Are the first two years of medical school optimally planned?

[want2beadoc]

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My class had a meeting with dean a few days ago where we discussed the future of medical education. One of the things the dean mentioned that he felt was detrimental to medical school education was the over-emphasis of the basic sciences. He didn’t elaborate fully, but I think he was implying that the first years of medical school should be more about “medicine” and less about rote memorization.

In undergrad engineering, we were basically taught that everything we needed to know we could look up in a book. We were taught to understand the principles of engineering. We didn’t have to memorize the formula after formula, just how to apply them. Could this approach be used in medical school? Are the basic science classes that dominate the first two years necessary to understanding the principles of medicine? Should we cede more ground to the scientists in order to become better clinicians in our med. school years? Or should we just suck it up and wait until residency?

 

[Law2Doc]

My class had a meeting with dean a few days ago where we discussed the future of medical education. One of the things the dean mentioned that he felt was detrimental to medical school education was the over-emphasis of the basic sciences. He didn’t elaborate fully, but I think he was implying that the first years of medical school should be more about “medicine” and less about rote memorization.

In undergrad engineering, we were basically taught that everything we needed to know we could look up in a book. We were taught to understand the principles of engineering. We didn’t have to memorize the formula after formula, just how to apply them. Could this approach be used in medical school? Are the basic science classes that dominate the first two years necessary to understanding the principles of medicine? Should we cede more ground to the scientists in order to become better clinicians in our med. school years? Or should we just suck it up and wait until residency?

First, I wouldn't want to change curriculum at a single med school too much and expect to do as well on Step 1. Step 1 covers the basic science years, and schools that have deviated far from the current format have generally met with poorer scores. And yes, those first two years DO provide a foundation upon which later learning ought to be built.

However I certainly would be a fan of replacing more of the PhD professors with clinicians, as the PhD's too often try to teach their classes as if they were teaching graduate students rather than med students. It often ends up being quite a stretch for them to try and show how something they are excited about is tangentially related to something clinically useful, and the focus of what is important in, say, biochem, is invariably different if you speak to a PhD versus a practicing MD.

 

[ANCAdoc]

The medical curriculum needs to be changed. Check out a recent editorial in JAMA:

http://jama.ama-assn.org/cgi/conten...um&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
JAMA. 2006;296:1128-1131.
Ezekiel J. Emanuel, MD, PhD

I highly agree with this editorial. He mentions many things would need to be changed along with the med curriculum. This article is even more interesting because he suggests what needs to be changed in the premed requirements as well (again, a change in things like the MCAT is a must for this to happen).

 

[Doctor Bagel]

First, I wouldn't want to change curriculum at a single med school too much and expect to do as well on Step 1. Step 1 covers the basic science years, and schools that have deviated far from the current format have generally met with poorer scores. And yes, those first two years DO provide a foundation upon which later learning ought to be built.

However I certainly would be a fan of replacing more of the PhD professors with clinicians, as the PhD's too often try to teach their classes as if they were teaching graduate students rather than med students. It often ends up being quite a stretch for them to try and show how something they are excited about is tangentially related to something clinically useful, and the focus of what is important in, say, biochem, is invariably different if you speak to a PhD versus a practicing MD.

The Dean mentioned Step 1 as a big factor determing how we are taught. He said Step 1 would have to change before we could implement any major curricular changes, but he did imply that lots of schools were wanting to change Step 1. Sort of following on what you're saying, but I don't think Step 1 is always the bigget issue. Some professors expect you to memorize a level of detail that I'm thinking goes beyond what's on Step 1 -- in fact, I suspect lots of them have no clue what Step 1 tests.

It sounds anti-intellectual (especially compared with law schools where teaching to the bar exam was considered to be something lower ranked schools did), but I think every school should ensure that everything taught to us in the first two years fits into one of two goals -- 1. to help us be better physicians and 2. to help us do well on the boards. That in and of itself would be a major improvement in classes like say biochem.

 

[AmericanIMG]

unfortunately, many schools are handcuffed to a certain curriculum based on step1.

lets make a hypothetical. lets say school X decides to break away from the norm, and change the game. school X adjusts its curriculum, and though the students are more clinically prepared, their step1 passing rate goes from 95% to 85%. this will cause for the school's reputation to drop, and that will change how the applicants look at the school. no school wants to deal with this, or see that they are dropping in rank.

i personally would like to see every school in the US and the Caribbean to follow a systems based approach. go system by system rather then subject by subject. within each system start with the anatomy, then go on. or, first semester teach anatomy and biochem and ethics, then go to a systems based approach.

just my 2c...

 

[45408]

The medical curriculum needs to be changed. Check out a recent editorial in JAMA:

http://jama.ama-assn.org/cgi/conten...um&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
JAMA. 2006;296:1128-1131.
Ezekiel J. Emanuel, MD, PhD

I highly agree with this editorial. He mentions many things would need to be changed along with the med curriculum. This article is even more interesting because he suggests what needs to be changed in the premed requirements as well (again, a change in things like the MCAT is a must for this to happen).

It was an interesting read, but I think the author underestimates the value of having students learn things like physics and organic chemistry. Organic has made biochemistry make a lot more sense, as I realize how certain reactions really work. Physics does have less value in the applied sense, but I don't think having weed-out classes is bad - because what he suggests (statistics, ethics, healthcare finance) won't be weed-out classes.