Feeling like my classes are not teaching me what I need for Step 1

[watchergub]

I go to a decent med school (top 30) apparently well-regarded by residency programs for the quality of our students. I chose my school based on perceived strength of curriculum and teaching, but now that I'm here, as a first year, I feel like my classes are a complete joke and I'm beginning to worry that my school is not preparing me well for boards. This block for instance, we're learning about renal physiology and our lectures are just terrible. Many of our lecturers are nephrologists with no teaching experience who just sort of ramble on with no discernible order to the information that they're throwing at us (and failing to properly explain). Since we are in class 8-5 most days, I have very little time to read the textbook to make up for things that I'm not learning properly from my lecturers. Moreover, I just opened up BRS Physio (a board review book) because I thought it might help to explain things more concisely than my giant Boron and Boulpaep text and just about had a panic attack. So many concepts in the renal physio section of BRS are being glossed over/badly explained in my classes. It seems like my school is more concerned using newfangled technology (like in class response apps, ipads, etc) than with making sure that we have good, clear lectures, that are covering the basics of what we need to know for Step 1.

I'm wondering, is this a normal feeling? Is the problem just that I'm still a 1st year or that I shouldn't be paying attention to board review books? I really dislike the feeling that no one is steering the "curriculum ship" at my school, but that is truly what I feel like half the time. Perhaps that problem is just that I'm in class so darn much that I feel like I'm just memorizing as fast as possible without time to truly internalize it all.

But as I said before, my school is supposedly a good one... so I don't know if I should just trust in their teaching and keep on keeping on, or if I should try to talk to someone about my concerns and maybe see if I need to be studying differently.

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[sobored]

Your school has probably been around for a while and knows what it's doing. You are so early in your medical training that probably most things seems obscure/don't make sense, but there will be a point in time where things will start to come together in a logical fashion. My advice is to trust your curriculum (because honestly, what other choice do you have?), and use review books as you go to fill in any gaps in knowledge. That way, when the time comes for step 1, you will be well acquainted with all your review resources. Also, think about the enormous amount of material being taught in med school...not every lecture is gonna be great. I saw my share of terribly presented topics, and I'm sure every student in every school in the country would say the same thing. Just do your best.

 

[JJMrK]

Sounds pretty typical. The MS1/MS2 curriculum at my school was horrible, for many of the reasons you described. My strategy was to attend class as little as possible and learn the material on my own. I also basically crammed for 4 or 5 days before an exam to make sure I did well on my school's tests, since I was studying board-relevant things the rest of the time. Worked for me, YMMV.

 

[tranquilo]

Consider skipping class if it's not required. Grab a copy of constanzo physiology (same woman who wrote BRS physio) and go to town on that book.

 

[RnVt]

Najeeb renal physio FTW!

 

[NickNaylor]

Sounds pretty typical. The MS1/MS2 curriculum at my school was horrible, for many of the reasons you described. My strategy was to attend class as little as possible and learn the material on my own. I also basically crammed for 4 or 5 days before an exam to make sure I did well on my school's tests, since I was studying board-relevant things the rest of the time. Worked for me, YMMV.

Pretty much what I did as well once I had the same revelation as the OP. Great for limiting your studying time and focusing on what's important.

 

[Kaustikos]

I feel like my classes are a complete joke and I'm beginning to worry that my school is not preparing me well for boards. This block for instance, we're learning about renal physiology and our lectures are just terrible. Many of our lecturers are nephrologists with no teaching experience who just sort of ramble on with no discernible order to the information that they're throwing at us (and failing to properly explain). Since we are in class 8-5 most days, I have very little time to read the textbook to make up for things that I'm not learning properly from my lecturers. Moreover, I just opened up BRS Physio (a board review book) because I thought it might help to explain things more concisely than my giant Boron and Boulpaep text and just about had a panic attack. So many concepts in the renal physio section of BRS are being glossed over/badly explained in my classes. It seems like my school is more concerned using newfangled technology (like in class response apps, ipads, etc) than with making sure that we have good, clear lectures, that are covering the basics of what we need to know for Step 1.

I'm wondering, is this a normal feeling? Is the problem just that I'm still a 1st year or that I shouldn't be paying attention to board review books? I really dislike the feeling that no one is steering the "curriculum ship" at my school, but that is truly what I feel like half the time. Perhaps that problem is just that I'm in class so darn much that I feel like I'm just memorizing as fast as possible without time to truly internalize it all.

I removed your comments about your school being good. It's irrelevant.

Join the club. The nice thing you have going for you is that your school doesn't make class mandatory. You can skip lectures if they don't help you. I'd do the same thing if I were in your shoes... and it's what I did on occasion at mine. Class is there to help some people. The others get screwed over. Not everyone in med school gains something from class. I always hated it because I had to get up early to go to lectures I didn't pay attention to when I could sleep till 9am, work out, eat and then study at 1pm till whatever. Instead, I had class in the morning till 12pm. Take nap... work out, eat and then start studying at like 2/3pm. It's stupid.

Realize I'm not using that same argument now in 3rd year... lol

 

[gettheleadout]

Pretty much what I did as well once I had the same revelation as the OP. Great for limiting your studying time and focusing on what's important.

Does any school have a good curriculum with competent teachers?

 

[mcloaf]

Does any school have a good curriculum with competent teachers?

I like mine for the most part.

 

[NickNaylor]

Does any school have a good curriculum with competent teachers?

There definitely seem to be schools that are more "boards-focused" from what I've seen. I think it really does depend on the individual professors more than anything, though.

 

[Rendar5]

One generally doesn't go to college to prepare them for mcats,
Nor do you go to med school for test preparation. Skip class if you need to but regardless you need to prep urself in addition to your classes at most any med school.

 

[alpinism]

Does any school have a good curriculum with competent teachers?

Baylor and Vandy are known for "teaching to the boards" and focusing on high yield information. However, realize that you will have good and bad professors at any school (obviously some have more bad ones than others). There is also a degree of subjectivity with regards to rating professors as some students may love a certain professor while others might hate them. Ultimately, wherever you go you'll end up teaching yourself ~90% of the material.

The OP could just as easily be complaining about having all PhDs during M1 and learning nothing clinically useful about renal physiology.

 

[Nesir]

Knowing the information for the boards is not necessarily what makes a good doctor. Remember that you go to med school to be a doctor not to ace the board exams.

My school is PBL and we probably spent way too much time in different aspects of patient care than in diagnosis/pathogenesis/treatment of disease. Step 1 is a standardized exam. You read First Aid use some Pathoma and do some questions and you will do fine on Step 1 (Source: I got a 269 in a curriculum that definitely dind't teach to Step 1)

 

[ulikedaggers]

Does any school have a good curriculum with competent teachers?

Sometimes mine seem to teach word for word out of FA. Other times they are worthless.

 

[sinombre]

Does any school have a good curriculum with competent teachers?

Definitely. My curriculum and professors are awesome.

Boron and Boulpaep is overkill... pick up a copy of Costanzo. The renal physiology chapter is 60 pages of high yield and easy-to-follow information.

 

[Armadillos]

I dont know about your particular school, but in general it seems like medstudents tend to vastly overestimate their understanding of what is important and vastly underestimate the competence of whoever is designing their curriculum.

 

[Laryngophed]

Are you going to school to get a good score on Step 1 or are you going to learn to be a physician? Despite how it gets represented, I doubt the two are one and the same. And that's a good thing.

 

[Brain Bucket]

Are you going to school to get a good score on Step 1 or are you going to learn to be a physician? Despite how it gets represented, I doubt the two are one and the same. And that's a good thing.

Get a good score on the step.

 

[Laryngophed]

Get a good score on the step.

Cool story, brah.

 

[Brain Bucket]

Cool story, brah.

True story, brah.

 

[chronicidal]

Are you going to school to get a good score on Step 1 or are you going to learn to be a physician? Despite how it gets represented, I doubt the two are one and the same. And that's a good thing.

The real question is, are you going to school to set yourself up for the residency position you want, or are you going to school to earn some marks on your transcript? Despite how it gets represented, I doubt the two are one and the same. And that's an unfortunate but existent reality.

 

[Laryngophed]

The real question is, are you going to school to set yourself up for the residency position you want, or are you going to school to earn some marks on your transcript? Despite how it gets represented, I doubt the two are one and the same. And that's an unfortunate but existent reality.

Somewhat true, though probably not the HYYYYYYYUUUUUUUUGGGGGEEEE factor it gets made out to be. Certainly important, but probably won't save an otherwise meh application or eliminate an otherwise stellar application. This is just conjecture, but I'd guess Step I is used as an application screen, and that once you hit whatever benchmark has been set, a 235 isn't significant different than a 250 to most programs. Again, I'm extrapolating based on the conversations I've had with PDs at one institution, but my guess is that approach is pretty wide reaching. And the school's obligation isn't to get you a 260+ (though I bet they'd love it if everyone did), they are to educate you and position you to match. Ideally high on your list. But on their end that means teaching people who can be good interns and residents, ensuring that students from your school are ranked by PDs. A good score is part of that, but the school isn't under any obligation to "teach to the boards."

And I know being on the other side of Step I (and II CK) it is really easy for me to say these things, but I think it is a little short-sighted to focus so hard on a standardized test. And I know that when I was second-year, all I could think about was getting a good Step 1 score.

 

[tantacles]

Somewhat true, though probably not the HYYYYYYYUUUUUUUUGGGGGEEEE factor it gets made out to be. Certainly important, but probably won't save an otherwise meh application or eliminate an otherwise stellar application. This is just conjecture, but I'd guess Step I is used as an application screen, and that once you hit whatever benchmark has been set, a 235 isn't significant different than a 250 to most programs. Again, I'm extrapolating based on the conversations I've had with PDs at one institution, but my guess is that approach is pretty wide reaching. And the school's obligation isn't to get you a 260+ (though I bet they'd love it if everyone did), they are to educate you and position you to match. Ideally high on your list. But on their end that means teaching people who can be good interns and residents, ensuring that students from your school are ranked by PDs. A good score is part of that, but the school isn't under any obligation to "teach to the boards."

And I know being on the other side of Step I (and II CK) it is really easy for me to say these things, but I think it is a little short-sighted to focus so hard on a standardized test. And I know that when I was second-year, all I could think about was getting a good Step 1 score.

Here's the problem: The best way to get people to match is to get them to do well on Step I.

 

[gettheleadout]

Here's the problem: The best way to get people to match is to get them to do well on Step I.

100% Derm match rate for 260+ Step 1 applicants.

 

[Laryngophed]

Here's the problem: The best way to get people to match is to get them to do well on Step I.

That's part of it, but not all. Stating that you (the general you, not "you") aren't getting taught the stuff for Step 1 assumes that Step 1 is the only important thing that your school must prepare you for. Remember, you're going to a medical school not a Step 1 school. Step 1 is important, but it isn't the "be-all, end-all" of matching, as far as I can tell. It is important, but if your school produced people who were good test-takers but had poor skills/knowledge otherwise expected of interns, they would be doing you a disservice. I suspect programs wouldn't continue to rank highly products of that curriculum if they aren't on par with other interns.

100% Derm match rate for 260+ Step 1 applicants.

Correlation =/= causation.

 

[chronicidal]

This is just conjecture, but I'd guess Step I is used as an application screen, and that once you hit whatever benchmark has been set, a 235 isn't significant different than a 250 to most programs. Again, I'm extrapolating based on the conversations I've had with PDs at one institution, but my guess is that approach is pretty wide reaching.

The 2012 NRMP PD survey says that 82% of programs use Step 1 in selecting applicants to interview and that when it comes to ranking interviewees to match, Step 1 score is a 4.1 out of 5 in importance, about the level of leadership qualities, recommendation letter in the specialty, clerkship grades. It's less important than the interview interactions, but nonetheless among the most important factors to ranking to match. If your approach were true, the benchmark would be set at the interview stage and then the score would not be important at the ranking stage. This is most certainly not the case on average.

 

[sinombre]

Definitely. My curriculum and professors are awesome.

I kind of take this back. Today I had a lecture by a physiology researcher. It was basically an hour of him presenting formulas I'll never have to use. I looked up what he was lecturing on in First Aid, and it only lists a single formula.

For the most part though, my professors are pretty good about teaching board-relevant information.

 

[alpinism]

I kind of take this back. Today I had a lecture by a physiology researcher. It was basically an hour of him presenting formulas I'll never have to use. I looked up what he was lecturing on in First Aid, and it only lists a single formula.

For the most part though, my professors are pretty good about teaching board-relevant information.

Reminds me of a few of our M1 CV lectures.

 

[sinombre]

Reminds me of a few of our M1 CV lectures.

Haha... yep. That's what it was.

 

[metopic]

Somewhat true, though probably not the HYYYYYYYUUUUUUUUGGGGGEEEE factor it gets made out to be. Certainly important, but probably won't save an otherwise meh application or eliminate an otherwise stellar application. This is just conjecture, but I'd guess Step I is used as an application screen, and that once you hit whatever benchmark has been set, a 235 isn't significant different than a 250 to most programs. Again, I'm extrapolating based on the conversations I've had with PDs at one institution, but my guess is that approach is pretty wide reaching. And the school's obligation isn't to get you a 260+ (though I bet they'd love it if everyone did), they are to educate you and position you to match. Ideally high on your list. But on their end that means teaching people who can be good interns and residents, ensuring that students from your school are ranked by PDs. A good score is part of that, but the school isn't under any obligation to "teach to the boards."

And I know being on the other side of Step I (and II CK) it is really easy for me to say these things, but I think it is a little short-sighted to focus so hard on a standardized test. And I know that when I was second-year, all I could think about was getting a good Step 1 score.

You may not like reality but that doesn't change it. A 235 vs a 250 makes a massive difference in terms of prospects for residency. And I guess schools aren't really obligated to do much of anything, but personally I'm glad board scores are at the top of my school's priority list.

 

[Laryngophed]

You may not like reality but that doesn't change it. A 235 vs a 250 makes a massive difference in terms of prospects for residency.

Depends on the specialty and program. Talking with some residents that are involved in their programs match process, Step 1 seems to be used as a filter point. Once your "screen" turns up positive, they review your app. If you get invited for an interview, score doesn't matter so much beyond that point.

And while I may have butchered my own point, Step 1 is important, but you are going to school to learn the basics to be a physician. Step 1 is a small part of that, but your school is hopefully presenting you with more than "just what you need for the boards."

 

[NickNaylor]

You may not like reality but that doesn't change it. A 235 vs a 250 makes a massive difference in terms of prospects for residency. And I guess schools aren't really obligated to do much of anything, but personally I'm glad board scores are at the top of my school's priority list.

Depends on the field. A 235 vs. 250 isn't going to make a big difference in fields like FM, peds, and psych because those fields are already not competitive. Sure, maybe if you want to end up at THE top program in the country it'll matter, but if the goal is to end up at a well-respected institution then you're more than likely going to be fine. I would, however, absolutely agree with you if we're talking about fields like derm, optho, ENT, etc.. In those cases I don't doubt that a 235 vs. a 250 can make a difference in getting interviews, which is obviously going to impact your prospects in the match.

As an undifferentiated pluripotent MS2 obviously your best play is to gun hard for step 1 to keep your options open. You never know what you may or may not like on the wards. Even then, though, my impression after talking with attendings and older students has been that no field is off the table even with a 235. A guy in the class above me is applying to derm with a similar "mediocre" (per SDN standards) score and has already had plenty of interviews and isn't concerned about matching. There are ways to "make up" for a crappy step score, largely by networking and being productive, particularly in the research realm.

I think it's important to be realistic, but look at the match data - it speaks for itself. Even in derm, the majority of applicants with a 230-239 match. Who knows what else is going on in their app, but that cohort is one of the largest in the group, so it's not as if these people are outliers. For a 221-230 score the match rate is 66%; for a 231-240 score the rate is 84%. The trend is similar in nearly all of the competitive fields. Everyone has different goals of course, but you are by no means doomed in almost any field with a sub-extraordinary step 1 score as long as you recognize that you will need to strengthen your app in other ways.

 

[gettheleadout]

Correlation =/= causation.

Implying we don't already have other evidence demonstrating that high Step 1 scores increase likelihood to match? Please.

 

[Laryngophed]

Implying we don't already have other evidence demonstrating that high Step 1 scores increase likelihood to match? Please.

No, but you have no idea how impactful the 260+ was on their individual match successes. I would guess that those applications had more going for them than just 260+ Step 1 scores. I don't know that, anymore than you know that they matched because they had scores >260. Correlation =/= causation.

 

[cbrons]

Najeeb renal physio FTW!

Amen

 

[cbrons]

MD profs are usually the worst

 

[DermViser]

Knowing the information for the boards is not necessarily what makes a good doctor. Remember that you go to med school to be a doctor not to ace the board exams.

My school is PBL and we probably spent way too much time in different aspects of patient care than in diagnosis/pathogenesis/treatment of disease. Step 1 is a standardized exam. You read First Aid use some Pathoma and do some questions and you will do fine on Step 1 (Source: I got a 269 in a curriculum that definitely dind't teach to Step 1)

Um, really? Love it or hate it. Your Step 1 score does determine which fields are essentially closed off to you. Medical school doesn't "teach" you to be a doctor. Sorry. You'll figure this out soon enough in your clerkships.
Also, I highly doubt anyone can use your method of "First Aid use some Pathoma and do some questions" and get a 269, as you did.

 

[DoctwoB]

What you need to get out of your classes is a solid understanding of physiology and pathophys. Believe or not, Step 1 actually involves a lot of thinking type questions (what would happen to X if you changed Y), etc. You should be able to understand how the organ systems work and mechanisms of homeostasis/regulation/feedback. It's true that there is a lot of memorization required as well, but most of the tiny details you will forget quickly and have to relearn in step 1 studying anyways. In that regard, "teaching to the boards" is relatively useless as the anatomy and biochemistry details you learned in year 1 will be completely forgotten by the time board studying comes around.

If your classes are teaching you so that you understand the concepts, you will fill in the details later with step1 studying. If your not learning the basics and physiology in class, then you need to supplement with other sources (BRS physio is a good one).

 

[chronicidal]

No, but you have no idea how impactful the 260+ was on their individual match successes. I would guess that those applications had more going for them than just 260+ Step 1 scores. I don't know that, anymore than you know that they matched because they had scores >260. Correlation =/= causation.

One way to get at your question is to perform multivariate analyses that control for important confounders. For instance, USMLE scores are independent predictors of matching to optho even after controlling for AOA membership, school ranking, and whether your school has an ophtho residency (http://1.usa.gov/IMH9E3) (odds ratio 1.6 for every 10 point increase).

 

[Laryngophed]

One way to get at your question is to perform multivariate analyses that control for important confounders. For instance, USMLE scores are independent predictors of matching to optho even after controlling for AOA membership, school ranking, and whether your school has an ophtho residency (http://1.usa.gov/IMH9E3) (odds ratio 1.6 for every 10 point increase).

So people who increase their score by 10 points on Step 1 are more likely to match in ophtho. Not really a surprise, but still not a causative relationship, and still doesn't disprove my original point that in medical school you are selling yourself short to only focus on the boards. There is more to learn than just being able to regurgitate all of the facts about NF1 and 2 and spot them from a mile away in a question stem.

 

[pathologyDO]

So people who increase their score by 10 points on Step 1 are more likely to match in ophtho. Not really a surprise, but still not a causative relationship, and still doesn't disprove my original point that in medical school you are selling yourself short to only focus on the boards. There is more to learn than just being able to regurgitate all of the facts about NF1 and 2 and spot them from a mile away in a question stem.

I don't necessarily think you're right or wrong on this, but with the amount of info thrown at us it's really hard to say that I will remember most if any of it. It would make more sense that the clinical skills I get during 3rd/4th years then during residency will be when I learn to be a physician. First two years seem more like the time where you learn what you need in order to pass the boards to land a good residency, which is where you learn to be a good physician.

What I mean to say is, I don't think you can sell yourself short if you're passing classes during the first two years.

So far, I'm utterly underwhelmed by pre-clinical medical education kind of like OP. It's just not satisfying to me, I cannot stop and thoroughly memorize anything like undergrad. The idea for our educators is to just mention everything necessary, speed through lectures, and have us learn it on our own, mainly for boards.

 

[DermViser]

Somewhat true, though probably not the HYYYYYYYUUUUUUUUGGGGGEEEE factor it gets made out to be. Certainly important, but probably won't save an otherwise meh application or eliminate an otherwise stellar application. This is just conjecture, but I'd guess Step I is used as an application screen, and that once you hit whatever benchmark has been set, a 235 isn't significant different than a 250 to most programs. Again, I'm extrapolating based on the conversations I've had with PDs at one institution, but my guess is that approach is pretty wide reaching. And the school's obligation isn't to get you a 260+ (though I bet they'd love it if everyone did), they are to educate you and position you to match. Ideally high on your list. But on their end that means teaching people who can be good interns and residents, ensuring that students from your school are ranked by PDs. A good score is part of that, but the school isn't under any obligation to "teach to the boards."

And I know being on the other side of Step I (and II CK) it is really easy for me to say these things, but I think it is a little short-sighted to focus so hard on a standardized test. And I know that when I was second-year, all I could think about was getting a good Step 1 score.

Sorry, but Step 1 IS a huge factor when it comes to matching in competitive specialties.

 

[DermViser]

Knowing the information for the boards is not necessarily what makes a good doctor. Remember that you go to med school to be a doctor not to ace the board exams.

My school is PBL and we probably spent way too much time in different aspects of patient care than in diagnosis/pathogenesis/treatment of disease. Step 1 is a standardized exam. You read First Aid use some Pathoma and do some questions and you will do fine on Step 1 (Source: I got a 269 in a curriculum that definitely dind't teach to Step 1)

Um no, residency prepares you to be a doctor, not medical school.

 

[DermViser]

The 2012 NRMP PD survey says that 82% of programs use Step 1 in selecting applicants to interview and that when it comes to ranking interviewees to match, Step 1 score is a 4.1 out of 5 in importance, about the level of leadership qualities, recommendation letter in the specialty, clerkship grades. It's less important than the interview interactions, but nonetheless among the most important factors to ranking to match. If your approach were true, the benchmark would be set at the interview stage and then the score would not be important at the ranking stage. This is most certainly not the case on average.

Somewhat true, though probably not the HYYYYYYYUUUUUUUUGGGGGEEEE factor it gets made out to be. Certainly important, but probably won't save an otherwise meh application or eliminate an otherwise stellar application. This is just conjecture, but I'd guess Step I is used as an application screen, and that once you hit whatever benchmark has been set, a 235 isn't significant different than a 250 to most programs. Again, I'm extrapolating based on the conversations I've had with PDs at one institution, but my guess is that approach is pretty wide reaching.

But why go based off of facts coming from PDs nationally, when we can go based on Physio Doc 2 Be's conjecture, extrapolation, and anecdote?

 

[GangaMaster]

But why go based off of facts coming from PDs nationally, when we can go based on Physio Doc 2 Be's conjecture, extrapolation, and anecdote?

From some "PDs" at one "institution," at that.

 

[Psai]

I've heard pds from competitive specialties say that when they look at your folder, it has your name and step 1 score on the front. Take from that what you will.

 

[ulikedaggers]

Does any school have a good curriculum with competent teachers?

I like mine so far. Unranked school with board scores around the national average, but I've found that they basically teach directly out of certain board review books with the occasional professor-specific minutiae. Not sure why our board scores aren't higher on a yearly basis.

Somewhat paradoxically, I'd be willing to wager that the higher ranked MD schools have less board-focused curricula solely because of their caliber of research. Some serious research guy teaching just to keep tenure might be more concerned with teaching you their research stuff and not what's going to show up on Step 1. The higher scores coming out of these schools is due mainly to the quality of students that get in and not the curriculum itself. Just conjecture, of course.

 

[Nasrudin]

The tenured professorial system is about as obsolete as you can get for gathering up massive amounts of information into usable form--both for board exams and for clinical preparation. Some feel comfortable in this system and like following a guide, no matter how inept, through the unknown wilderness.

But I'm for dismantling the whole thing and doing years 1 and 2 online meeting only for small discussion groups. Kaplan and pathoma and the like just do it better. I'm sorry to say--but I don't give a crap for meandering, idiosyncratic, obtuse experts. I have yet to once use their archane approaches to anything I've done in years 3 and 4. And I don't expect to be surprised as intern in a few months by a sudden...."damn! I wish I had paid closer attention to that histology lecture!"

 

[alpinism]

Most M2 courses in a nutshell:

4hrs of lecture --->some basic understanding but mostly wtf??
1hr of Pathoma and Goljan --->ahh it all makes sense now!!



(To be fair we also had some really great profs that better explained things in more depth than the review books)

 

[DermViser]

I've heard pds from competitive specialties say that when they look at your folder, it has your name and step 1 score on the front. Take from that what you will.

Wouldn't surprise me at all. Board scores in certain competitive specialties are highly valued, almost to the point of ridiculousness. It's kind of sad really.