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

[IamPsychiatrist]

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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!"

Yeah.

Medical school isn't efficient. It's not designed to be.

It's designed to be 4 years long - which was a plan created nearly a century ago.

Medical school is a monopoly system. There is no competition - the hundred or so allopathic institutions have no one to compete with - they hold the keys to the system. If someone could do this in 1/2 the hours with a more efficient system, they wouldn't care. It's partly a hazing process. It's a hoop jumping obstacle course no different from fraternity hazing. Is everything we do educational? Sure. You could argue that learning botany in medical school could be educational. Is everything we do efficient and highly effective? HA! No one thinks this.

Studying for Step 2 is enlightening. In the light of clinical findings, diagnosis, treatment options - so much of Step 1 is highly irrelevant. And then, we have all these PhDs who teach 10 levels beyond Step 1. I think teaching to Step 1 would be fine, it's in more depth than most clinicians operate.

It's unfortunate but they hold the keys to enter this profession. No one else can get in, except through their doors.

The fact that Pathoma or other courses can teach twice as much in a quarter of the time only reinforces that the system is broken.

But why fix it!? It's a huge business. Our total cost of attendance for 4 years is just under $300,000 per student - and the government and banks making money off the interest too! So why fix what's not broken? You see, student education isn't the end goal - the true end goal is something entirely different.

 

[skiing42]

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[Akali]

lol. Stop going to class.

 

[notbobtrustme]

The first two years are basically a lot of hazing with some important stuff thrown in. There is that adage that what we learn in the first two years becomes useless the moment Step 1 is over. The real meat of med school is 3rd/4th year, where you actually learn what is going on on the floors. It's not until residency (or in some places, the Sub-I) that you actually have some responsibilities and the buck stops with you (mostly).

No one is going to care that you can rattle off the steps in the lysosomal degradation pathway for LSDs or that you know the genes involved for HTCM or that V. chlorea can grow on basic media or that astrocytes use gradients to remove metabolites from the CSF/extracellular matrix. That **** is just standardized hazing. What's more important is recognizing what Tay-Sachs or Niemann-Pick presents like, or hte proper management of a patient with HTCM, or how to handle a chlorea outbreak, or how current therapies are directed against astrocytes in the setting of strokes. That's what matters and that has nothing to do with what we learn in the first two years of med school.

When you're in the moment, it looks like everything is important. However, after dealing with nothing but zebras all day (seriously, most of these conditions are like 1 in 100-500 thousand), we lose sight of what we will really be dealing with as physicians for 99.99% of the time.