Are American Doctors "Too Educated?"

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thegreengreatdragon

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Interesting op-ed in The Washington Post. Curious what others thought. Not sure if I'm sold on the argument that doctors spend way too much time in school (maybe shaving a year off would be ok?) or that the number of clerkships students do should be reduced, although I do agree with his point that a lot of the research medical that med students do is low-quality padding (quantity over quality) for residency applications.

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Imo the argument that US docs are "too educated" is idiotic and doesn't give credit to the reasons our educational system is set up the way it is. Just work with some midlevels who have shorter educations periods but still go through years of post-UG training and the differences are glaring.

I think the more appropriate argument is "educational waste/bloat" in terms of type of education required and the efficiency of the time spent in school. The first point of this is 'do we really need 4 years of UG education before med school?' I think you could likely cut a year out of UG and require fewer humanities and soft science courses and churn out the same quality of physicians. There are also some valid arguments for shortening med school due to inefficient periods like spring of M4 which is basically a 4 month vacation/waste of time for many students. Some people also make the argument that you can cram first two years into 1.5 years or even 1 year. I personally don't like this and feel like it would have been disastrous for me personally as it would have likely destroyed my relationship/family life or led to me failing out of school, but some people feel like it can be done. Do both of those and you can knock off 1.5-2 yrs of the educational process without a significant difference in outcomes. I do NOT think shortening residency is an appropriate measure. Others may disagree with me, but I think this would legitimately effect the quality of physicians produced and there are already enough crappy docs out there as it is.

My biggest problem with shortening medical education is the loss of maturity by allowing students to enter residency and full practice sooner. It may not seem like much, but in my city there's 2 "traditional" 4-year med schools and a 6-year combined UG/Med school program. There is a very significant difference in maturity levels and life experience from the average student from that school compared to the traditional schools and every attending I've worked with (outside of that school's academic hospital) has noticed it as well. I realize that's a pretty major generalization, but I do think there is truth to it through my own observations as well as those who taught me and other medical students.
 
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Imo the argument that US docs are "too educated" is idiotic and doesn't give credit to the reasons our educational system is set up the way it is. Just work with some midlevels who have shorter educations periods but still go through years of post-UG training and the differences are glaring.

I think the more appropriate argument is "educational waste/bloat" in terms of type of education required and the efficiency of the time spent in school. The first point of this is 'do we really need 4 years of UG education before med school?' I think you could likely cut a year out of UG and require fewer humanities and soft science courses and churn out the same quality of physicians. There are also some valid arguments for shortening med school due to inefficient periods like spring of M4 which is basically a 4 month vacation/waste of time for many students. Some people also make the argument that you can cram first two years into 1.5 years or even 1 year. I personally don't like this and feel like it would have been disastrous for me personally as it would have likely destroyed my relationship/family life or led to me failing out of school, but some people feel like it can be done. Do both of those and you can knock off 1.5-2 yrs of the educational process without a significant difference in outcomes. I do NOT think shortening residency is an appropriate measure. Others may disagree with me, but I think this would legitimately effect the quality of physicians produced and there are already enough crappy docs out there as it is.

My biggest problem with shortening medical education is the loss of maturity by allowing students to enter residency and full practice sooner. It may not seem like much, but in my city there's 2 "traditional" 4-year med schools and a 6-year combined UG/Med school program. There is a very significant difference in maturity levels and life experience from the average student from that school compared to the traditional schools and every attending I've worked with (outside of that school's academic hospital) has noticed it as well. I realize that's a pretty major generalization, but I do think there is truth to it through my own observations as well as those who taught me and other medical students.
Maybe that's the answer. Require the standard pre-reqs and MCAT, but require that you be X years old to matriculate and Y years old by graduation.
 
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So one of my biggest issues with this is the author's assertion that students shouldn't be learning things that they won't directly be doing in the future. I don't see why a radiologist knowing about skin disorders is a waste. Ultimately, it's all medicine, isn't it? As a second-generation immigrant, I know a lot of FMGs (of which my dad is one) who did the roughly 10 years of training for medicine in their home countries, and they have generally told me that they think the system here produces better doctors. I think it goes back to the general education question that comes up a lot in high school and college. Is being well-rounded worth it? I actually do think so, and I think it's remarkable that doctors who didn't have the chance to do that think it's a real advantage.

I do agree with Stagg's assertion that there's a lot of educational bloat that could probably be streamlined, but I can't imagine that would be a really significant difference in terms of time spent in school. 1 year off? Maybe 2?

Also, if we did end up doing what the author suggests, what would the difference between a doctor and a PA be?
 
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Needing a bachelor's for med school is silly.

I don't think any other developed country is like that but us.
 
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My biggest problem with shortening medical education is the loss of maturity by allowing students to enter residency and full practice sooner. It may not seem like much, but in my city there's 2 "traditional" 4-year med schools and a 6-year combined UG/Med school program. There is a very significant difference in maturity levels and life experience from the average student from that school compared to the traditional schools and every attending I've worked with (outside of that school's academic hospital) has noticed it as well. I realize that's a pretty major generalization, but I do think there is truth to it through my own observations as well as those who taught me and other medical students.

Yes, there is a big difference between a non-trad and a trad in terms of life experience. Those 6-year combined kids are still going off to residency and becoming doctors, despite the judgements about their maturity that older people may have.

Who does the federal government want to train? Somebody who is going to be a doctor for 45+ years (somebody who is 20 starting medical school) or somebody who is going to be in practice for 30 years (say a non-trad starting at 35)?

Maybe that's the answer. Require the standard pre-reqs and MCAT, but require that you be X years old to matriculate and Y years old by graduation.

LOL. C'mon, man. Are there 6-year BS/MD kids getting kicked out of school for their immaturity routinely? We don't age restrict almost any profession, why would we start now?


In regards to the rest of the op-ed: Get rid of bachelor's degree requirement. If people want to get bachelor's that's fine and won't be looked down upon, but it shouldn't be a requirement to get into medical school. That trims 2 years. Take pre-reqs, do MCAT. Can trim medical school down to 3 years successfully. Residency shouldn't be touched.

Of course, the author doesn't mention that at the end of those 10 years in other countries, you're generally still not at the top of the totem pole (as you'll be a registrar and not a consultant) versus here it'll be just you.
 
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Needing a bachelor's for med school is silly.

I don't think any other developed country is like that but us.

There is also a significant difference between the quality and expectations of a high school education in those countries than in the US though. The average high school graduate in the US has a 7th grade reading level and the average college freshman has a 9th grade reading level. That's pathetic and something that you just don't see in other first-world countries. A full bachelor's may not be necessary, but the poor outcomes of the primary and secondary education systems in the US implicate that a more rigorous vetting process is necessary here than in other countries which start medical school earlier.

LOL. C'mon, man. Are there 6-year BS/MD kids getting kicked out of school for their immaturity routinely?

Actually, yes. The 6-year school I'm referring to had a 21% attrition rate according the last report from the school I saw (I believe a 2015 report), which is absurdly high compared the the US average of around 5-6%.
 
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The Decline and Fall of WaPo
 
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Yes, there is a big difference between a non-trad and a trad in terms of life experience. Those 6-year combined kids are still going off to residency and becoming doctors, despite the judgements about their maturity that older people may have.

Who does the federal government want to train? Somebody who is going to be a doctor for 45+ years (somebody who is 20 starting medical school) or somebody who is going to be in practice for 30 years (say a non-trad starting at 35)?



LOL. C'mon, man. Are there 6-year BS/MD kids getting kicked out of school for their immaturity routinely? We don't age restrict almost any profession, why would we start now?


In regards to the rest of the op-ed: Get rid of bachelor's degree requirement. If people want to get bachelor's that's fine and won't be looked down upon, but it shouldn't be a requirement to get into medical school. That trims 2 years. Take pre-reqs, do MCAT. Can trim medical school down to 3 years successfully. Residency shouldn't be touched.

Of course, the author doesn't mention that at the end of those 10 years in other countries, you're generally still not at the top of the totem pole (as you'll be a registrar and not a consultant) versus here it'll be just you.
I was being quite sarcastic.

Interestingly, a bachelor's isn't actually a requirement at lots of places. It wasn't at my school, you just needed the usual pre-reqs and 90 credit hours.
 
Interesting op-ed in The Washington Post today. Curious what others thought. Not sure if I'm sold on the argument that doctors spend way too much time in school (maybe shaving a year off would be ok?) or that the number of clerkships students do should be reduced, although I do agree with his point that a lot of the research medical that med students do is low-quality padding (quantity over quality) for residency applications.

The op-ed in question actually appeared four days ago, and I'm surprise it took this long to appear on SDN. I read it with some bemusement, but I can understand the author's feelings. When you're a resident it is easy to feel exhausted by the training process, and you are desperate to move on and get full autonomy and a real paycheck. That said, I find Dr. Pathipati's opinion to be a bit myopic.

Now that I'm 10+ years post-residency, I am eternally grateful that I received a Bachelor's degree before going to medical school. A decent liberal arts education is a powerful thing. After medical practice became somewhat routine I actually found more interest and engagement in topics that I would never have been exposed to outside of college.

Shortening medical school is possible, but it rests on the supposition that an M1 knows what he/she will go into (typically primary care). Could you cram the basic sciences into one year, the core clerkships into one year, and have a third year of electives and residency interviews? Sure, welcome to PA school. I know medical school isn't one-size-fits-all, but it does have to be one-size-fits-most. And that includes people who don't figure out what they want to do until October of M4. And those that need three away electives to impress. And those that need two ICU sub-Is to swim come intern year.

Perhaps I am wrong, but I suspect the author's views on physician education will soften over the years.
 
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I say there should be more 2 year undergrad-to-med school programs, but other than that I feel like it's about right.

in fact, as computer science and technology play more and more a role in medicine there may even be a push for more CS education among doctors.. who knows
 
Bloated? Yes. Too much education? No such ****ing thing in medicine.

If physicians were too educated, I wouldn't have to deal with the endless ****ty imaging studies they order.

With that said, I agree that the unwritten research requirement is a trash generator. Then again, 90% of the studies out there are "garbage in, garbage out" anyway.
 
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I also feel like the author's complaints about the process are largely a product of choices rather than requirements.

I am also not certain how shortening training is supposed to yield more physicians without expanding GME. We are also sorely lacking enough quality clerkship site for the students currently in the system. Pile on thousands more and we'll be in a world of hurt.
 
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There is also a significant difference between the quality and expectations of a high school education in those countries than in the US though. The average high school graduate in the US has a 7th grade reading level and the average college freshman has a 9th grade reading level. That's pathetic and something that you just don't see in other first-world countries. A full bachelor's may not be necessary, but the poor outcomes of the primary and secondary education systems in the US implicate that a more rigorous vetting process is necessary here than in other countries which start medical school earlier.

I'd say the US education system is somewhat unique compared to other developed nations in that it tries to prepare all high school graduates to be "generalists" rather than have them decide/test into specific "tracks" (like science vs humanities vs vocational) during their high school years or before. Most other countries have some sort of system of segregating their secondary education; Germans have their gymnasiums and Abitur, UK with A levels, South Korea with hagwon and tracks in high school, Japan has juku and high school entrance exams, etc. The upside is that in the US many get a more "well rounded" education that supposedly leads to our better innovations and adaptability, the downside is that it takes a few more years of specialized education.

I think it goes back to the idea/dream that in the US you can be anything you want to be, and even if the first time around you don't perform/pick wisely you will always have another chance. Look at the number of nontraditional applicants to med school, you don't really see that in other developed countries where if you weren't on the right track from the start it's nearly impossible to try again.
 
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Although I disagree with his theses on medical education, I'd like to hear @Perrotfish chime in on this. I believe that he pointed out that the reasons surgery is required is because doctors had to be handy with the bone saw for amputations 100 years ago out on the farm, or something like that.
Ahhh....found it!
Med School is Broken
 
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A couple of years (2) can be shaved off easily. 3 years prereq and 3 years of med school. Not sure about residency itself.
 
I'd say the US education system is somewhat unique compared to other developed nations in that it tries to prepare all high school graduates to be "generalists" rather than have them decide/test into specific "tracks" (like science vs humanities vs vocational) during their high school years or before. Most other countries have some sort of system of segregating their secondary education; Germans have their gymnasiums and Abitur, UK with A levels, South Korea with hagwon and tracks in high school, Japan has juku and high school entrance exams, etc. The upside is that in the US many get a more "well rounded" education that supposedly leads to our better innovations and adaptability, the downside is that it takes a few more years of specialized education.

I think it goes back to the idea/dream that in the US you can be anything you want to be, and even if the first time around you don't perform/pick wisely you will always have another chance. Look at the number of nontraditional applicants to med school, you don't really see that in other developed countries where if you weren't on the right track from the start it's nearly impossible to try again.

This is a very valid point, but it doesn't address the significant differences in outcomes of high school graduates in the US compared to other countries. I do see the upsides to the US system for those who successfully complete it at the expected level of competency/education. However, a broader and more well-rounded education is meaningless when you're at a level 6 years behind where you're expected to be upon completion.
 
I think the easiest place to cut would be at the undergraduate stage. We teach too many things that aren't particularly useful and have too much room to "explore." Cut undergraduate training down to two years for medicine then cut preclinical training down to one year (some schools already do that) and you'll have shaved three years off. I don't think that cutting time in the clinical years or residency is the way to go though because that's the only way to build your experience base.
 
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I think that you definitely need some sort of undergraduate education, because that's where a lot of the weeding out happens. Otherwise you'd just have a bunch of high schoolers, with no inkling of what they want to do or knowledge of how hard a rigorous science course load can be, applying and clogging up the application pipeline. You need a challenge to apply yourself in undergrad to understand what it takes to get into and through med school. You don't really get that in high school nor is anyone really ready to take on that challenge at the high school level (unless you're a child prodigy who was reading books in the womb).

Plus, undergrad is where a lot of maturation happens, on a personal and intellectual level. I didn't know **** about anything coming out of high school and really needed to grow up. After thinking about it, the only thing I would suggest in terms of shortening is allowing med students to matriculate to med school after their junior year of college -- that is, forgo their final year of undergrad if they completed all other requirements and pre-requisites -- if they feel ready, and give others the choice to wait if they wish to. Some med schools already do this kind of head start program.
 
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If I had to apply to medical school directly from high school, I never would have gotten in, so there's that. I think it's important to demonstrate strong aptitude in college-level science classes before med school. The physiology we learn can be conceptually difficult, involving concepts from physics, chemistry and biochem, and AP classes (or what ever classes the smart kids take) in high school don't seem like sufficient preparation for the rigors of med schools. College also gives you the opportunity to gain clinical experience to see if medicine is right for you. Some very high performing students decide it isn't, having worked in a clinical setting. I don't think think it would be a good idea to hire 14-16 year olds to work as scribes and do basic science research. The last half of year 4 or so could be eliminated if you're in a program that matches you directly to residency, bypassing the lengthy application process, though.
 
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I would advocate for reducing the preclinical years of med school down to 1.5 yrs. A good chunk of what I learned during those pre-clinical 2 years is basically complementary Ph.D. level research that doesn't really translate well into the clinical setting (and also wasn't tested at all on the USMLE exams). You can then replace that 0.5 yr difference with more clinical experiences instead. I wouldn't change anything else in regards to the length of undergrad years or the clinical years of med school, residency, etc. I didn't really think about medicine until senior year of college, and I don't regret taking it a little slow to make that decision.
 
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Actually, yes. The 6-year school I'm referring to had a 21% attrition rate according the last report from the school I saw (I believe a 2015 report), which is absurdly high compared the the US average of around 5-6%.
Is that attrition including people who drop out during the undergrad portion, because if so it's not really fair to count that considering how few pre-meds actually make it to med school. If the med school portion is actually 21%, that's insane and I would wonder why the school hasn't shut the program down already.

I did an accelerated program and our med school attrition rate is nearly zero. With how selective our program is from high school and the undergrad GPA/MCAT requirements, we tend to get people with a strong track record of high academic performance who do fine in med school. Sure, there are some immature idiots in the group, but that's true for med school as a whole. If there really was such a systematic issue with BS/MD programs, higher-ranked med school programs which have been running for decades would have shut down a long time ago considering how competitive the admissions process has gotten and how easy it would be for any US MD school to fill those seats with traditional applicants.

The programs that have actually been shutting down in recent years are the lower-tier med school affiliated ones, and anecdotally I have heard of there being issues with excessive partying and dropping out at some of those programs, but even that was at the undergraduate level. Despite that, there are also a handful of newer program that have popped up in recent years as well, so overall I don't think they're going anywhere.
 
This joker is misrepresenting his credentials. He is currently a transitional intern, not a ophthalmology resident yet. An intern 1 month into residency is not exactly an expert in medical education or what radiology residents should know. I can see the value of a dermatology rotation for radiologists.

His analysis of NYU's three year program is very superficial as well. It's a subset of the student body and there's no guarantee that you're comparing an equivalent three year to four year student when looking at grades.
 
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This is a very valid point, but it doesn't address the significant differences in outcomes of high school graduates in the US compared to other countries. I do see the upsides to the US system for those who successfully complete it at the expected level of competency/education. However, a broader and more well-rounded education is meaningless when you're at a level 6 years behind where you're expected to be upon completion.

Can you link the studies? I'm very interested in what exactly they were comparing.

I alluded to it in my post but it's not an apple to apples comparison. In the US for the most part "high school" is high school, most everyone who graduates from junior high/middle school/etc (at grade 8) goes on to a high school (grades 9-12). And there's also no national exit exam, it's entirely possible to mercy pass through high school if that's what your school wants. The worst high school graduate still has the chance to attend post-secondary education via community college/etc if they want to.

In comparison many other countries segregate students into different tracks by the time they are in "high school" and only some are them will be eligible for post-secondary education. Germany for example has traditional had 3 different types of "high school" that they are divided into in 5th grade based on their abilities (and as some allege based on their parents background), only 1 of which really leads to college/university. Japan doesn't even have compulsory high school and requires students to take entrance exams for high school. China is similar with their junior/senior high school system. Also many countries have a national exit exam that they need to pass if they are to be considered "high school" graduates and eligible to attend college/university (A levels, Abritur, Matriculation Exam; in the US only 13 states have exit exams).

PS I don't necessarily agree with you, I think in the US we sell too many dreams and not enough reality, especially to children vs other countries where they may learn early on that they'll never go on to college/university/med school but other side is that in many developed countries ditch digging still provides a guaranteed retirement. But I'd argue that's also our strength and what makes us unique.
 
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Is that attrition including people who drop out during the undergrad portion, because if so it's not really fair to count that considering how few pre-meds actually make it to med school. If the med school portion is actually 21%, that's insane and I would wonder why the school hasn't shut the program down already.

I did an accelerated program and our med school attrition rate is nearly zero. With how selective our program is from high school and the undergrad GPA/MCAT requirements, we tend to get people with a strong track record of high academic performance who do fine in med school. Sure, there are some immature idiots in the group, but that's true for med school as a whole. If there really was such a systematic issue with BS/MD programs, higher-ranked med school programs which have been running for decades would have shut down a long time ago considering how competitive the admissions process has gotten and how easy it would be for any US MD school to fill those seats with traditional applicants.

The programs that have actually been shutting down in recent years are the lower-tier med school affiliated ones, and anecdotally I have heard of there being issues with excessive partying and dropping out at some of those programs, but even that was at the undergraduate level. Despite that, there are also a handful of newer program that have popped up in recent years as well, so overall I don't think they're going anywhere.

I would generally agree with this. I was a BS/MD graduate and my classmates and I were all extremely successful both professionally and personally. I would say the one or two immature folks in my class of about 20 grew out of it quickly in residency (it was usually more emotional immaturity) and that there were plenty of traditional applicants who were in my medical school class of varying ages who had plenty of immaturity. I think it’s a huge false stereotype that going to one of these programs reflects a predisposition immaturity of any sort. We were usually the top of our high school class and had strong standardized test scores but also I would say we all (mostly) had exhibited some form of interest in medicine previously. Most of us went into clinical fields involving direct patient care (IM, EM, surgery, various surgical subspecialties, etc) and a rare few actually hated direct patient care and went into rads/path. Our attrition rate is exceedingly low and only one person I know of dropped out of the program - and that was to pursue a PhD. There are definitely crappy BS/MD programs out there which have a higher attrition rate but they’re in the minority.

As to whether our training is too long - I am somewhat ambivalent about this. Truncating a year of undergrad didn’t make me less prepared for medical school or life. I don’t think I would shorten the length of medical school.
 
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This joker is misrepresenting his credentials. He is currently a transitional intern, not a ophthalmology resident yet. An intern 1 month into residency is not exactly an expert in medical education or what radiology residents should know. I can see the value of a dermatology rotation for radiologists.

His analysis of NYU's three year program is very superficial as well. It's a subset of the student body and there's no guarantee that you're comparing an equivalent three year to four year student when looking at grades.

A transitional year? That’s like an extended elective fourth year. This guy has no idea about real clinical medicine hahahaha
 
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I would generally agree with this. I was a BS/MD graduate and my classmates and I were all extremely successful both professionally and personally. I would say the one or two immature folks in my class of about 20 grew out of it quickly in residency (it was usually more emotional immaturity) and that there were plenty of traditional applicants who were in my medical school class of varying ages who had plenty of immaturity. I think it’s a huge false stereotype that going to one of these programs reflects a predisposition immaturity of any sort. We were usually the top of our high school class and had strong standardized test scores but also I would say we all (mostly) had exhibited some form of interest in medicine previously. Most of us went into clinical fields involving direct patient care (IM, EM, surgery, various surgical subspecialties, etc) and a rare few actually hated direct patient care and went into rads/path. Our attrition rate is exceedingly low and only one person I know of dropped out of the program - and that was to pursue a PhD. There are definitely crappy BS/MD programs out there which have a higher attrition rate but they’re in the minority.

As to whether our training is too long - I am somewhat ambivalent about this. Truncating a year of undergrad didn’t make me less prepared for medical school or life. I don’t think I would shorten the length of medical school.
I think it is really program specific. Out of high school I had interviewed at a few combined programs. The one I got into only took a handful of students (15 I think?) and had an attrition rate of 50%!!

I believe about half of that 50 dropped out to apply to other schools. Though this was almost 7 years ago at this point
 
Is that attrition including people who drop out during the undergrad portion, because if so it's not really fair to count that considering how few pre-meds actually make it to med school. If the med school portion is actually 21%, that's insane and I would wonder why the school hasn't shut the program down already.

I did an accelerated program and our med school attrition rate is nearly zero. With how selective our program is from high school and the undergrad GPA/MCAT requirements, we tend to get people with a strong track record of high academic performance who do fine in med school. Sure, there are some immature idiots in the group, but that's true for med school as a whole. If there really was such a systematic issue with BS/MD programs, higher-ranked med school programs which have been running for decades would have shut down a long time ago considering how competitive the admissions process has gotten and how easy it would be for any US MD school to fill those seats with traditional applicants.

The programs that have actually been shutting down in recent years are the lower-tier med school affiliated ones, and anecdotally I have heard of there being issues with excessive partying and dropping out at some of those programs, but even that was at the undergraduate level. Despite that, there are also a handful of newer program that have popped up in recent years as well, so overall I don't think they're going anywhere.

Most attrition occurred in the first two years and the med school attrition rate is ~8% for the last 4 years. Problem is those individuals are on a fast-track with classes geared specifically towards preparing them for medical school curriculum and not much else. I've interacted with a few of the drop-outs from the program and they said they basically had to either apply to other medical schools (not promising since they struggled with the UG portion of that program) or retake a bunch of classes and extend their UG education for some other field. Not the end of the world, but not really a promising model to set up.

Can you link the studies? I'm very interested in what exactly they were comparing.

I can look for them. It's been a while since I looked into it but basically they showed that the US lags significantly behind other countries in math and science and relatively average when it comes to reading.

PS I don't necessarily agree with you, I think in the US we sell too many dreams and not enough reality, especially to children vs other countries where they may learn early on that they'll never go on to college/university/med school but other side is that in many developed countries ditch digging still provides a guaranteed retirement. But I'd argue that's also our strength and what makes us unique.

Not sure where we disagree then, since I think we're very unrealistic about the what many individuals in the US are capable of achieving academically and many people end up in college who frankly don't belong there.

I would say the one or two immature folks in my class of about 20 grew out of it quickly in residency

That's a tiny class size and not an adequate cohort to suggest this could be successful on a large scale. There's a huge difference between taking the top 20 students available and saying they can do it vs. all of the first year medical students in the country. The school I'm referring to has class sizes of over 100 students and will never have to meet the criteria that almost every other medical student in the country does (like taking the MCAT, fulfilling full pre-reqs, etc.). Sure, there are people who are fully capable of taking this path, but to suggest that the vast majority of medical students could is a statement I consider naive. I'd also point out that residency when you're treating patients and have their lives in your hand is not a time to be working out significant immaturity. By then you should be a fully functioning adult capable of caring for your patients without coming across as a child (which many traditional residents struggle with as well, but I'm not about to encourage lowering that standard).
 
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There is also a significant difference between the quality and expectations of a high school education in those countries than in the US though. The average high school graduate in the US has a 7th grade reading level and the average college freshman has a 9th grade reading level. That's pathetic and something that you just don't see in other first-world countries. A full bachelor's may not be necessary, but the poor outcomes of the primary and secondary education systems in the US implicate that a more rigorous vetting process is necessary here than in other countries which start medical school earlier.



Actually, yes. The 6-year school I'm referring to had a 21% attrition rate according the last report from the school I saw (I believe a 2015 report), which is absurdly high compared the the US average of around 5-6%.

Is that attrition during the undergraduate portion or during actual medical school. If its just during the undergraduate portion (which I imagine it is) that's less than the average college freshman who says they are premed.
 
Is that attrition during the undergraduate portion or during actual medical school. If its just during the undergraduate portion (which I imagine it is) that's less than the average college freshman who says they are premed.
Yes but regular undergrads hopefully have a major to fall back on. These kids likely don't.
 
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Is that attrition during the undergraduate portion or during actual medical school. If its just during the undergraduate portion (which I imagine it is) that's less than the average college freshman who says they are premed.

Read my post above yours. It still doesn't make any sense for them to enter a program where those credits will essentially be useless once they drop out.
 
Yes but regular undergrads hopefully have a major to fall back on. These kids likely don't.
Read my post above yours. It still doesn't make any sense for them to enter a program where those credits will essentially be useless once they drop out.
You can drop out and complete a degree easily, even in the ones that only require gen ed + medical pre-reqs for those in the program. It's not hard to switch into a regular major and the people I know who quit had no issue graduating in 4 years.
 
First off, I find it stupid, but predictable that it takes an attention-seeking medical resident at Harvard reciting talking points he probably found over the past decade on SDN to finally have this reach mainstream. Also, while it's an op-ed, I feel like a stronger argument could have been made, but I guess the main points were communicated effectively.

Are Doctors in the U.S. over-educated?

If we define over-education as years of schooling, absolutely and I am not even going to entertain anyone who claims that the education we receive is necessary to manage an AKI. I have two issues with the over-education of US Medical Students and both problems are the fault of the US medical education system.

1.) The path to a US M.D. school leads to burn out and insanity. It starts now in middle school where you go to summer camps to learn about science and enroll in advanced math classes. It continues in high school where you kill yourself to get a near 4.0 GPA so you can attend a solid college. You take the SAT/ACT which at that time seems like the one thing that will determine the trajectory of your life. You put undue strain on yourself studying for advanced placement tests to get college credit. You emerge triumphant with your social, athletic, and academic accomplishments in high school to college where you are told everything you did in high means nothing. You slave away for hours in classes to keep that perfect GPA, find time to do activities not for your interest, but to please others, and to do research that you don't even care about. You sacrifice every summer to either do the aforementioned, take the MCAT which now seems like the test that makes or breaks your future, or apply to medical school. You come to medical school and its basically like a new beginning where absolutely 0% of all the skills you've developed over the course of the last 16 years matter and everyone starts anew. People who are good at memorizing or come from medical backgrounds pick things up quicker than others and based on one 8 hour test (which is really the test that actually determines the trajectory of your life...the other two were just whatever...) determine what field are eligible to practice for the next 40 or so years. It doesn't matter that you got a 5 on your all your AP exams and mastered differential equations in high school or submitted 5 publications as an undergraduate student and got an amazing SAT/MCAT score. Score below 240 on this one exam you take based only on 1 year of education out of your last 17 and you're probably not going to be that cardiac surgeon you dreamed of being when you were a kid.

2.) There is so much wasted potential. As U.S. trained physicians, all these liberal arts (history, writing, etc.), technical (computer science, applied physical sciences, etc.), athletic (varsity/collegiate sports), and creative (instruments, acting, etc.) we spent 16 years cultivating before medical school is dumped down the drain. Compared to IMGs, many U.S. medical graduates have far more to contribute to society in general . Many of us come from backgrounds outside of medicine and could write for the NYT, speak 5 languages, design software, and do other amazing things, but what medicine makes us do is forget all that. We're told to study non-stop memorizing useless minutiae or else all of what we did is worthless and then we slave away for 80 hours a week in residency and get old. Instead, medicine needs to find a way to utilize the other 16 years of education and apply it to patient care...or else we may as well be teaching second graders (because I guess you need first grade to learn how to read) that at elevated creatinine means someone has hurt their kidneys and that they either need to inject some fluid in their veins or give them a pill that makes them pee depending on how they look.
 
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First off, I find it stupid, but predictable that it takes an attention-seeking medical resident at Harvard reciting talking points he probably found over the past decade on SDN to finally have this reach mainstream. Also, while it's an op-ed, I feel like a stronger argument could have been made, but I guess the main points were communicated effectively.

Are Doctors in the U.S. over-educated?

If we define over-education as years of schooling, absolutely and I am not even going to entertain anyone who claims that the education we receive is necessary to manage an AKI. I have two issues with the over-education of US Medical Students and both problems are the fault of the US medical education system.

1.) The path to a US M.D. school leads to burn out and insanity. It starts now in middle school where you go to summer camps to learn about science and enroll in advanced math classes. It continues in high school where you kill yourself to get a near 4.0 GPA so you can attend a solid college. You take the SAT/ACT which at that time seems like the one thing that will determine the trajectory of your life. You put undue strain on yourself studying for advanced placement tests to get college credit. You emerge triumphant with your social, athletic, and academic accomplishments in high school to college where you are told everything you did in high means nothing. You slave away for hours in classes to keep that perfect GPA, find time to do activities not for your interest, but to please others, and to do research that you don't even care about. You sacrifice every summer to either do the aforementioned, take the MCAT which now seems like the test that makes or breaks your future, or apply to medical school. You come to medical school and its basically like a new beginning where absolutely 0% of all the skills you've developed over the course of the last 16 years matter and everyone starts anew. People who are good at memorizing or come from medical backgrounds pick things up quicker than others and based on one 8 hour test (which is really the test that actually determines the trajectory of your life...the other two were just whatever...) determine what field are eligible to practice for the next 40 or so years. It doesn't matter that you got a 5 on your all your AP exams and mastered differential equations in high school or submitted 5 publications as an undergraduate student and got an amazing SAT/MCAT score. Score below 240 on this one exam you take based only on 1 year of education out of your last 17 and you're probably not going to be that cardiac surgeon you dreamed of being when you were a kid.

2.) There is so much wasted potential. As U.S. trained physicians, all these liberal arts (history, writing, etc.), technical (computer science, applied physical sciences, etc.), athletic (varsity/collegiate sports), and creative (instruments, acting, etc.) we spent 16 years cultivating before medical school is dumped down the drain. Compared to IMGs, many U.S. medical graduates have far more to contribute to society in general . Many of us come from backgrounds outside of medicine and could write for the NYT, speak 5 languages, design software, and do other amazing things, but what medicine makes us do is forget all that. We're told to study non-stop memorizing useless minutiae or else all of what we did is worthless and then we slave away for 80 hours a week in residency and get old. Instead, medicine needs to find a way to utilize the other 16 years of education and apply it to patient care...or else we may as well be teaching second graders (because I guess you need first grade to learn how to read) that at elevated creatinine means someone has hurt their kidneys and that they either need to inject some fluid in their veins or give them a pill that makes them pee depending on how they look.

There's so much wrong with this post I'm not even going to try to dissect every jacked-up piece of it, so I'll just say this:

The point of an undergraduate degree, any undergraduate degree is, aside from teaching specific subjects for a major that possibly qualifies you for the workforce in general (which is more important now that we no longer have the manufacturing base in this country that a high school diploma would be sufficient for, but to give the recipient of said education a wider understanding of the world, the people in it, how we got here, and where we could go.

One last function of the undergraduate degree vis-vis the physician is to make sure there isn't something else out there that you'd rather do. This is very important.

If you don't have that, what are you? Who are you? Are you someone that looks good for a leadership role? Nope. You're a worker bee. A high-functioning worker bee maybe, but a worker bee nonetheless.

Doctors aren't worker bees. That's not the goal. We have CNA's, RN's/BSN's and PA's for that. They're worker bees. High-level skilled workers. The goal is to have the tools to be a high level decision maker and leader, to be someone that your patients will naturally look at and see some level of accomplishment, which is what imparts the intrinsic authority to which you're hoping your words carry when you advise them about their health decisions. That level of effort that you've put in sets you apart from the skilled employees that carry out your instructions. Those documents hanging on the glory wall behind your desk speak for you.

I think you'll start to see that once you've gotten past training and have lived in the world a while. I don't think you have the life experience to understand the value of everything you've learned so far, because you haven't really applied much of it yet so you don't see the value in a well rounded education.
 
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Saw this last week. The part about research I can agree with.

The rest is just another case of someone believing they can solve the world's problems by virtue of the fact they're at Harvard.
 
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Saw this last week. The part about research I can agree with.

The rest is just another case of someone believing they can solve the world's problems by virtue of the fact they're at Harvard.

Though credit to Mr. Harvard Man for actually pitching his whiny piece to a legit paper for some $$ rather than just dumping his thoughts onto KevinMD or SDN.
 
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Honestly, I hated a lot of my non-science classes in college. I know some say that it makes you "well rounded" and ****, but I felt I could have done without the liberal arts stuff.
 
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I understand the sentiment about streamlining, but this headline is asinine. “I wish my doctor was dumber” — said no one ever.
 
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First off, I find it stupid, but predictable that it takes an attention-seeking medical resident at Harvard reciting talking points he probably found over the past decade on SDN to finally have this reach mainstream. Also, while it's an op-ed, I feel like a stronger argument could have been made, but I guess the main points were communicated effectively.

Are Doctors in the U.S. over-educated?

If we define over-education as years of schooling, absolutely and I am not even going to entertain anyone who claims that the education we receive is necessary to manage an AKI. I have two issues with the over-education of US Medical Students and both problems are the fault of the US medical education system.

1.) The path to a US M.D. school leads to burn out and insanity. It starts now in middle school where you go to summer camps to learn about science and enroll in advanced math classes. It continues in high school where you kill yourself to get a near 4.0 GPA so you can attend a solid college. You take the SAT/ACT which at that time seems like the one thing that will determine the trajectory of your life. You put undue strain on yourself studying for advanced placement tests to get college credit. You emerge triumphant with your social, athletic, and academic accomplishments in high school to college where you are told everything you did in high means nothing. You slave away for hours in classes to keep that perfect GPA, find time to do activities not for your interest, but to please others, and to do research that you don't even care about. You sacrifice every summer to either do the aforementioned, take the MCAT which now seems like the test that makes or breaks your future, or apply to medical school. You come to medical school and its basically like a new beginning where absolutely 0% of all the skills you've developed over the course of the last 16 years matter and everyone starts anew. People who are good at memorizing or come from medical backgrounds pick things up quicker than others and based on one 8 hour test (which is really the test that actually determines the trajectory of your life...the other two were just whatever...) determine what field are eligible to practice for the next 40 or so years. It doesn't matter that you got a 5 on your all your AP exams and mastered differential equations in high school or submitted 5 publications as an undergraduate student and got an amazing SAT/MCAT score. Score below 240 on this one exam you take based only on 1 year of education out of your last 17 and you're probably not going to be that cardiac surgeon you dreamed of being when you were a kid.

2.) There is so much wasted potential. As U.S. trained physicians, all these liberal arts (history, writing, etc.), technical (computer science, applied physical sciences, etc.), athletic (varsity/collegiate sports), and creative (instruments, acting, etc.) we spent 16 years cultivating before medical school is dumped down the drain. Compared to IMGs, many U.S. medical graduates have far more to contribute to society in general . Many of us come from backgrounds outside of medicine and could write for the NYT, speak 5 languages, design software, and do other amazing things, but what medicine makes us do is forget all that. We're told to study non-stop memorizing useless minutiae or else all of what we did is worthless and then we slave away for 80 hours a week in residency and get old. Instead, medicine needs to find a way to utilize the other 16 years of education and apply it to patient care...or else we may as well be teaching second graders (because I guess you need first grade to learn how to read) that at elevated creatinine means someone has hurt their kidneys and that they either need to inject some fluid in their veins or give them a pill that makes them pee depending on how they look.
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First off, I find it stupid, but predictable that it takes an attention-seeking medical resident at Harvard reciting talking points he probably found over the past decade on SDN to finally have this reach mainstream. Also, while it's an op-ed, I feel like a stronger argument could have been made, but I guess the main points were communicated effectively.

Are Doctors in the U.S. over-educated?

If we define over-education as years of schooling, absolutely and I am not even going to entertain anyone who claims that the education we receive is necessary to manage an AKI. I have two issues with the over-education of US Medical Students and both problems are the fault of the US medical education system.

1.) The path to a US M.D. school leads to burn out and insanity. It starts now in middle school where you go to summer camps to learn about science and enroll in advanced math classes. It continues in high school where you kill yourself to get a near 4.0 GPA so you can attend a solid college. You take the SAT/ACT which at that time seems like the one thing that will determine the trajectory of your life. You put undue strain on yourself studying for advanced placement tests to get college credit. You emerge triumphant with your social, athletic, and academic accomplishments in high school to college where you are told everything you did in high means nothing. You slave away for hours in classes to keep that perfect GPA, find time to do activities not for your interest, but to please others, and to do research that you don't even care about. You sacrifice every summer to either do the aforementioned, take the MCAT which now seems like the test that makes or breaks your future, or apply to medical school. You come to medical school and its basically like a new beginning where absolutely 0% of all the skills you've developed over the course of the last 16 years matter and everyone starts anew. People who are good at memorizing or come from medical backgrounds pick things up quicker than others and based on one 8 hour test (which is really the test that actually determines the trajectory of your life...the other two were just whatever...) determine what field are eligible to practice for the next 40 or so years. It doesn't matter that you got a 5 on your all your AP exams and mastered differential equations in high school or submitted 5 publications as an undergraduate student and got an amazing SAT/MCAT score. Score below 240 on this one exam you take based only on 1 year of education out of your last 17 and you're probably not going to be that cardiac surgeon you dreamed of being when you were a kid.

Umm, what? That's not even close to true. OK yes, I'm sure some people take it to that extreme. But its hardly universal. I know it wasn't for me - wasn't even top 10% in high school, took the SAT once and didn't exactly kill it, of the 8 AP classes I took I only passed 4 of them. Went to a good undergrad, but its admission standards are something of a joke.

What about non-traditional students? I'm pretty sure the path you describe pre-med doesn't match theirs.

The mean step 1 score for general surgery has been pretty much the same as the average step 1 score for all comers for the last several years. This means, all other things being equal, that if you're an average medical student you have a very good shot at matching in surgery.

It also means that if you score below average, you still have a good chance (someone has to balance out those 260 scores) if you get good letters and do research. So no, it doesn't all ride on a single 8-hour test so long as you don't do terribly. And let's be honest, if you're a horrible test taker the MCAT would have weeded you out before this point.

2.) There is so much wasted potential. As U.S. trained physicians, all these liberal arts (history, writing, etc.), technical (computer science, applied physical sciences, etc.), athletic (varsity/collegiate sports), and creative (instruments, acting, etc.) we spent 16 years cultivating before medical school is dumped down the drain. Compared to IMGs, many U.S. medical graduates have far more to contribute to society in general . Many of us come from backgrounds outside of medicine and could write for the NYT, speak 5 languages, design software, and do other amazing things, but what medicine makes us do is forget all that. We're told to study non-stop memorizing useless minutiae or else all of what we did is worthless and then we slave away for 80 hours a week in residency and get old. Instead, medicine needs to find a way to utilize the other 16 years of education and apply it to patient care...or else we may as well be teaching second graders (because I guess you need first grade to learn how to read) that at elevated creatinine means someone has hurt their kidneys and that they either need to inject some fluid in their veins or give them a pill that makes them pee depending on how they look.
This is just silly. If you're good at things outside of medicine, you can easily tie the two together.

If you're good at writing, then write. Atul Gawande did it. Jen Gunter currently does write for the Times.

If you speak multiple languages, you'd be a huge asset to mission trips or in areas with a high population of non-English speakers - Texas if you speak Spanish, for example. My office is 100 yards from the state Deaf and Blind school. I'd love a doctor that spoke ASL.

I have a med school classmate who did computer programming before med school. He's a practicing anesthesiologist designing a new EMR on the side.
 
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There is also a significant difference between the quality and expectations of a high school education in those countries than in the US though. The average high school graduate in the US has a 7th grade reading level and the average college freshman has a 9th grade reading level. That's pathetic and something that you just don't see in other first-world countries. A full bachelor's may not be necessary, but the poor outcomes of the primary and secondary education systems in the US implicate that a more rigorous vetting process is necessary here than in other countries which start medical school earlier.



Actually, yes. The 6-year school I'm referring to had a 21% attrition rate according the last report from the school I saw (I believe a 2015 report), which is absurdly high compared the the US average of around 5-6%.

For the first paragraph - Yes, and the people going to medical school aren't in that group. The BS/MD folks definitely aren't average in high school. BS/MD kids are uniformly at the top of their class in high school.

Is that 21% out of the group that made it into medical school? Or in the whole program (meaning including the undergrad)? Some people start off in BS/MD but either don't get the grades to maintain their seat or have a change of heart.

*EDIT* - I see others have addressed this same point. 8% attrition through 4 years of med school is not unreasonable. Maybe a tad bit higher than the average, but likely not significant. Agree with others that if this was happeneing at outrageous rates, schools would shut down their BS/MDs. A few places have closed down their programs, but there's a ton more that are open now compared to 10 years ago when I was applying to them out of high school, so likely not a perfect system either way. I'd like the link to the 2015 report for further reading as well, if you happen to have it (or know which school, or who did the reporting).

I was being quite sarcastic.

Interestingly, a bachelor's isn't actually a requirement at lots of places. It wasn't at my school, you just needed the usual pre-reqs and 90 credit hours.

Fair enough - hard to read sarcasm on the internet sometimes. Especially when there are people with the mindset like the above quoted post.

Yes but regular undergrads hopefully have a major to fall back on. These kids likely don't.

That's not how it works. Most BS/MD programs confer you a bachelor's degree. That's why they call it BS/MD, because you get both degrees. The timing of that is dependent on the school. Mine for example, gave you the bachelor's after first year of medical school. If I had failed out of medical school, I'd go back to undergrad and take the necessary credits to graduate with a degree in biology.
 
That's not how it works. Most BS/MD programs confer you a bachelor's degree. That's why they call it BS/MD, because you get both degrees. The timing of that is dependent on the school. Mine for example, gave you the bachelor's after first year of medical school. If I had failed out of medical school, I'd go back to undergrad and take the necessary credits to graduate with a degree in biology.
Right, I'm saying that if you get into the BS/MD program but decide after the 2nd year not to do the MD part. How hard is it to get a non-biology degree starting at that point? Looking at a few of the 6 year programs I could find, it would be quite difficult to finish in anything other than biology in the standard 4 years.

I also note that the 6 year programs seems to have quite a few summer classes, so its not too dissimilar from people who go to summer school and graduate in 3 years instead of 4.
 
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Right, I'm saying that if you get into the BS/MD program but decide after the 2nd year not to do the MD part. How hard is it to get a non-biology degree starting at that point? Looking at a few of the 6 year programs I could find, it would be quite difficult to finish in anything other than biology in the standard 4 years.

I also note that the 6 year programs seems to have quite a few summer classes, so its not too dissimilar from people who go to summer school and graduate in 3 years instead of 4.

However long it would take you to work towards a biology degree for 2 years and then switch majors into a different degree. If you started as biology for 2 years and then switched into economics you probably wouldn't graduate in 4 years either. Most of your general pre-reqs for any degree get taken as well during that time frame, so that'd probably shave a year or a year and half from starting a new degree from scratch.

I went to a 7-year program and had normal summers - I personally wouldn't have been a huge fan of shortening it further to a 6-year program.
 
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However long it would take you to work towards a biology degree for 2 years and then switch majors into a different degree. If you started as biology for 2 years and then switched into economics you probably wouldn't graduate in 4 years either. Most of your general pre-reqs for any degree get taken as well during that time frame, so that'd probably shave a year or a year and half from starting a new degree from scratch.

I went to a 7-year program and had normal summers - I personally wouldn't have been a huge fan of shortening it further to a 6-year program.
I am happy with the route I took, but I'm not opposed to a 7 year program in the slightest so I suspect we're in agreement more than not.

Still not a huge fan of the 6 year programs, but there are comparatively few of those compared to 7 years so it seems the schools aren't either.
 
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Just adding in my two cents. Sorry it is a few months late. This is actually my first post on STN!

I was in a combined 6 year program and I can tell you that for me personally, it ruined me for a good amount of years. There were other students who did really well. However, when taking 21 credits/semester it really trains you to cram material. Many people did not pass the minimum MCAT score at the time (24). My issue was that I had never really learned how to adapt to challenges before. I was a star student in high school who rarely took home a book, took 5 AP classes my senior year, scored a 34 on the ACT without really trying, and worked 35 hours a week while doing two sports. Things came very easily for me, and I was not used to recognizing when I was in over my head and knowing when to reach out. The synopsis of my experience is that I tried to keep working (my worst mistake), fell behind in classes, and genuinely felt completely lost when I was dismissed after my second year. With those programs only requiring super low GPAs (and the courseload leading many kids to just try to get by), I was left with a GPA barely over a 3.0 and a shattered identity. School was how I had defined myself up until that point. Out of my class of 33 students, I doubt 20 matriculated. Probably less in the 2 year time period alotted. At least 2 or 3 had to redo M1. The year my class took boards was the year that medical school had to redo their curriculum because of their failure rate.

I'm not saying all kids aren't cut out for dealing with stressers without developing some serious fear of failure, but I wasn't. I didn't have the life experience or the coping mechanisms yet. I'm glad it happened though. Honestly, I'm grateful that I worked crappy minimum wage jobs for 6 some years and faced the scary reality that I may never achieve what my high school self had envisioned for myself. It helped me understand people from all different backgrounds, and humbled me at a time that I centainly was entitled (like many young students handed a golden ticket).

It's hard to explain how dark those years were that followed though. I did have a string of toxic relationships during that time that probably didn't help, but life isn't easy for the kids that don't make it through. And it's hard to know you haven't developed resilience yet until you find out the hard way. Doing a program that is accelerated (and hard for even the best students in it to get good grades) is a pretty high stakes way to test whether or not you have the maturity for it. That GPA follows you forever as I found out.

Life's okay now though :) It just took me many more years (and debt) to get back on track. I'm not at an MD school, but I'm at a DO school with a solid reputation within the state.
 
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I thought college was a blast. Probably not necessary to becoming a competent physician but it sure was fun. Would go back and do it again if I could
 
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