How medical school works

[TheDBird90]

I've read a lot about it, but without actually being there I'm curious as to what each part of med school accomplishes (what it really prepares you for). Specifically, internship - is that where you actually learn to practice medicine independently (on-the-job training)? It seems like the clinical years really exist just to prepare you for residency, correct? People say that there's a "steep learning curve" for internship, but they seem to differ with specialty (from what I've read). For an Internal Medicine intern there is a steep learning curve, and for certain other specialties you have to do a preliminary internship or transitional year in IM, but then you switch to your desired specialty in the second year. Yet for a pathology resideny you go straight into it, without a preliminary internship. So does this mean that some doctors are trained better than others? Or do preliminary internships in IM not matter that much? What I'm trying to say is - can a pathologist, for example, still prescribe medications and the like even though they haven't had a preliminary internship?

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[Fluffy123]

Yeah, not every residency requires a prelim internship prior to residency. In emergency med, you go straight from med school to residency and still prescribe meds, order labs, interpret results, take care of patients, run codes, etc.

 

[Dr. Death]

In many (all?) specialties your first year of residency is called "intern year." Residency itself is basically a 3-7+ year internship.

 

[mimelim]

I've read a lot about it, but without actually being there I'm curious as to what each part of med school accomplishes (what it really prepares you for). Specifically, internship - is that where you actually learn to practice medicine independently (on-the-job training)? It seems like the clinical years really exist just to prepare you for residency, correct? People say that there's a "steep learning curve" for internship, but they seem to differ with specialty (from what I've read). For an Internal Medicine intern there is a steep learning curve, and for certain other specialties you have to do a preliminary internship or transitional year in IM, but then you switch to your desired specialty in the second year. Yet for a pathology resideny you go straight into it, without a preliminary internship. So does this mean that some doctors are trained better than others? Or do preliminary internships in IM not matter that much? What I'm trying to say is - can a pathologist, for example, still prescribe medications and the like even though they haven't had a preliminary internship?

This is a confusing topic. The first year or residency is called "intern year". But, this is a vestige of the past, it means nothing, it is just a label.

The key concepts to understand are the following:
#1 Prelim vs. categorical - preliminary residency positions are 1 year contracts. They are cheap labor spots. Some specialties require a prelim year prior to starting their specialty training. It is a way to get a better product before their specialty training starts. It forces the student to spend a year working, learning how the hospital works, learning some medicine, etc. There are a lot of discussions on the resident forums about the utility of prelim years for these students. It is also a repository for students who could not obtain a categorical position and needed something to do while they reapplied the following year. Categorical positions are 3-7 year positions. While your contract may be for 1 year, you are generally protected and once you are in a categorical position, it is relatively hard to lose.

#2 Yes, some doctors are better trained than others. Where you go to residency matters. Not all training programs are equal. To learn medicine effectively, you need two things, a large amount of pathology and good mentorship. Not every residency excels in both of those. There is a tremendous amount of variability between programs within a single specialty. Different specialties are simply trained differently, not really 'better' or 'worse'. But, consider, when I graduate from my program, I will have been living/breathing vascular surgery at 80-100 hours/week between clinical/research/reading/studying/administrative etc. 50 weeks a year for 7 years. There are many hospitalists that are in their first year of practice who have 3 years of 60-80 hours/week of experience from residency. That is a pretty big gap in terms of raw number of hours spent in the hospital caring for patients. Means nothing if you don't have pathology/mentorship as above, but in general, yes, there is a difference.

 

[JB50]

This is a confusing topic.

Pretty crazy. Do you think with how much time you've put in to such a specialized subfield that you could identify pathologies beyond those you see regularly in vascular surgery?

 

[Goro]

A Hemet/Once colleague once told me that "Medicine is knowing more and more about less and less."

Pretty crazy. Do you think with how much time you've put in to such a specialized subfield that you could identify pathologies beyond those you see regularly in vascular surgery?

 

[JB50]

A Hemet/Once colleague once told me that "Medicine is knowing more and more about less and less."

So you're saying you essentially become more and more specific as you go on.

 

[Goro]

Yes, especially if you specialize.

So you're saying you essentially become more and more specific as you go on.

 

[Endoxifen]

So you're saying you essentially become more and more specific as you go on.

I think this applies to any academic or highly intellectual field. My laboratory mentors have spent years thinking about the structure and function of a few proteins. My father, a lawyer, has only thought about contract law for the last 20 years. Its good in a way, because you can become really proficient at your specialty, but it has always struck me as a bit sad too. It definitely speaks to our limitations as humans.

 

[JB50]

I think this applies to any academic or highly intellectual field. My laboratory mentors have spent years thinking about the structure and function of a few proteins. My father, a lawyer, has only thought about contract law for the last 20 years. Its good in a way, because you can become really proficient at your specialty, but it has always struck me as a bit sad too. It definitely speaks to our limitations as humans.

I agree. I guess the anal side of me wants to be able to know everything about a lot of things but that's probably not for the better. Now that I think about it that's probably dangerous to think like that and not reach out for help when needed.

 

[mimelim]

Pretty crazy. Do you think with how much time you've put in to such a specialized subfield that you could identify pathologies beyond those you see regularly in vascular surgery?

Not likely. I fall prey to the "patient has a skin lesion, call Derm." mainly because I have no clue what it is if it isn't completely obvious. Same goes for anything outside of the garden variety vascular risk factors. Diabetes, hypertension, kidney failure etc? I got those down. Also by virtue of working with thousands of patients my psych diagnoses are usually pretty good too. I know enough cardiology, stroke neurology, nephrology etc. that I can tell when someone is way outside of guidelines. Has come into play a couple of times, but still relatively rare.

 

[JB50]

Not likely. I fall prey to the "patient has a skin lesion, call Derm." mainly because I have no clue what it is if it isn't completely obvious. Same goes for anything outside of the garden variety vascular risk factors. Diabetes, hypertension, kidney failure etc? I got those down. Also by virtue of working with thousands of patients my psych diagnoses are usually pretty good too. I know enough cardiology, stroke neurology, nephrology etc. that I can tell when someone is way outside of guidelines. Has come into play a couple of times, but still relatively rare.

Interesting. How do you think that differs from a more general field like internal med, hospitalist, etc. Also, do you ever wish you hadn't specialized for any reason?