mostly memorization of facts and concrete material, not abstract concepts. The thing about med school was, if I was up till 2 am the night before, cramming information into my skull about the latissimus dorsi muscle or cranial nerves, and was tired, I could sit in class and vege and just process information. In law, you must be on your toes, prepared, for EVERY class, as the professor may call on you and ask you to:

a) Recite the facts of one of the maybe 50 cases you were assigned to read the night before, in detail, grilling you, ad nauseum, about subtle nuances (was this contract bilateral or unilateral, what was the consideration used to form the contract, were the rights assignable or not, did the exculpatory clause obviate liability???) of the facts, etc. If you are not prepared, in some schools, you are penalized.

-- also, being called to recite the facts is one thing, but being to called on to explain the court's reasoning or the "letter of the law" or what you're supposed to glean from the case is a whole other story; it can be grueling to be grilled, for an hour, on your feet, in front of everyone, about one case. I've seen professors rip students apart in front of their peers. While some are nice about it, others take their role as Grand Inquisitor very seriously. I've seen it border on sadistic in a few classes!

b) You can only miss like 2-3 classes a term, even if it's an emergency; the ABA mandates this, and professors, as much as they might not care if you're there or not, do have to take strict attendance and you can fail due to family problems or illness -- or have to retake classes you may dread, like Property.

c) In many classes, like Torts and Property, the cases are lengthy and numerous. One class's assignment might be 20-50 200+ page cases. Some of the cases are repetitive, some are district; each has a point to convey to the student. You can't just read, but you need to brief the cases (see point a ).

d) In most law schools, there is only one exam. While that might seem like a good thing to some of you who are sick of the multiple exams in optometry school, think about this: your average law class is 16 weeks, give or take, and you have ONE final exam at the end. It's usually a combo exam: essay (long and complicated replete with multiple facts and multiple issues) and multiple choice. The multiple choice are awful; four incorrect answers, but which is the MOST incorrect. In law, reading the CALL of the question is important. You must carefully read the question in order to answer. It's not like undergrad where you can skim and select. Professors purposefully try to deceive you in order to test your ability to read and process the CALL of the question. Which of the four is the MOST incorrect, which of the following 5 choices is the least accurate, etc. Nasty stuff if you're crunched for time, which in law exams, you always are -- all exams are timed carefully and proctored carefully. No mid-terms to balance your grade. Everything rests on the one exam, one grade. Sometimes you earn "points" if you accurately answer questions during the term, and sometimes, you lose points if you do not are not prepared. If you miss more than 2 or 3 classes, depending on the credit hour of the class, you may either be forced to drop the class or you may lose grade points (see point b above). Of course, you have one professor, not a TA or GA, reading your exam, and if you don't say the magic words in your essay, you're bull****ting and you'll lose points. No BS allowed in law school (yeah, hard to believe!).

Usually, they give about one week "reading" period before exams to study for 4-5 final exams, often back-to-back, in multiple and diverse subjects (see above sample schedule for L1).

Third, 3-4 years of law school usually costs more than a combined MS-PhD program, including dissertation study, even at a public law school. Like medicine, law ain't cheap.

Fourth, an interesting thing about ALL professional programs in the United States is that you do a weird order placement for degrees. By this, I mean, in MOST graduate programs, a student typically earns a BACHELORS --> MASTERS --> DOCTORATE. In professional school, however, most students earn a BACHELORS --> DOCTORATE --> MASTERS --> PhD (if you want to research).

This is because historically, in the US, all professional programs started off as an undergrad degree (high school to some college to professional degree, which was the first degree, in usually 5 years). These degrees then moved to require 2-3 years of "pre" study before 3-4 years of professional study, but one degree was still earned (BM, LLB). The MB evolved into the MD and eventually med schools required, or strongly preferred a BA/BS prior to medical study. Law was the same way. Lawyers, in the US, earned a BA/BS, then went on to earn a post grad undergrad (oxymoron?) LLB degree, which was NOT equivalent to the LLB in the Commonwealth countries as a first degree was required. So, that meant lawyers in the US earned two bachelor's degrees in about 7-8 years -- it was neither fair, nor accurate. So, the degree was retooled as a doctorate (JD).

However, the more advanced degree, LLM, never changed. So, back in 1950, one would finish college with a BA, graduate law school with an LLB, and if he or she wished to specialize or study academic law, went on to earn an LLM and then even possibly a JSD (Dr of the Science in Law). LLMs were common and still are, whereas JSDs, which are basically PhDs in law, are rare and primarily for academics.

So, when the degree was changed to a JD, which also involved adding more research and writing (JD requires more writing and research than most master's programs and often parallels some EdD and PhD programs), the order of progression did not change: --> BA/BS --> JD --> LLM. No different than medicine or optometry, which were also undergrad degrees at one point in time, with BA --> OD --> MS (optics, bio, etc.). Dentists usually get BS --> DDS --> MS or MSD (endo/perio). Physicians often do BS --> MD --> MPH/MS.

Now, having said that, in the US, if you are American, and you wish to practice law, you MUST earn a JD. You can earn an LLM in a specialty area, like taxation or family law, AFTER your JD, or in some cases, concurrent with your JD, but you cannot enter an LLM program directly from a BA/BS or other degree. If you're a foreign-educated lawyer (LLB, D Jur, Mag Jur), you CAN enter an LLM program directly that is designed to prepare the foreign-trained lawyer to take the bar exam in the US. Your friend from Singapore went to law school there first, so she can do this. You did not, so you cannot.

Your only options are: 1) earn a JD if you wish to practice law or 2) earn a special "legal studies" master's degree if you wish to learn legal methodology, but have no desire to practice. Some schools offer these "mini" law degrees for people who need a legal background, but don't want the hard work or ability to sit for the bar and practice. They are limiting degrees for people who wish to have knowledge, but not use that knowledge in a practice setting. Some examples of these programs:

http://www.luc.edu/law/academics/MJ.html

http://www.law.msu.edu/llm/ipclp/gen.html

http://www.law.pitt.edu/academics/msl

I hope this helps! 🙂
Zack

 

[qwopty99]

Hi Zack

What I meant about the LLM - wasn't whether it was suitable for me. What I was asking about - is how big an accomplishment is admission to Harvard, Stanford, Berkeley, Columbia LLM programs? I can appreciate how competitive it is to get acceptances to Harvard/Stanford JD, but what about LLM?

Is this girl that I know, really exceptional?

 

[KHE]

I'm no expert in testing, but based on my experience in both medical and law school, I would say you can make inferences about a student's potential to succeed in either program based upon undergrad GPA and admission testing scores; however, as with most things in life, you cannot simply make a blanket extrapolation.

The number one predictor of success in elementary school, all the way through graduate school is not your GPA, SAT scores, MCAT scores, IQ, or any other psychometric score.

The number one predictor of success is......your ATTENDANCE RECORD.

This has been published in multiple educational journals time and time and time again. Yes...we all know a person or two who rarely went to class, spent their days studying in the library or in their apartments and scored well. But on average, the biggest predictor of academic success is the students attendance record.

 

[DOCTORSAIB]

The number one predictor of success in elementary school, all the way through graduate school is not your GPA, SAT scores, MCAT scores, IQ, or any other psychometric score.

The number one predictor of success is......your ATTENDANCE RECORD.

This has been published in multiple educational journals time and time and time again. Yes...we all know a person or two who rarely went to class, spent their days studying in the library or in their apartments and scored well. But on average, the biggest predictor of academic success is the students attendance record.

I disagree. There are many ways of learning -- some visual, some auditory and some a combination of the two. If you're a visual learner there is little benefit of going to class assuming what is discussed in class is either written down in note format or found in a book. This is why most med schools don't make attendance mandatory. They know that forcing a visual learner to sit in class for 8 hours is not going to be very productive learning.

After first block of 1st year of med school, I didn't go to a single class. Not one. Instead I sat in a quiet room with cubicles and studied most of the day with notes (every lecture was scribed) and followed along with review books. Scored low to mid 90's in every class and graduated top quintile of my class.

OTOH, auditory learners could sit through lecture, absorb and do minimal studying outside of class. So skipping lecture and would be torture to them.

And then there's everyone else in btw.

So, I'm not quit sure the attendance thing really holds true at every level of education.

 

[blysssful]

I disagree. There are many ways of learning -- some visual, some auditory and some a combination of the two. If you're a visual learner there is little benefit of going to class assuming what is discussed in class is either written down in note format or found in a book...OTOH, auditory learners could sit through lecture, absorb and do minimal studying outside of class. So skipping lecture and would be torture to them.

I agree with this. A few of the most intelligent people I know in my classes don't actually GO to class, but they generally do just as well, if not better than me (and I always go to class..."torture" is completely accurate). I'm an auditory learner... so as far as class material, all I need is to hear it, review my notes later and I'm set. My friends that don't go to class read the book, and get it from there.


Zack, question. It's a little bit outside of the scope of this conversation... but the "med pushing" comment made me wonder. Do they spend much time training psychiatrists in how to spot when someone is faking (i.e. only looking for a prescription)?

 

[KHE]

I disagree. There are many ways of learning -- some visual, some auditory and some a combination of the two. .

Whether you agree or not is immaterial. Numerous studies in numerous educational journals have concluded time and time again that on average, the biggest predictor of a students success at all levels of education is their attendance record.

Is this a universal rule? Of course not, as you yourself have indicated. But on average, it's the number one predictor.

 

[ProZackMI]

Hi Zack

I'm an OD, and tried grad school for two terms before withdrawing.

What I meant about the LLM - wasn't whether it was suitable for me. What I was asking about - is how big an accomplishment is admission to Harvard, Stanford, Berkeley, Columbia LLM programs? I can appreciate how competitive it is to get acceptances to Harvard/Stanford JD, but what about LLM?

Is this girl that I know, really exceptional?

qwopty99,

To be perfectly honest, I don't know much about foreign-trained LLM admissions. Based on my perusal of the websites (Harvard, Stanford, Yale), it seems like grades are an important role in LLM admission, but LSAT scores are not necessary.

Harvard's site says:

Admissions

Harvard Law School welcomes applications to the LL.M. Program, the S.J.D. Program, and the Program for Visiting Scholars and Researchers. In order to apply, applicants must complete the relevant parts of the Graduate Program's application materials. These call for applicants to provide information about themselves and the studies they propose to pursue at Harvard. Normally applicants also must submit letters of recommendation from professors and others who know their work, and transcripts from each university they have attended. To obtain copies of these application materials, please either download the application from our website or ask us to send you a copy.

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Based on that vague description, it would appear to gain admission as a foreign-trained attorney, you'd have to walk on water academically to get a seat.

Stanford also appears to lack the LSAT, but emphasis is placed on grades and LOR. So, I would say, yes, this person you're talking about had to do extremely well academically to get into the LLM program. How this compares to the JD admission, I really can't say.

 

[ProZackMI]

The number one predictor of success in elementary school, all the way through graduate school is not your GPA, SAT scores, MCAT scores, IQ, or any other psychometric score.

The number one predictor of success is......your ATTENDANCE RECORD.

This has been published in multiple educational journals time and time and time again. Yes...we all know a person or two who rarely went to class, spent their days studying in the library or in their apartments and scored well. But on average, the biggest predictor of academic success is the students attendance record.

👍

 

[ProZackMI]

I disagree. There are many ways of learning -- some visual, some auditory and some a combination of the two. If you're a visual learner there is little benefit of going to class assuming what is discussed in class is either written down in note format or found in a book. This is why most med schools don't make attendance mandatory. They know that forcing a visual learner to sit in class for 8 hours is not going to be very productive learning.

After first block of 1st year of med school, I didn't go to a single class. Not one. Instead I sat in a quiet room with cubicles and studied most of the day with notes (every lecture was scribed) and followed along with review books. Scored low to mid 90's in every class and graduated top quintile of my class.

OTOH, auditory learners could sit through lecture, absorb and do minimal studying outside of class. So skipping lecture and would be torture to them.

And then there's everyone else in btw.

So, I'm not quit sure the attendance thing really holds true at every level of education.

At my medical school, (MSU CHM), attendance was discretionary, but those students who chose the method of study like you, failed miserably. True, there are many modalities of learning, but there is a reason why no accredited MD or JD program is offered through "distance learning"; you need hands-on experiential learning for medicine, optometry, law, etc. An MBA is one thing, but an MD, especially your M3 and M4, needs to be in class.

 

[ProZackMI]

I agree with this. A few of the most intelligent people I know in my classes don't actually GO to class, but they generally do just as well, if not better than me (and I always go to class..."torture" is completely accurate). I'm an auditory learner... so as far as class material, all I need is to hear it, review my notes later and I'm set. My friends that don't go to class read the book, and get it from there.


Zack, question. It's a little bit outside of the scope of this conversation... but the "med pushing" comment made me wonder. Do they spend much time training psychiatrists in how to spot when someone is faking (i.e. only looking for a prescription)?

That's what we call malingering. Yes and no. In my residency program, one of my preceptors was big on "watch for people looking for the magic pill" and "never trust pain-medication seeking people". It was his bias. Consequently, and also the result of being somewhat jaded myself, and skeptical, I always screen for malingering in patients. Unlike most psychiatrists, I don't get my Rx pad easily -- I actually LISTEN and examine the whole picture of what's going, not a quick Rx and be done with it.

In general, however, most psychiatrists and therapists/psychologists learn through experience how to spot malingerers. What's difficult is how to differentiate between malingerers, borderline malingerers, and those with factitious disorder (e.g., Muenchausen's). That can be difficult and while the DSM-IV is pretty detailed on how to make this dx, a patient's presentation can be tricky if you're naive, easily fooled, or simply dumb. Many of the FMGs have difficulty making a differential dx and it can cost lives/suffering.

Of course, most FMGs diagnose everyone with bipolar disorder without looking at the DSM to see if ALL of the criteria are actually met for BAD; they are usually way off and it's actually Major Depression or Depression NOS or even Dysthymic D/O, NOT Bipolar I or II.

 

[WoodyJI]

Whether you agree or not is immaterial. Numerous studies in numerous educational journals have concluded time and time again that on average, the biggest predictor of a students success at all levels of education is their attendance record.

Is this a universal rule? Of course not, as you yourself have indicated. But on average, it's the number one predictor.

It occurs to me that these studies back up your point so strongly (which certainly is correct, btw) probably because the curricula used was in no way designed for distance learning. Obviously studying how people learn is extremely complicated, and I can see how attendance record might be the only hard factor that one could possibly nail down. As others have pointed out, distance learning cannot possibly work in every situation, and optometry does require a lot of hands-on experience to master techniques. I'd like to see how attendance record fairs as a discriminating factor in the future schools. Since schools are only getting more crowded as time goes on, I feel like they're going to need to be more flexible in this regard (you think they'd pass up the chance to admit even more students and not have to build a bigger lecture hall to do it?). I know that if I skipped class in optometry school, things would be extremely difficult for me b/c a lot of times courses are organized as handouts every few classes. There'd be no way for me to follow some of the bullet points out of context. I think in most places this is probably the teaching style.

On the other hand, OSU Medicine actually allows qualifying students to opt for an "independent study pathway" where modules are designed with recommended time frames and maximum test dates set in stone. This doesn't work for every class—independent studiers still have to attend certain lectures (usually those w/ a group-work component, examination technique demonstration, etc.)—but for much of the 1st & 2nd year curriculum, that approach is almost a no-brainer (and I think this would hold true in many other professional schools as well). These students can't be directly compared to those who sat in class all day...except perhaps for boards scores, where you might guess that they consistently outperform their peers. My theory is that they're better equipped to organize themselves/design their own study plans when boards approach. Also, when they go back to look at their old "course notes" they don't end up looking at bullet points designed by someone else which made sense in the context of the class lecture at the time but now, a year later, they have no clue what that professor was talking about when they put up that powerpoint slide.

 

[ProZackMI]

It occurs to me that these studies back up your point so strongly (which certainly is correct, btw) probably because the curricula used was in no way designed for distance learning. Obviously studying how people learn is extremely complicated, and I can see how attendance record might be the only hard factor that one could possibly nail down. As others have pointed out, distance learning cannot possibly work in every situation, and optometry does require a lot of hands-on experience to master techniques. I'd like to see how attendance record fairs as a discriminating factor in the future schools. Since schools are only getting more crowded as time goes on, I feel like they're going to need to be more flexible in this regard (you think they'd pass up the chance to admit even more students and not have to build a bigger lecture hall to do it?). I know that if I skipped class in optometry school, things would be extremely difficult for me b/c a lot of times courses are organized as handouts every few classes. There'd be no way for me to follow some of the bullet points out of context. I think in most places this is probably the teaching style.

On the other hand, OSU Medicine actually allows qualifying students to opt for an "independent study pathway" where modules are designed with recommended time frames and maximum test dates set in stone. This doesn't work for every class—independent studiers still have to attend certain lectures (usually those w/ a group-work component, examination technique demonstration, etc.)—but for much of the 1st & 2nd year curriculum, that approach is almost a no-brainer (and I think this would hold true in many other professional schools as well). These students can't be directly compared to those who sat in class all day...except perhaps for boards scores, where you might guess that they consistently outperform their peers. My theory is that they're better equipped to organize themselves/design their own study plans when boards approach. Also, when they go back to look at their old "course notes" they don't end up looking at bullet points designed by someone else which made sense in the context of the class lecture at the time but now, a year later, they have no clue what that professor was talking about when they put up that powerpoint slide.

It works in a health-related professional program, like optometry or medicine, especially your first 2 years, which are predominantly basic science foundation classes like GA, phys, pharm, etc. This would never work in law school, however, as Socratic teaching and learning are essential in mastering legal analysis, issue spotting, legal reasoning, and basic oral argumentation skills. An independent study in L3 would be possible in some classes, like Jurisprudence or advanced legal research classes, or even advanced Con Law classes (like a class on First Amendment and Religion or something along those lines), but it would fail miserably in a first year contracts, torts, crim law, civil procedure, or other class of that nature.

 

[IndianaOD]

It works in a health-related professional program, like optometry or medicine, especially your first 2 years, which are predominantly basic science foundation classes like GA, phys, pharm, etc. This would never work in law school, however, as Socratic teaching and learning are essential in mastering legal analysis, issue spotting, legal reasoning, and basic oral argumentation skills. An independent study in L3 would be possible in some classes, like Jurisprudence or advanced legal research classes, or even advanced Con Law classes (like a class on First Amendment and Religion or something along those lines), but it would fail miserably in a first year contracts, torts, crim law, civil procedure, or other class of that nature.

Zack,

What was medicine lacking for you that Law provides? It sounds like you were a psychiatrist that actually considered all Tx options for your patients and I would think there would be plenty intellectual info in the field to keep you motivated. Definitely to be commended. I think its similar to most OMDs and MDs who immediately perform strabismus surgery for squints when Optometric vision therapy has better functional outcomes.

 

[ProZackMI]

Zack,

What was medicine lacking for you that Law provides? It sounds like you were a psychiatrist that actually considered all Tx options for your patients and I would think there would be plenty intellectual info in the field to keep you motivated. Definitely to be commended. I think its similar to most OMDs and MDs who immediately perform strabismus surgery for squints when Optometric vision therapy has better functional outcomes.

Indiana,

IM was interesting because it had diversity. While I didn't practice IM much, went right into psych, I appreciated diversity. In psychiatry, it was the same sh|t, different day. Very little diversity and very little use for my clinical skills beyond writing a script. After a while, there was no challenge or interest.

I was also sick of the chiropractic school of mental health. You know, keep coming back for a psyche "adjustment" and never get better. I used to tell my patients, "Why the *&)# are you back? You're on meds, you're receiving therapy, why haven't you taken steps to change your maladaptive behaviours?"

My patients, most of whom were middle class suburban women, just wanted someone to talk to. While an MSW might enjoy that, I had no patience for those patients. What's worse, we live in a culture where we covet diagnoses; it gives us attention and justifies our need to be dependent. If I told a patient "you have an adjustment disorder or dysthymia (mild depression)", they would argue, "But, doctor, I'm bipolar!" or..."but Oprah says I have bipolar disorder or ADHD or social anxiety or...(insert dx de jour)..." In other words, they WANTED a dx, a label. WTF! I used to get so angry with my patients and would tell them "there's nothing wrong with you except being lazy and dim-witted. Go do something with your life and you won't be so depressed!" Well, not quite that way! 🙂

You get the picture. Our culture encourages disease and disorder. Guess what? Most doctors love it. Using your example, an OMD can cut into your eye muscle and "fix your problem", buy a new Lexus in the process, by bilking the insurance the company for an unnecessary surgery, which may cause post op infections, which in turns, feeds more money into the Internist's pocket, the ID's pocket, and the hospital, without regarding the patient's inconvenience, discomfort, loss of work, etc.

Do you realize how many unnecessary surgeries are performed every year? It's a racket and scam. Quack neurosurgeons and orthopods perform tons of laminectomies, fusions, and discectomies every year for mild canal stenosis, mild disc bulging, or worse, disc dessication! They make tons of money every year and the end result: Failed Back Syndrome!

How many CABGs are performed where a PTCA with stenting would be adequate? How many endarterectomies are performed due to carotid lesions under 30% without TIA/CVA sxs?

How many MRIs, CTs, and XRs are performed for vague complaints? True, you want to CYA, but still...test after test after test is ordered and to what end? If it hurts, why do PT, write a magic script? If you're fat, lazy, and depressed, why change your lifestyle, take a happy pill! Cholesterol too high? Why stop eating fries and Big Macs, just take Zocor and your problems are solved.

That's the American way, my friend. Allopathic medicine encourages this. Most doctors do encourage smoking cessation, weight loss, and healthy living, but...we still push the pills and see the same whiny ass cranks day after day. After all, it buys the fancy cars, big houses, and country club memberships. All for our patients, right!

 

[DOCTORSAIB]

ProZackMI, I may be wet behind the ears still but your post was starting to sound very Kevin Troudeau-ish at the end.

 

[VA Hopeful Dr]

ProZackMI, I may be wet behind the ears still but your post was starting to sound very Kevin Troudeau-ish at the end.

Sounds to me like he's just repeating what most of us already know. For mild depression, I recall quite a few studies suggesting that regular exercise was every bit as effective as antidepressants. But exercise is hard, I just want a pill.

Overweight people are more likely to have hypertension and high cholesterol. But I don't wanna work hard to lose weight - just give me pills. Same with diabetes.

It all boils down to personal responsibility - or, rather, our lack thereof.

 

[IndianaOD]

Sounds to me like he's just repeating what most of us already know. For mild depression, I recall quite a few studies suggesting that regular exercise was every bit as effective as antidepressants. But exercise is hard, I just want a pill.

Overweight people are more likely to have hypertension and high cholesterol. But I don't wanna work hard to lose weight - just give me pills. Same with diabetes.

It all boils down to personal responsibility - or, rather, our lack thereof.

I really think that MDs who aren't honest with their patients and don't tell them they need to lose weight etc are failing their patients big time. Most MDs have full schedules so there shouldn't be any fear of upsetting a patient.

It actually does make a difference. If I tell patients that smoking doubles the risk of ARMD or if they don't get thier glucose under control they could lose their vision, many pay attention. Well at least they knod their head! 🙁

 

[DOCTORSAIB]

I really think that MDs who aren't honest with their patients and don't tell them they need to lose weight etc are failing their patients big time. Most MDs have full schedules so there shouldn't be any fear of upsetting a patient.

It actually does make a difference. If I tell patients that smoking doubles the risk of ARMD or if they don't get thier glucose under control they could lose their vision, many pay attention. Well at least they knod their head! 🙁

Every single MD/DO I have worked with tells their patients to lose weight, stop smoking, cut down the drinking, etc, etc.

But do they say it on every encounter? No.

Would you nag your SO everytime you saw him/her? No. Why? B/c you get tuned out after a while. In fact, the nagging itself may end up being an obstracle for change.

I'm sure ProZackMI can attest to this...

 

[JeffChou]

This may be another bias as well, but my pharmacology instructor (past life as clinical pharmacist, UCSF, now director of pharm program at UCI) never sugar coated her recommendations. Sometimes, "you should exercise weekly to help your condition" isn't quite enough to get people moving. "If you don't start exercising, you may die" is a lot more convincing, but it's saved her patient's lives. Sometimes there just isn't a drug that will work considering contraindications and individual metabolism. Sometimes the most effective medicine takes the most effort (runninggggg!!!!!).

 

[IndianaOD]

Every single MD/DO I have worked with tells their patients to lose weight, stop smoking, cut down the drinking, etc, etc.

But do they say it on every encounter? No.

Would you nag your SO everytime you saw him/her? No. Why? B/c you get tuned out after a while. In fact, the nagging itself may end up being an obstracle for change.

I'm sure ProZackMI can attest to this...

I believe ODs spend much more time with patients on average than other professionals. Locally there are a few realists who tell it like it is, but I would say most don't.


The problem with optometry is you have to be overly nice to everyone because there is such an oversupply, so I think it would be much easier for an overbooked physician to say it how it is.

 

[hello07]

totally agree with IndianaOD and his comments. we ODs spend way too much time with our patients, whether it is examining them or just shooting the wind with them. I'm always so nice to all my patients not b/c I want to but that is just my nature. Makes me sick sometimes to realize how nice I am with people and how rude, disrespectful, or mean they can be back.
Did we create this mess? are we our own enemy?

 

[ProZackMI]

totally agree with IndianaOD and his comments. we ODs spend way too much time with our patients, whether it is examining them or just shooting the wind with them. I'm always so nice to all my patients not b/c I want to but that is just my nature. Makes me sick sometimes to realize how nice I am with people and how rude, disrespectful, or mean they can be back.
Did we create this mess? are we our own enemy?

Maybe it's the area you practice in? Usually, in my experience in medicine and law, if you're nice to your patients/clients, they are usually nice to you.

However, NOT always. Understandably, some people don't like seeing doctors, and psychiatrists are often avoided until a problem gets significant. No one likes seeing lawyers either, so some people are defensive. If they are rude, I give it back to them or remind them that I'm not their spouse.

I can't imagine being rude to an optometrist. There's hardly ever a wait in an ODs office, the exam is painless and not embarrassing, and most ODs are friendly. What's to be rude about? Maybe it's your staff? I hate bitchy little receptionists. I have fired many for having a power-play attitude.

 

[IndianaOD]

Maybe it's the area you practice in? Usually, in my experience in medicine and law, if you're nice to your patients/clients, they are usually nice to you.

However, NOT always. Understandably, some people don't like seeing doctors, and psychiatrists are often avoided until a problem gets significant. No one likes seeing lawyers either, so some people are defensive. If they are rude, I give it back to them or remind them that I'm not their spouse.

I can't imagine being rude to an optometrist. There's hardly ever a wait in an ODs office, the exam is painless and not embarrassing, and most ODs are friendly. What's to be rude about? Maybe it's your staff? I hate bitchy little receptionists. I have fired many for having a power-play attitude.

Try telling a vision plan patient with a $10 co-pay that their diabetic exam should be filed with their medical insurance with a $30 copay. This petty crap is where it gets ugly. 😱 The dual "insurance" situation of optometry causes big problems b/c nobody understands the vision plan is only for refractive conditions. I love it when a 65 yo glaucoma patient with diabetic retinopathy, cataracts and dry eye swears the vision plan covers his detailed medical eye exam.

It also gets ugly in the optical with people who don't understand you are trying to help them.