Clinical relevance of med school biochem

[chronicangina]

i have a biochem exam tomorrow on metabolism and pathways and enzymes. I find we learn very rare diseases as well as very small details regarding Enzymes and regulation. To me it seems like this block is more relevant for Step 1 (some slides even point out that it’s a rare disorder but it appears on step). So I get the whole having to learn it for step and I’ve taken this block seriously, but how relevant will this be in 3rd year and beyond as a practicing physician? I can appreciate some specialties will definitely use this knowledge but id Like to know more in a broad aspect.

thanks!

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[7331poas]

This is 100% a bait post.

 

[khnz786]

Just learn it for the sake of learning. This is what separates us from midlevels.

 

[catnip12]

Like you said, some patients have deficiencies in certain enzymes which might predispose them to certain conditions. Depending on your practice, this may or may never be something you have to think about.

 

[Osminog]

If you don’t have an understanding of the fundamental scientific basis for the ailments you’re treating, you just become an algorithm-following, box-checking robot. You can probably do a fine job as a physician if you just follow best practices and use the recommended algorithms, but it seems unfulfilling to just go through the motions all day, thoughtlessly regurgitating memorized associations between diagnoses and chart numbers, symptoms, and basic image patterns. You become a human body repairman rather than a medical expert.

 

[Ho0v-man]

On my IM rotation I was asked to explain type 1 and type 2 DM. I went through glycolysis, Krebs, the role of malonyl-Coa, fatty acid oxidation, etc.

Very impressed attendings, but no one really cared

 

[Goro]

i have a biochem exam tomorrow on metabolism and pathways and enzymes. I find we learn very rare diseases as well as very small details regarding Enzymes and regulation. To me it seems like this block is more relevant for Step 1 (some slides even point out that it’s a rare disorder but it appears on step). So I get the whole having to learn it for step and I’ve taken this block seriously, but how relevant will this be in 3rd year and beyond as a practicing physician? I can appreciate some specialties will definitely use this knowledge but id Like to know more in a broad aspect.

thanks!

Wise @SLC, @VA Hopeful Dr @LunaOri, care to comment?

 

[SLC]

Wise @SLC, @VA Hopeful Dr @LunaOri, care to comment?

It’s probably not going to feel good to hear this, but generally, most minutiae isn’t terribly clinically important.

I will say, it helps to have the background knowledge, it’s what separates us from the midlevel’s. And occasionally something you learned way back in M1 will come rifling back to your memory during a clinical interaction. But you will rarely, if ever, need to have some obscure biochemical pathway (Krebs cycle, etc) memorized in order to treat a patient or make a diagnosis.

Now on the other hand; physiology, anatomy, microbio and pharmacology etc, you’ll want that stuff down cold for 3rd year.

 

[Goro]

It’s probably not going to feel good to hear this, but generally, most minutiae isn’t terribly clinically important.

I will say, it helps to have the background knowledge, it’s what separates us from the midlevel’s. And occasionally something you learned way back in M1 will come rifling back to your memory during a clinical interaction. But you will rarely, if ever, need to have some obscure biochemical pathway (Krebs cycle, etc) memorized in order to treat a patient or make a diagnosis.

Now on the other hand; physiology, anatomy, microbio and pharmacology etc, you’ll want that stuff down cold for 3rd year.

No med student needs to know about the Krebs cycle!

 

[SLC]

No med student needs to know about the Krebs cycle!

its true, but somehow learning all that minutiae contributed toward making us equipped to practice solo. That and the years of clinical rotations and residency.

It constantly blows me away how big the knowledge gap is between physicians and midlevels. It shows in the types of questions I (as a still new attending) get from even seasoned PA’s/NP’s. They just lack the context to fully understand the ins and outs of medicine.

 

[RunsOnCaffeine]

You gotta learn it for Step. I don't think it's terribly helpful in the long run unless you become someone who works in a place that treats rare genetic conditions, in which case, you'll probably relearn it may times over, but having heard about something before so you know it exists can be helpful. At the end of the day, becoming proactive at studying what you see on clinicals is probably more important than knowing the some minutia.

 

[FutureInternist]

Never has the fact that Vancomycin binds the D-ala-D-ala part of the cell wall, or that CF is a mutation on chrom 7 ever come up in practice. (Yet unfortunately its in my brain taking space that could be used to remember my wife’s bday).

Just think of how much you learned in college, and what was actually on MCAT, and then how much you learned in med school and what a small % of it was actually on USMLE.

This “grunt work” just gets your mind used to absorbing large amount of info in a short time. Helps when you have a complicated pt who got transferred from an outside facility with a ream of paper with labs, imaging etc.

This info is worthless but unfortunately you must pay the Pied Piper.

 

[FrkyBgStok]

You may think it is bullcrap, and it might be, but the first two years are to lay the foundation. I may not use much biochem at all, but I also don't use much anatomy. However geneticists and toxicologists use a lot of biochem and surgeons use a lot of anatomy. anesthesiologists and critical care docs use a bunch of physiology, but it is much less common in other specialties.

the point of those first two years is to lay the same foundation for everyone. So while you think it is pointless and a waste of time, and you may be right, if you go into certain specialties, it won't be. so just power down and learn it.

 

[ThetisAntithesis]

You might not need it in clinical practice but it helps things connects. I just learned why methylmalonate is high in B12 deficiency- ordered that **** for years as a mid-level and just now learning the biochem of it was pretty mind-blowing.
#Imsuchanerd #sorrynotsorry

 

[Radetzky]

The minutiae are not important but a good understanding of how it all comes together is, and you don’t get that unless you waddle through the minutiae first.

I thought it was all terribly irrelevant when I was a medical student, but actually understanding the Krebs cycle helps you understand lactic acidosis and why toxic alcohol ingestion or the recovery phase of DKA results in a lactic acidosis, it helps me remember the vital importance of thiamine, it helps me remember the effects of under and over feeding my patients, it helps me remember the causes and treatment of methemoglobinemia and once or twice I’ve come across newly diagnosed metabolic disorders in adults.

Could I remember any of the intermediaries in the Krebs cycle however ... no... except for a keto glutarate for some reason

 

[Yhwach]

This is what makes us (future) physicians and not just people following algorithms. If a pt is atypical an algorithm isn't going to save you.

 

[VA Hopeful Dr]

Wise @SLC, @VA Hopeful Dr @LunaOri, care to comment?

I think biochem is the least clinically useful of pretty much everything in the first 2 years. But, its a necessary building block to pharmacology and pathophysiology.

 

[scoopdaboop]

I mean certain biochem pathways are relevant...mostly in NICU settings. But, to pretend like you don't need to learn it is a bit silly, especially considering research and pharmacology are mainstays of medicine, both of which (depending on research) rely heavily on biochem.

 

[Real McCoy]

Much of biochemistry pathway minutiae is completely irrelevant to the vast majority of practicing physicians. However, foundational biochemistry underlies nearly all (patho)physiology, anatomy, genetics, microbiology, immunology, pharmacology, etc. which contributes to everything a practicing clinician sees/uses throughout their career. Learning biochemistry is not for the faint of heart (nor is literally all of medical school). If you don't want to understand the "why" behind what you're doing, years 1 and 2 of medical school will be painful, and biochemistry is a pretty good chunk of that pain. Much of your training is aimed at exposing you to what's known so that when you have a patient somewhere down the line, you can associate their presentation with something to which you've previously been exposed, giving you a starting point, and making your search for the information you haven't committed to memory much more rapid.

 

[QuizzicalApe]

The point of these minutiae-filled preclinical classes is to leave enough of an imprint on your brain that if there is related information later, like mechanisms you learn that might actually matter for disease processes or drugs, they stick a little bit better, and if you ever actually need to know more detailed biochemistry, it'll be easier to take in again when you're reading up on it.

Unless you're going into some very specific specialties, the majority of it will rarely be needed.

 

[chronicangina]

Thanks everyone for the responses! Very insightful and some times differing points of view. Thanks for helping out an M1 who isn’t best friends with Biochem haha I do see how it might come in handy later on, as well as it’s a base for everything! Thanks again