Any docs/students have a similar experience?

[deleted1174449]

Edit: It looks like I was being melodramatic and as long as I study my butt off for step 1 it'll be fine. Thanks all for the encouragement. Gonna leave this post here for future readers/philosophical discussion

Sorry for the throwaway, don't want my admin to flame me in my MSPE. Although they're actually great folks. But nobody likes being criticized. And sorry for the text wall.

Anyways, I've lost faith in my medical school. It's low-tier USMD with nice profs, but the last couple years we've had 10-20% of our classes fail step 1. I've been doing some boards prep with school, so I'll probably be fine, but it's just a little shocking that nobody told my class this until a few months before step (we're on an abbreviated curriculum, so about to take step 1 after Christmas). Most of my class just trusted my school's curriculum over UFAPS, and we have mandatory class 20-30 hours a week, so I doubt people are going to be able to catch up with the step-relevant stuff. It's looking like my class will also have a high boards fail rate, and hopefully the M1s after us will heed our warnings to do AnKing/Boards and Beyond/etc.

The thing that really bothers me is that, at this stage in my training, I don't feel like I'm learning stuff that will make me a physician. I feel like I'm regurgitating somewhat useless science factoids (evolutionary biology of an organ system for example) to pass exams, and then immediately braindumping all but the board relevant material. I don't think this would bother me if I wanted to be a subspecialist, but because I want to be a PCP/hospitalist, I think I actually should know a decent bit of whole-body anatomy, physiology, pharmacology, etc and retain it for my future job. (I'm not flaming specialists. I'm just saying I don't feel like I'm allowed to forget really any of this preclinical stuff to be a generalist, and that I'm worried I won't be able to catch up as a resident).

My question is: if I PASS (not crush and do great, but pass) step 1 and step 2, and go to an okayish community IM/FM/peds residency, will I end up being a competent clinician in the end? Have any of you docs experienced this? I'm just worried my USMD school isn't training me adequately. Nothing I can do about it now, but wondering if anyone has had this experience and whether it shook out good/bad.

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[pyrrion89]

If NPs can practice medicine, then even a low-quality MD/DO school + residency is WAAAAY better. I would not worry at all. Also, at least 50% of what you learn at any medical school is useless to clinical practice, so it is what it is.

 

[LunaOri]

Sometimes community programs have the best training, if what you want is to be a practicing physician (not in academics). They tend to be very hands-on, and you don't have med students and fellows, so the attendings have more time with you.

 

[operaman]

Have no fear my friend, you are going to be just fine. Learning medicine is a bit like learning any art - it’s a long process and there is graduated responsibility as competence grows. Just like every beginner pianist has been frustrated by learning their scales, struggling to understand how they will get from that point to one day playing Liszt, so too do medical students have a hard time seeing how relevant what they’re doing really is.

I definitely remember having similar thoughts. What’s funny now is I’ll sometimes overhear students mentioning some obscure factoid and lamenting its useless, yet I know it’s actually a pretty useful piece of info that’s going to keep coming back in real practice.

Preclinical years are really for learning the language of medicine. The wards and residency/fellowship are where you learn the art itself.

Your board failure rate is definitely a big issue. I’d be curious how high it was prior to unscored step one. I know many schools have seen similar spikes in failures, so you are wise to supplement with boards study materials just like we used to do when s1 was scored.

 

[mrbreakfast]

My question is: if I PASS (not crush and do great, but pass) step 1 and step 2, and go to an okayish community IM/FM/peds residency, will I end up being a competent clinician in the end?

How M2 year is going for you has almost no bearing on this. It's mostly residency and the effort you put into it.

I view preclinical learning, and all the basic science stuff, similarly to the old adage on calculus and other advanced mathematics - it may be hard to see how you'll use it, but that's because you don't know how to apply it until you know it. And if you want to do IM or peds, you'll be expected to know at least some things from your preclinical years in residency. You don't have to dedicate embryology to heart, necessarily, but try to learn things, not just cram for tests and forget. Ultimately, keep in mind that med school is an opportunity to learn; you won't get all the knowledge you need just by following a syllabus. What differentiates med students from each other, in part, is the learning they do outside of the powerpoints they're given.

 

[Goro]

Anyways, I've lost faith in my medical school. It's low-tier USMD with nice profs, but the last couple years we've had 10-20% of our classes fail step 1.

That's concerning, but I'll wafer it's due to the students not taking Step I seriously after it went to P/F. My own school, and others, saw a drop in pass rates for COMLEX

I've been doing some boards prep with school, so I'll probably be fine, but it's just a little shocking that nobody told my class this until a few months before step (we're on an abbreviated curriculum, so about to take step 1 after Christmas). Most of my class just trusted my school's curriculum over UFAPS,

Mistake #1.
You have to be an active learner and use other resources. In addition to UFAPFS, consider Boards and Beyond, and Amboss.

and we have mandatory class 20-30 hours a week,

Mandatory labs? Or lectures? If the latter, what penal colony do you attend???!!!

so I doubt people are going to be able to catch up with the step-relevant stuff.

Why not? You have what, 4-6 weeks of dedicated for Step I study, and it's not even the end of September!

It's looking like my class will also have a high boards fail rate,

Proactive students will not let this happen. Tell your classmates to quit sitting on their asses.

The thing that really bothers me is that, at this stage in my training, I don't feel like I'm learning stuff that will make me a physician.

You're learning the foundations. Once you get to residency and practice, you'll see where it pops up in the "this makes sense".

I feel like I'm regurgitating somewhat useless science factoids (evolutionary biology of an organ system for example)

Now that is straight up useless for a med student! While this subject was actually part of my thesis project, and I love the subject, I would never inflict that on my students!

So tell your profs that this is not relevant for Boards nor Wards.

My question is: if I PASS (not crush and do great, but pass) step 1 and step 2,

You can't crush Step I because it's P/F. Just strive to do your best, and more importantly, take it seriously.

and go to an okayish community IM/FM/peds residency, will I end up being a competent clinician in the end?

YES!!!!!!!!!

 

[deleted1174449]

Sometimes community programs have the best training, if what you want is to be a practicing physician (not in academics). They tend to be very hands-on, and you don't have med students and fellows, so the attendings have more time with you..

Definitely not against a community program actually that's probably where I'll land regardless. Thanks doc!

 

[deleted1174449]

If NPs can practice medicine, then even a low-quality MD/DO school + residency is WAAAAY better. I would not worry at all. Also, at least 50% of what you learn at any medical school is useless to clinical practice, so it is what it is.

I forgot this until you mentioned it but that 50% rule was thrown out at my white coat ceremony. It seems I'm being dramatic.

 

[deleted1174449]

How M2 year is going for you has almost no bearing on this. It's mostly residency and the effort you put into it.

I view preclinical learning, and all the basic science stuff, similarly to the old adage on calculus and other advanced mathematics - it may be hard to see how you'll use it, but that's because you don't know how to apply it until you know it. And if you want to do IM or peds, you'll be expected to know at least some things from your preclinical years in residency. You don't have to dedicate embryology to heart, necessarily, but try to learn things, not just cram for tests and forget. Ultimately, keep in mind that med school is an opportunity to learn; you won't get all the knowledge you need just by following a syllabus. What differentiates med students from each other, in part, is the learning they do outside of the powerpoints they're given.

Interesting. Duly noted. We do have cases we work through, sims, grand rounds, etc, and I put great effort into those. Guess I just need to trust the process more. Thank you doctor

 

[deleted1174449]

Have no fear my friend, you are going to be just fine. Learning medicine is a bit like learning any art - it’s a long process and there is graduated responsibility as competence grows. Just like every beginner pianist has been frustrated by learning their scales, struggling to understand how they will get from that point to one day playing Liszt, so too do medical students have a hard time seeing how relevant what they’re doing really is.

I definitely remember having similar thoughts. What’s funny now is I’ll sometimes overhear students mentioning some obscure factoid and lamenting its useless, yet I know it’s actually a pretty useful piece of info that’s going to keep coming back in real practice.

Preclinical years are really for learning the language of medicine. The wards and residency/fellowship are where you learn the art itself.

Your board failure rate is definitely a big issue. I’d be curious how high it was prior to unscored step one. I know many schools have seen similar spikes in failures, so you are wise to supplement with boards study materials just like we used to do when s1 was scored.

This is comforting. I honestly think my schools' classes (and me) have just swung too far in the direction of not stressing over step at all. I'll definitely be hitting UEarth and etc until Christmas. Thanks doc!

 

[deleted1174449]

That's concerning, but I'll wafer it's due to the students not taking Step I seriously after it went to P/F. My own school, and others, saw a drop in pass rates for COMLEX

Mistake #1.
You have to be an active learner and use other resources. In addition to UFAPFS, consider Boards and Beyond, and Amboss.

Mandatory labs? Or lectures? If the latter, what penal colony do you attend???!!!

Why not? You have what, 4-6 weeks of dedicated for Step I study, and it's not even the end of September!

Proactive students will not let this happen. Tell your classmates to quit sitting on their asses.

You're learning the foundations. Once you get to residency and practice, you'll see where it pops up in the "this makes sense".

Now that is straight up useless for a med student! While this subject was actually part of my thesis project, and I love the subject, I would never inflict that on my students!

So tell your profs that this is not relevant for Boards nor Wards.

You can't crush Step I because it's P/F. Just strive to do your best, and more importantly, take it seriously.

YES!!!!!!!!!

Thanks for the detailed and encouraging post Goro!

Yeah.... I'll get off my ass and lovingly encourage my colleagues to do the same.

 

[Ho0v-man]

You don’t feel like you’re well-prepared to be a physician because you’re still training to be a physician.

I thought my school was doing a terrible job preparing me for residency. No one complained louder than me.

Now that I’m out, I realize my training was pretty great minus the Covid hiccups. You really can’t judge anything besides board prep at this stage, unfortunately. And my school was terrible for that.

The biggest mistake your class made was trusting the curriculum for boards. If you have lectures from clinical faculty that finished IM residency this year, that means that they took step 1 like 5 years ago. That’s the best case scenario. Your non-clinical faculty haven’t taken it at all. There’s no way for them to be more up to date than board review resources.

 

[deleted1174449]

You don’t feel like you’re well-prepared to be a physician because you’re still training to be a physician.

I thought my school was doing a terrible job preparing me for residency. No one complained louder than me.

Now that I’m out, I realize my training was pretty great minus the Covid hiccups. You really can’t judge anything besides board prep at this stage, unfortunately. And my school was terrible for that.

The biggest mistake your class made was trusting the curriculum for boards. If you have lectures from clinical faculty that finished IM residency this year, that means that they took step 1 like 5 years ago. That’s the best case scenario. Your non-clinical faculty haven’t taken it at all. There’s no way for them to be more up to date than board review resources.

It's absolutely insane to me, like bizarre to me, that after admin admitting (props to them for their transparency) to my class the board failure rate has been high, my classmates still telling me how crazy I am for suggesting people do Pathoma and sketchy micro/pharm. And a pass of UWorld.

Like that ain't grinding as hard as you guys did when it was scored, that's just the basics. I was foolish enough before the failure rate news to think I didn't even have to do that, but here we are. I'll make it

You're right, I have no idea how to judge my curriculum for clinical competency since I know nothing about clinical medicine. I appreciate the reassurance from all you guys that it'll work out.

 

[DOVinciRobot]

Pre-clinical is for learning all of the names and functions of the buttons and knobs for the jet.

Clinical years are for learning how to they interact with each other and getting to have some excitement of seeing how it feels to push one.

Residency is where you learn to fly the jet.

Unfortunately I don’t have much sympathy for high fail rates. I have personally seen how little students prepare for Step 1 now compared to how my cohort did now that it is P/F. It’s orders of magnitude less.

You’ll learn and see that a LOT of medicine learning is self driven.

 

[mrbreakfast]

It's absolutely insane to me, like bizarre to me, that after admin admitting (props to them for their transparency) to my class the board failure rate has been high, my classmates still telling me how crazy I am for suggesting people do Pathoma and sketchy micro/pharm. And a pass of UWorld.

The simple fact is that this speaks more towards the quality of students your school admits than the curriculum (though likely both are to blame). Your program is sharing the failure rate to motivate students.

I don't know how students are preparing for Step 1 these days (where I work, everyone seems to still do Uworld, etc) but the medical school adage still rings true: don't worry about what other people are doing. If you're worried about passing Step 1, there are plenty of old-school study schedules laid out on SDN; why not follow them? At worst, you're building a foundation for the future. You'll have to pass Step 2 and 3, multiple in-service exams, and your boards, the majority of which will require mostly self-directed study. Might as well start now.

 

[Tenk]

Don’t worry. Every time I slam droperidol into one of my meth infested cyclical vomiting regulars, I think about the Krebs Cycle and use that knowledge to save their life.

 

[Ho0v-man]

Pre-clinical is for lesrning all of the names and functions of the buttons and knobs for the jet.

Clinical years are for learning how to they interact with each other and getting to have some excitement of seeing how it feels to push one.

Residency is where you learn to fly the jet.

Unfortunately I don’t have much sympathy for high fail rates. I have personally seen how little students prepare for Step 1 know compared to how my cohort did now that it is P/F. It’s orders of magnitude less.

You’ll learn and see that a LOT of medicine learning is self driven.

Kids these days…*shakes fist at clouds*