Does M1 and M2 serve a real purpose?

[zeppelinpage4]

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I apologize if this is a duplicate, I posted this in the wrong forum and tried to delete that, but here it is.

So...this may be because I just sat through a very frustrating 3 hour pathophysiology lecture that nobody understood as the professor mumbled away...and my brain feels fried.

BUT, is there even a point to these first two years, other than to say we did them and took the boards?
I know we need to have a solid knowledge base, and that's what I thought these first two years did. But when I read threads and hear about students going in to third year feeling unprepared, or saying they don't remember anything from the first two years, it frustrates the hell out of me to be grinding away at something that seems so pointless.

Now, I know it's important and I gotta get through it...but can someone please shine some light on what the purpose of M1 and M2 are? Is it really as pointless as it seems, or do something these details we learn actually come back and help at some point. I feel like all these PhD taught classes are just more hoops to keep jumping through. If there is a benefit what is it? And if there isn't? Then what's the point?

I'm seriously asking, maybe someone who's been through this can shine some light onto this cause I here mixed things now. Some say M1 and M2 are waste of time (and it certainly feels that way right now), but others say it gives a solid foundation, and even if you don't remember everything, having seen these things once does help.

Okay, I'm done venting. I apologize if this seems aggressive, a lot of us were frustrated today, it was a 3 hour barage of mumbled info. that no one understood. Everything just feels like a big waste of time. I'm so sick of lectures and slides, I don't mind working hard, but it's really hard to stay motivated when I feel my effort now will not help make me a better clinician in the future...it's just for boards (which are important, but a standardized test score doesn't give me any motivation). Time to go finish an endocrine lecture....

Also, why are we not taught practical things like placing IVs and other hands on procedural stuff before third year? Maybe it's just my school, but none of us have been CPR trained, and they haphazardly taught us some basics on taking a physical exam. That would prepare us for 3rd year I feel...but they don't teach it.

 

[Anastomoses]

I'm going to keep in mind that you're presently frustrated with a situation.

That said, I am fairly confident that a "doctor" should know the mechanisms behind actions that we see in a clinical setting. Having had the benefit of doing a 3 month "rotation" of sorts in IM, I can assure you that TONS of what we learn in class ends up clicking much more when we see it in clinic. It's like a fuzzy picture that ends up growing sharper in focus. If you don't know the details of how a disease works, progresses...how will you detect aberrations even in the progression of a patient's disease?

When you learn a language, you learn the alphabet and grammar...it's really the fastest way to learn. That's M1 + M2.

If you just jump in and try to pick up words over time without that foundation, you'll get there...but you'll have the grammar and language skills of a Vietnamese nail salonist*.

*No racism intended.

 

[HLxDrummer]

At our school they teach us a good PE and BLS but they also give us random information that no body needs to know except pathologists, lab techs, or microbiologists. That is what gets me.. I am convinced we will forget 50% of what we learn in MS1 and MS2 and learn useful stuff through MS3/4/residency.

 

[Frazier]

As a fellow MS1, I agree that particular facets of the coursework seem to be a waste of time...cough cough PBL cough cough.

In regards to the rest of MS1 (and MS2, I assume) it serves pretty important purposes. The repetitive, longitudinal experiences with medical interviewing, taking H&P's, and general interactions with patients in clinical settings have purpose. I'm already prepared to accept the idea that I will be a deer in headlights when actually doing stuff in the hospital during 3rd year. Hard to imagine what it would be like if you were thrown into 3rd year with only "passing Step 1" in your arsenal of experience.

The science curriculum is important for gaining an understanding of "what and why" things happen and how to correct these issues when possible. While much of the facts and trivia it will be forgotten after exams/STEP 1, the familiarity and retention of concepts is important so you can synthesize data as it arises in clinical settings -- or at least be able to more effectively utilize resources that complement what you retained. It is also useful for synthesizing what we currently know with what we haven't yet learned (i.e. keeping up to date with literature when we are attendings).

That said, I don't enjoy this time, but I still appreciate it (hesitantly 😉 ).

 

[mvenus929]

M1 and M2 give you the foundation for all the knowledge that you will develop throughout the rest of your clinical training.

As far as not doing anything clinically-oriented--we had a focus group session the other day and while many of the things we said went back to preparing us for third year more, they would also take away from focus on step 1, which like it or not, is the culmination of all the efforts of first and second year and a good chunk of what residencies look at when selecting new residents. Yes, it's neat to be able to learn how to place IVs, but you're not going to be doing it all the time, even when you are a third year. Same with suturing, splinting, placing a central line, intubating, etc.

Learning how to take a history and physical, write a note, and present a patient are skills that you should know and should be emphasized during the first two years.

I do think it's a bit weird that you weren't CPR trained, though. We were required to have BLS training before we started med school.

 

[Elisabeth Kate]

Of course it serves a purpose. Are you ever going to walk around diagramming sentences? No. But you had to learn it because it was important to learning proper sentence structure so you can communicate. You may never, ever diagram the endocrine pathways, but knowing them is essential to managing a patient with an endocrine disorder beyond DM or thyroid. Understanding cardio physiology is essential to managing a patient with heart problems. Understanding how the lungs actually work is essential to managing patients with COPD. Sure, you can manage all the above patients with algorithms, but then why go to med school?

 

[Elisabeth Kate]

We were required to have BLS training before we started med school.

Why?

 

[Arkangeloid]

It's total bull, but then again most of life is bull.

I'll eat my words if Charcot Marie Tooth disease ever comes up in clinic. But I doubt it.

Psych was cool though.

 

[DermViser]

I apologize if this is a duplicate, I posted this in the wrong forum and tried to delete that, but here it is.

So...this may be because I just sat through a very frustrating 3 hour pathophysiology lecture that nobody understood as the professor mumbled away...and my brain feels fried.

BUT, is there even a point to these first two years, other than to say we did them and took the boards?
I know we need to have a solid knowledge base, and that's what I thought these first two years did. But when I read threads and hear about students going in to third year feeling unprepared, or saying they don't remember anything from the first two years, it frustrates the hell out of me to be grinding away at something that seems so pointless.

Now, I know it's important and I gotta get through it...but can someone please shine some light on what the purpose of M1 and M2 are? Is it really as pointless as it seems, or do something these details we learn actually come back and help at some point. I feel like all these PhD taught classes are just more hoops to keep jumping through. If there is a benefit what is it? And if there isn't? Then what's the point?

I'm seriously asking, maybe someone who's been through this can shine some light onto this cause I here mixed things now. Some say M1 and M2 are waste of time (and it certainly feels that way right now), but others say it gives a solid foundation, and even if you don't remember everything, having seen these things once does help.

Okay, I'm done venting. I apologize if this seems aggressive, a lot of us were frustrated today, it was a 3 hour barage of mumbled info. that no one understood. Everything just feels like a big waste of time. I'm so sick of lectures and slides, I don't mind working hard, but it's really hard to stay motivated when I feel my effort now will not help make me a better clinician in the future...it's just for boards (which are important, but a standardized test score doesn't give me any motivation). Time to go finish an endocrine lecture....

Also, why are we not taught practical things like placing IVs and other hands on procedural stuff before third year? Maybe it's just my school, but none of us have been CPR trained, and they haphazardly taught us some basics on taking a physical exam. That would prepare us for 3rd year I feel...but they don't teach it.

Yes several purposes:
1) Ability for your medical school to rank students based on your performance in the first 2 years which goes toward AOA selection
2) Ability to charge you ridiculous amounts of tuition for what is essentially self-study
3) Teach you physical exam skills through your Physical Diagnosis course (now if this course is not put well together, or terrible in quality, then... ---- I'll admit this takes organization, faculty caring, and availability of resources, something lower tier/lower quality MD schools may not have.

Also, why are we not taught practical things like placing IVs and other hands on procedural stuff before third year? Maybe it's just my school, but none of us have been CPR trained, and they haphazardly taught us some basics on taking a physical exam. That would prepare us for 3rd year I feel...but they don't teach it.

You'll realize a lot of medical school is stuck in the halls of academia in which knowing esoteric facts for the sake of knowing them is placed above practical knowledge. It's always pushed off to "Oh, you'll learn that in residency." This is very different in comparison to nursing. That being said, nurses are also missing a lot of foundational basic science knowledge which applies to clinical medicine as well.

 

[Arkangeloid]

Let's not forget that it keeps the Ph.D.s in a job!

You'll realize a lot of medical school is stuck in the halls of academia in which knowing esoteric facts for the sake of knowing them is placed above practical knowledge. It's always pushed off to "Oh, you'll learn that in residency." This is very different in comparison to nursing. That being said, nurses are also missing a lot of foundational basic science knowledge which applies to clinical medicine as well.

Makes sense I guess. One of my friends is a Gen Surg Resident who always complains that the IM Residents at our program don't know how to suture properly, and he has to correct their "mangling." When he is on an "easy service" (not sure what that means), he runs a suturing class for our medical students, because the school doesn't teach suturing.

At our school, anything related to practical knowledge, physical exams, history, whatever, is taught pretty haphazardly and treated as a formality that gets in the way of "real learning." Many students state that learning about histories or physicals is "stupid," a "waste of time," or (my favorite), "homo."

 

[DermViser]

Let's not forget that it keeps the Ph.D.s in a job!

Makes sense I guess. One of my friends is a Gen Surg Resident who always complains that the IM Residents at our program don't know how to suture properly, and he has to correct their "mangling." When he is on an "easy service" (not sure what that means), he runs a suturing class for our medical students, because the school doesn't teach suturing.

At our school, anything related to practical knowledge, physical exams, history, whatever, is taught pretty haphazardly and treated as a formality that gets in the way of "real learning." Many students state that learning about histories or physicals is "stupid," a "waste of time," or (my favorite), "homo."

Most PhDs if given the option don't wish to teach your medical school basic science course. They would much rather do their research. Teaching is a quid pro quo - hardly a job requirement as PhDs are paid more on grants they bring in and publications, not on teaching dinky med students.

Easy service = Easier rotation with respect to time commitment and call responsibility. To be fair, IM residents' job isn't to suture - that's why they didn't do Surgery. I am sure IM residents could find something that Surgery residents are terrible at when it comes to a procedures or cognitive thinking.

The students who believe that histories and and physicals are "stupid" or a "waste of time", are usually the ones who do well in the book work and absolutely crash and burn on the wards which is reflected in their MS-3 grades, when you're expected to put things together, which kills their class rank.

 

[Psai]

It's total bull, but then again most of life is bull.

I'll eat my words if Charcot Marie Tooth disease ever comes up in clinic. But I doubt it.

Psych was cool though.

I shadowed a neurologist a while back and the first patient I saw had Charcot Marie Tooth.

 

[ChEMD]

I personally love learning how every organ system works, it's so exquisite and still continues to amaze me. I can't imagine someone trying to practice clinical medicine without knowing how the body actually works. It wouldn't be efficient to have the first time you ever see something be in a clinical setting, you have to have a foundation first. That being said, there are plenty of minute details that we are all required to learn and will almost certainly forget by the time we're doing our clinical rotations. But that doesn't mean that you shouldn't be understanding and retaining the basic concepts.

Let's put it this way, would you want a doctor who is only treating you based on an algorithm and doesn't have a firm grasp of what's actually wrong with you? I wouldn't.

 

[HLxDrummer]

I want to understand how physio and path work, but I don't want to know what anything looks like under a microscope, whether a virus replicates in the cytoplasm or nucleus, what color a certain bacteria is on a petri dish, or what species of mosquito carries a disease. In real life the pathologist will look at the slides, Ph.D.s will look at virus replication, microbiologists will identify a colony, and patients aren't going to tell you they were bitten by an Anopheles mosquito. Am I wrong?

I wish all of our classes were taught by MDs. Those lectures are always the best.

 

[gregoryhouse]

Of course it serves a purpose. You need to understand what is going on in a disease to really understand a patient presenting in front of you. Sure you could memorize symptoms and tests but that is an incredibly inefficient way to do medicine.

Every week we meet up with clinicians and discuss the material we have learned that week, and the clinical insight provides us with a look at how these basic sciences play into the clinic area.

Perhaps its different because I go to an integrated curriculum based school so its much easier to see how things work together towards diagnosing and treating patients.

 

[gregoryhouse]

I want to understand how physio and path work, but I don't want to know what anything looks like under a microscope, whether a virus replicates in the cytoplasm or nucleus, what color a certain bacteria is on a petri dish, or what species of mosquito carries a disease. In real life the pathologist will look at the slides, Ph.D.s will look at virus replication, microbiologists will identify a colony, and patients aren't going to tell you they were bitten by an Anopheles mosquito. Am I wrong?

I wish all of our classes were taught by MDs. Those lectures are always the best.

What about people interested in path?

I agree with you about micro that, most of that stuff seems incredibly useless

 

[Wordead]

I apologize if this is a duplicate, I posted this in the wrong forum and tried to delete that, but here it is.

So...this may be because I just sat through a very frustrating 3 hour pathophysiology lecture that nobody understood as the professor mumbled away...and my brain feels fried.

BUT, is there even a point to these first two years, other than to say we did them and took the boards?
I know we need to have a solid knowledge base, and that's what I thought these first two years did. But when I read threads and hear about students going in to third year feeling unprepared, or saying they don't remember anything from the first two years, it frustrates the hell out of me to be grinding away at something that seems so pointless.

Now, I know it's important and I gotta get through it...but can someone please shine some light on what the purpose of M1 and M2 are? Is it really as pointless as it seems, or do something these details we learn actually come back and help at some point. I feel like all these PhD taught classes are just more hoops to keep jumping through. If there is a benefit what is it? And if there isn't? Then what's the point?

I'm seriously asking, maybe someone who's been through this can shine some light onto this cause I here mixed things now. Some say M1 and M2 are waste of time (and it certainly feels that way right now), but others say it gives a solid foundation, and even if you don't remember everything, having seen these things once does help.

Okay, I'm done venting. I apologize if this seems aggressive, a lot of us were frustrated today, it was a 3 hour barage of mumbled info. that no one understood. Everything just feels like a big waste of time. I'm so sick of lectures and slides, I don't mind working hard, but it's really hard to stay motivated when I feel my effort now will not help make me a better clinician in the future...it's just for boards (which are important, but a standardized test score doesn't give me any motivation). Time to go finish an endocrine lecture....

Also, why are we not taught practical things like placing IVs and other hands on procedural stuff before third year? Maybe it's just my school, but none of us have been CPR trained, and they haphazardly taught us some basics on taking a physical exam. That would prepare us for 3rd year I feel...but they don't teach it.

If you want to place IVs and not learn rare conditions, you should become a nurse instead.

 

[HooliganSnail]

If you want to place IVs and not learn rare conditions, you should become a nurse instead.

Be nice....

Leave the poor MS1 stuck in the dolldrums of pre-clinicals alone. You know you thought everything he/she is thinking before.

 

[HooliganSnail]

The MS1 and MS2 years are important. A house built on a foundation of sand will crumple. You will ask the same questions of MS3 and MS4 btw. A ton of what goes on in those years seems to be a waste of time. When you are finished with medical school you will look back and realize that all of the lessons/rotations were important parts of a well rounded medical education.

That being said, medical school really sucked. I said they were all important experiences, not fun ones.

 

[Elisabeth Kate]

It's total bull, but then again most of life is bull.

You might want to rethink your "it's total bull" philosophy when it comes to anatomy and repro.

 

[Elisabeth Kate]

Makes sense I guess. One of my friends is a Gen Surg Resident who always complains that the IM Residents at our program don't know how to suture properly, and he has to correct their "mangling." When he is on an "easy service" (not sure what that means), he runs a suturing class for our medical students, because the school doesn't teach suturing.

All med schools should have a suturing lab, but that doesn't mean that everyone will master it. Those going into IM aren't expected to be able to suture like a surgeon would. Your friend became a surgeon. Surgeons suture. He's complaining that someone else can't do his job -- what he is trained to do -- as well as him? I'm sure there are plenty of things those IM residents can manage that he wasn't properly trained to.

At our school, anything related to practical knowledge, physical exams, history, whatever, is taught pretty haphazardly and treated as a formality that gets in the way of "real learning." Many students state that learning about histories or physicals is "stupid," a "waste of time," or (my favorite), "homo."

And those students will get a huge dose of reality in third year.

 

[DermViser]

I want to understand how physio and path work, but I don't want to know what anything looks like under a microscope, whether a virus replicates in the cytoplasm or nucleus, what color a certain bacteria is on a petri dish, or what species of mosquito carries a disease. In real life the pathologist will look at the slides, Ph.D.s will look at virus replication, microbiologists will identify a colony, and patients aren't going to tell you they were bitten by an Anopheles mosquito. Am I wrong?

I wish all of our classes were taught by MDs. Those lectures are always the best.

Psst...Pathologists are MDs too....

 

[Elisabeth Kate]

I want to understand how physio and path work, but I don't want to know what anything looks like under a microscope, whether a virus replicates in the cytoplasm or nucleus, what color a certain bacteria is on a petri dish, or what species of mosquito carries a disease. In real life the pathologist will look at the slides, Ph.D.s will look at virus replication, microbiologists will identify a colony, and patients aren't going to tell you they were bitten by an Anopheles mosquito. Am I wrong?

I wish all of our classes were taught by MDs. Those lectures are always the best.

All of the above should be a very minimal part of your first year of medical education and I agree, that stuff is annoying. But the OP is specifically referring to pathophys, not petri dishes in micro lab. There's a huge difference.

 

[DermViser]

And those students will get a huge dose of reality in third year.

Which is always fun to watch. http://forums.studentdoctor.net/thr...into-dermatology.1056859/page-2#post-14990336

 

[Elisabeth Kate]

The MS1 and MS2 years are important. A house built on a foundation of sand will crumple. You will ask the same questions of MS3 and MS4 btw. A ton of what goes on in those years seems to be a waste of time. When you are finished with medical school you will look back and realize that all of the lessons/rotations were important parts of a well rounded medical education.

That being said, medical school really sucked. I said they were all important experiences, not fun ones.

I don't know, I enjoyed med school and I really didn't think a ton of 3rd and 4th year was a waste of time. Some of it, sure. But for the most part, I was learning the entire time. Third year is when you learn medicine. Fourth year is when you learn things you never really learned/won't ever learn again, like anesthesiology.

 

[HooliganSnail]

I don't know, I enjoyed med school and I really didn't think a ton of 3rd and 4th year was a waste of time. Some of it, sure. But for the most part, I was learning the entire time. Third year is when you learn medicine. Fourth year is when you learn things you never really learned/won't ever learn again, like anesthesiology.

I disagree. 4th year is where you attempt to do as little as possible and just get through medical school. Glorious year 4th year.

 

[Elisabeth Kate]

I disagree. 4th year is where you attempt to do as little as possible and just get through medical school. Glorious year 4th year.

And pay a fortune for what you consider a "waste of time." I was happy with my 4th year schedule. Didn't work too hard and still learned a lot.

 

[HLxDrummer]

Psst...Pathologists are MDs too....

Ya I guess I can understand that, but at the same time, we don't really learn how to interpret imaging studies yet radiologists are MDs.

 

[DermViser]

Ya I guess I can understand that, but at the same time, we don't really learn how to interpret imaging studies yet radiologists are MDs.

You should have been exposed to reading imaging in your Gross Anatomy course. If you weren't, you will definitely interpret imaging in the clinical years even if you're not going for Radiology.

 

[DermViser]

I disagree. 4th year is where you attempt to do as little as possible and just get through medical school. Glorious year 4th year.

And pay a fortune for what you consider a "waste of time." I was happy with my 4th year schedule. Didn't work too hard and still learned a lot.

Unless you're going for a competitive specialty, in which case you're still working hard for a major part of MS-4.

 

[Arkangeloid]

Unless you're going for a competitive specialty, in which case you're still working hard for a major part of MS-4.

Most of my fourth year friends are going into Peds or IM, and they spent the majority of M4 drunk, I think.

I don't know anyone who went for a competitive specialty, but I'll go to one of the post-match panels and ask them about this.

 

[DermViser]

Most of my fourth year friends are going into Peds or IM, and they spent the majority of M4 drunk, I think.

I don't know anyone who went for a competitive specialty, but I'll go to one of the post-match panels and ask them about this.

That's not surprising at all. Audition electives during MS-4 and resume building are not as necessary for Peds and IM, as they would be for the more competitive specialties, in order to match. That being said, top institutions in specialties such as Peds and IM, will be highly competitive.

 

[HooliganSnail]

And pay a fortune for what you consider a "waste of time." I was happy with my 4th year schedule. Didn't work too hard and still learned a lot.

Can we call a spade a spade.

The fourth year of medical school has been seriously watered down in the last few decades. Due to legal concerns, CMS regulations, and advances in technology, medical students are rarely given anything close to patient responsibilities. I am sure you "learned a ton", but in reality that amount likely pales in comparison to what could have been learned in a world where we didn't have mamby pamby medical education.

No matter how much you learned in your entire 4th year, you and I will likely learn 10x that in our first month of internship.

 

[HooliganSnail]

Most of my fourth year friends are going into Peds or IM, and they spent the majority of M4 drunk, I think.

I don't know anyone who went for a competitive specialty, but I'll go to one of the post-match panels and ask them about this.

I too, spent much of 4th year drunk.

Can't wait for the massive hangover known as internship to start

 

[Elisabeth Kate]

Can we call a spade a spade.

The fourth year of medical school has been seriously watered down in the last few decades. Due to legal concerns, CMS regulations, and advances in technology, medical students are rarely given anything close to patient responsibilities. I am sure you "learned a ton", but in reality that amount likely pales in comparison to what could have been learned in a world where we didn't have mamby pamby medical education.

No matter how much you learned in your entire 4th year, you and I will likely learn 10x that in our first month of internship.

So the suggestion among some on SDN is to get rid of 4th year. Great in that you don't have to learn tuition, but if lack of learning is your beef, getting rid of it won't solve that problem either. You still can't go straight from third year to residency. It's logistically impossible without speeding up the basic sciences to one year and I don't see that happening any time soon.

 

[Frazier]

So the suggestion among some on SDN is to get rid of 4th year. Great in that you don't have to learn tuition, but if lack of learning is your beef, getting rid of it won't solve that problem either. You still can't go straight from third year to residency. It's logistically impossible without speeding up the basic sciences to one year and I don't see that happening any time soon.

Duke does it...I think Vandy might too. However, I agree, that such a trend won't be ubiqutous anytime in the foreseeable future.

 

[username456789]

It's total bull, but then again most of life is bull.

I'll eat my words if Charcot Marie Tooth disease ever comes up in clinic. But I doubt it.

Came up last week in my Derm clinic, of all places.

 

[DermViser]

It's total bull, but then again most of life is bull.

I'll eat my words if Charcot Marie Tooth disease ever comes up in clinic. But I doubt it.

Psych was cool though.

Then an MD is no different than a PA when it comes to knowledge base. If you want a 6 figure paycheck, you have to be able to offer more.

 

[Priapism4tooLong]

A wise man once told me, Your medical career is like the human body. I said "what??? huh?? what do you mean??" As you can imagine i was utterly bewildered by this statement. After this he continued to speak words that would change my life, and my medical career forever.

He Said "The Human body wants to STEP forward. Move Forward" I said " Yeah thats true" He said " Just like the human body wants to step forwards you will have to take the STEPS, one and two." - Amazing. Then he said " In order for the human body to work you need to have parts that work, and just like your medical career it will never move forward until you have parts, or subjects that you know. For instance imagine Physiology as being your lungs, now without the lungs as a whole the human body will not function. And without physiology your medical career will not move forward".

I said "wow that is true, without physiology medicine would be impossible, just like it would be to live"

He said " Now imagine pathology/pathophysiology as your liver. Without the liver you would not be able to live and without pathology/pathophysiology you would not be able to take STEPS (steps one and two) In your medical career."

I said "Thats very true"

He said "Now imagine the lungs got an infection. Imagine the infection as the tests you take. How do you fight off the infection? With your immune system and antibiotics!!, And the immune system and antibiotics are your STUDY HABITS, you Want to STUDY HARD so you can fight off the infection! And over come the infection to take your steps!" (I'm guessing he meant one and two)
Then he said "Sometimes you have a little infection (small tests) where you might not need a lot of antibiotics or a strong immune system. Which means you don't have to study as hard. But other times you get big bad infections. Where you need a very strong immune system and strong antibiotics (you want to study harder!)!. You don't want to end up in sepsis!."

Anyway so overall if you want to take your first STEPS then you need all of ms1 and ms2.

 

[colbgw02]

A wise man once told me, Your medical career is like the human body. I said "what??? huh?? what do you mean??" As you can imagine i was utterly bewildered by this statement. After this he continued to speak words that would change my life, and my medical career forever.

He Said "The Human body wants to STEP forward. Move Forward" I said " Yeah thats true" He said " Just like the human body wants to step forwards you will have to take the STEPS, one and two." - Amazing. Then he said " In order for the human body to work you need to have parts that work, and just like your medical career it will never move forward until you have parts, or subjects that you know. For instance imagine Physiology as being your lungs, now without the lungs as a whole the human body will not function. And without physiology your medical career will not move forward".

I said "wow that is true, without physiology medicine would be impossible, just like it would be to live"

He said " Now imagine pathology/pathophysiology as your liver. Without the liver you would not be able to live and without pathology/pathophysiology you would not be able to take STEPS (steps one and two) In your medical career."

I said "Thats very true"

He said "Now imagine the lungs got an infection. Imagine the infection as the tests you take. How do you fight off the infection? With your immune system and antibiotics!!, And the immune system and antibiotics are your STUDY HABITS, you Want to STUDY HARD so you can fight off the infection! And over come the infection to take your steps!" (I'm guessing he meant one and two)
Then he said "Sometimes you have a little infection (small tests) where you might not need a lot of antibiotics or a strong immune system. Which means you don't have to study as hard. But other times you get big bad infections. Where you need a very strong immune system and strong antibiotics (you want to study harder!)!. You don't want to end up in sepsis!."

Anyway so overall if you want to take your first STEPS then you need all of ms1 and ms2.

 

[Anastomoses]

He just doesn't look quite bewildered enough.

 

[colbgw02]

The bewilderment is tempered by disdain.

 

[neusu]

I apologize if this is a duplicate, I posted this in the wrong forum and tried to delete that, but here it is.

So...this may be because I just sat through a very frustrating 3 hour pathophysiology lecture that nobody understood as the professor mumbled away...and my brain feels fried.

BUT, is there even a point to these first two years, other than to say we did them and took the boards?
I know we need to have a solid knowledge base, and that's what I thought these first two years did. But when I read threads and hear about students going in to third year feeling unprepared, or saying they don't remember anything from the first two years, it frustrates the hell out of me to be grinding away at something that seems so pointless.

Now, I know it's important and I gotta get through it...but can someone please shine some light on what the purpose of M1 and M2 are? Is it really as pointless as it seems, or do something these details we learn actually come back and help at some point. I feel like all these PhD taught classes are just more hoops to keep jumping through. If there is a benefit what is it? And if there isn't? Then what's the point?

I'm seriously asking, maybe someone who's been through this can shine some light onto this cause I here mixed things now. Some say M1 and M2 are waste of time (and it certainly feels that way right now), but others say it gives a solid foundation, and even if you don't remember everything, having seen these things once does help.

Okay, I'm done venting. I apologize if this seems aggressive, a lot of us were frustrated today, it was a 3 hour barage of mumbled info. that no one understood. Everything just feels like a big waste of time. I'm so sick of lectures and slides, I don't mind working hard, but it's really hard to stay motivated when I feel my effort now will not help make me a better clinician in the future...it's just for boards (which are important, but a standardized test score doesn't give me any motivation). Time to go finish an endocrine lecture....

Also, why are we not taught practical things like placing IVs and other hands on procedural stuff before third year? Maybe it's just my school, but none of us have been CPR trained, and they haphazardly taught us some basics on taking a physical exam. That would prepare us for 3rd year I feel...but they don't teach it.

If you don't want to know how things work go to PA or NP school.

Doctors traditionally understood the pathophysiology of the diseases they treat, the pharmacology of the medications they use, and the interactions therein to be able to appropriately manage active issues in patients. It is not a cook-book. Likewise, historically, most doctors played a significant role in advancing the common understanding in medicine by publishing their findings. Surgeons developed new techniques and internists and surgeons alike reviewed their patients' charts for commonalities or effects of treatment to notify others of good, or bad results. Simply reading the white-paper on a new medication from Pfizer or Merck, without a baseline knowledge of things like what a receptor is let alone a signal transduction pathway or pharmacokinetics is useless. Take that to the next step and you are blindly writing prescriptions based on what you were told by the person selling the medicine, to patients who come in complaining of something that may or not be related, without actually understanding either the problem or solution.

I agree, it can be painful. I could care less about dead space in the lung or the Starling curve. Do I know what they are and how medications or management can change this, and how that ultimately may effect what I am seeing? Absolutely.

 

[sazerac]

So the suggestion among some on SDN is to get rid of 4th year. Great in that you don't have to learn tuition, but if lack of learning is your beef, getting rid of it won't solve that problem either. You still can't go straight from third year to residency. It's logistically impossible without speeding up the basic sciences to one year and I don't see that happening any time soon.

The median MCAT for accepted MD students was 33 this year. I think incoming med students are a lot smarter than we ever were, and they are more than capable of handling a compressed MS1 and MS2.

 

[Elisabeth Kate]

The median MCAT for accepted MD students was 33 this year. I think incoming med students are a lot smarter than we ever were, and they are more than capable of handling a compressed MS1 and MS2.

If average MCAT scores determined intelligence, would you call doctors from the 60s *****s? Come on.

 

[Frazier]

The median MCAT for accepted MD students was 33 this year. I think incoming med students are a lot smarter than we ever were, and they are more than capable of handling a compressed MS1 and MS2.

Speak for yourself, madam/sir. 🙂

 

[alpinism]

Can we call a spade a spade.

The fourth year of medical school has been seriously watered down in the last few decades. Due to legal concerns, CMS regulations, and advances in technology, medical students are rarely given anything close to patient responsibilities. I am sure you "learned a ton", but in reality that amount likely pales in comparison to what could have been learned in a world where we didn't have mamby pamby medical education.

No matter how much you learned in your entire 4th year, you and I will likely learn 10x that in our first month of internship.

In reality M4 could easily be compressed to half a year as could M1 which would give you a 3 yr MD degree w/ essentially the same curriculum.

IMHO a good chunk of M1 material doesn't even belong in med school. Biochem and genetics could be taken as prereqs instead of ochem or physics and you could have applicants take an anatomy/physiology course in UG to go over the basics. Some med schools already require or highly suggest taking all those courses so it wouldn't be anything new or groundbreaking.

 

[GadRads]

The median MCAT for accepted MD students was 33 this year. I think incoming med students are a lot smarter than we ever were, and they are more than capable of handling a compressed MS1 and MS2.

I don't think students are smarter. There are just more applicants and applications, giving medical school admission committees more options.

Secondly, we also underestimate that we have better resources to approach these tests. Relevant example: I took the MCAT in 2005. Scored a 26 and 28 (Damn verbal, but got in with those scores; national average then for "acceptees" was a 27). My prep at the time consisted of passively reading EK books for 2 months and ZERO practice tests. Took it again in 2011 as a graduate student. Prepped in 2.5 weeks while working 10-12 hrs/day busy in the lab. I made sure I took 2 full length tests and analyzed them. Result? scored a 33 (was expecting higher), despite forgetting a lot of pre-med stuff. With more time I'm sure I could have pulled a 35+. This is when I thought the test was useless and didn't mean much.

Albert Einstein (IIRC) had a study demonstrating a mean 10-pt increase in Step 1 scores when U-World was incorporated into a student's Step 1 study schedule, thus demonstrating the importance of doing questions and available resources targeted towards a test.

 

[Priapism4tooLong]

If you don't want to know how things work go to PA or NP school.

Doctors traditionally understood the pathophysiology of the diseases they treat, the pharmacology of the medications they use, and the interactions therein to be able to appropriately manage active issues in patients. It is not a cook-book. Likewise, historically, most doctors played a significant role in advancing the common understanding in medicine by publishing their findings. Surgeons developed new techniques and internists and surgeons alike reviewed their patients' charts for commonalities or effects of treatment to notify others of good, or bad results. Simply reading the white-paper on a new medication from Pfizer or Merck, without a baseline knowledge of things like what a receptor is let alone a signal transduction pathway or pharmacokinetics is useless. Take that to the next step and you are blindly writing prescriptions based on what you were told by the person selling the medicine, to patients who come in complaining of something that may or not be related, without actually understanding either the problem or solution.

I agree, it can be painful. I could care less about dead space in the lung or the Starling curve. Do I know what they are and how medications or management can change this, and how that ultimately may effect what I am seeing? Absolutely.

Nicely said, i think along with my post and this post you have found your answer OP

 

[alpinism]

Despite the copious amounts of useless minutiae taught in M1/M2, there is still a ton of useful and clinically relevant information you need to learn before the wards.

You need to know basic anatomy for procedures, reading imaging, localizing pain, evaluating traumatic injuries, cancer spread and mets, etc...
You need to know physiology so you can understand nerve conduction, cardiac output, renal clearance, hepatic function, etc...
You need to know microbiology and immunology in order to understand how the IS responds to infections, how bugs adapt and evade these responses, which bugs are most likely in certain populations and age groups, etc...

I usually hate metaphors but think of the preclinical years as the foundation of a skyscraper that's under construction. When you're a patient you only see what's visible above ground i.e. your knowledge of clinical medicine. But, in order to apply that knowledge you have to understand the underlying pathophysiology, how that pathophysiology presents as signs/symptoms, and all the treatments available including their risks/benefits.