How much of step 1 is first year material?

Burrell College of Osteopathic Medicine
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Locrian said:
Hey that's good! Atleast you put in the work. And should you ever need to see that stuff again/read about it in research papers/drug action mechanisms, it will come back to you, or be easier for you to understand what they are saying. Vs. people im talking about that just gloss over whats not high yield -.- Just make everything harder for themselves later.
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There are a lot of ways, BETTER ways, to advance medicine than studying molecular pathways.
 
chronicidal said:
You point out an important choice facing medical students and how they approach their preclinical education.

What is the purpose of learning knowledge that is deemed "interesting" by PhD researchers or by subspecialist clinicians but is otherwise irrelevant to the current clinical practice of medicine or is not something that you can expect every good doctor in any field to know?

Is it that there is a small chance (and it's small, because it's low-yield) that this knowledge-for-knowledge's-sake may BECOME relevant later and that learning it NOW will be EASIER than learning it LATER?

I don't think that's worthwhile, in terms of efficiency. Rather than learning how BID functions in apoptosis now in case there is a cancer drug 20 years from now that targets it, I would rather learn it in 20 years, if and only if there is that drug, when I have significantly more perspective on how important knowing this stuff is to my area of clinical expertise. You COULD learn it once now, at considerable difficulty because it lacks certain relevance and meaning in your life, and then you let that memory decay exponentially without any added meaning or repetition for the next 20 years. It doesn't come up on boards (because it's low-yield), it doesn't come up on the wards (because the drug doesn't exist yet), it doesn't come up in your research (because you choose to specialize in an area that, statistically, is highly unlikely to deal with this one tidbit of minutia). Then 20 years from now, the strength of that memory trace is <1% of its initial strength. Now you read about this new miracle drug, you have to almost essentially re-learn the entire concept to get that memory from 1% to 100%. I would rather learn it (go from 0% to 100%) in 20 years because it will have an added layer of MEANING and relevance. When items of knowledge are elaborated with meaning, they stick in your memory better, i.e. they are easier to learn. Further, I'll know that the effort I'm putting into it is going to be worth it because it will be relevant, rather than just knowledge for knowledge's sake.

Preclinical medical education is not like a liberal arts education. They're not trying to get us to open our minds and think about things in new ways across different disciplines and learn knowledge for knowledge's sake. Preclinical medical education is professional school. It's about dumping a ton of knowledge in a single domain on us, forcing us to create declarative memories for everything, hoping some of it sticks and that we can apply it in the clinical context.

You might object, "Remember you supposed to be a clinical scientist." meaning we are supposed to be advancing the field and that we are a step above the mid-levels, nurses, PAs, technicians. I get that. I don't think teaching us a broad variety of esoteric KNOWLEDGE is the way to cultivate the SKILLS it takes to be a clinical scientist who can advance the field. We can only be experts in a small slice of medicine and forge ahead there, and our success in that endeavor will not be determined by how much of it we learned in the first two years of medical school. My ideal curriculum would pare down the content of first two years into the most clinically relevant things in order to create time for research. A few progressive-thinking schools are already doing this. Duke has had this idea for decades with its 1 year preclinical model. Vanderbilt is following in its steps. Many other schools have the 1.5 year, like Penn and Emory.
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Well said Chronicidal.
 
chronicidal said:
You point out an important choice facing medical students and how they approach their preclinical education.

What is the purpose of learning knowledge that is deemed "interesting" by PhD researchers or by subspecialist clinicians but is otherwise irrelevant to the current clinical practice of medicine or is not something that you can expect every good doctor in any field to know?

Is it that there is a small chance (and it's small, because it's low-yield) that this knowledge-for-knowledge's-sake may BECOME relevant later and that learning it NOW will be EASIER than learning it LATER?

I don't think that's worthwhile, in terms of efficiency. Rather than learning how BID functions in apoptosis now in case there is a cancer drug 20 years from now that targets it, I would rather learn it in 20 years, if and only if there is that drug, when I have significantly more perspective on how important knowing this stuff is to my area of clinical expertise. You COULD learn it once now, at considerable difficulty because it lacks certain relevance and meaning in your life, and then you let that memory decay exponentially without any added meaning or repetition for the next 20 years. It doesn't come up on boards (because it's low-yield), it doesn't come up on the wards (because the drug doesn't exist yet), it doesn't come up in your research (because you choose to specialize in an area that, statistically, is highly unlikely to deal with this one tidbit of minutia). Then 20 years from now, the strength of that memory trace is <1% of its initial strength. Now you read about this new miracle drug, you have to almost essentially re-learn the entire concept to get that memory from 1% to 100%. I would rather learn it (go from 0% to 100%) in 20 years because it will have an added layer of MEANING and relevance. When items of knowledge are elaborated with meaning, they stick in your memory better, i.e. they are easier to learn. Further, I'll know that the effort I'm putting into it is going to be worth it because it will be relevant, rather than just knowledge for knowledge's sake.

Preclinical medical education is not like a liberal arts education. They're not trying to get us to open our minds and think about things in new ways across different disciplines and learn knowledge for knowledge's sake. Preclinical medical education is professional school. It's about dumping a ton of knowledge in a single domain on us, forcing us to create declarative memories for everything, hoping some of it sticks and that we can apply it in the clinical context.

You might object, "Remember you supposed to be a clinical scientist." meaning we are supposed to be advancing the field and that we are a step above the mid-levels, nurses, PAs, technicians. I get that. I don't think teaching us a broad variety of esoteric KNOWLEDGE is the way to cultivate the SKILLS it takes to be a clinical scientist who can advance the field. We can only be experts in a small slice of medicine and forge ahead there, and our success in that endeavor will not be determined by how much of it we learned in the first two years of medical school. My ideal curriculum would pare down the content of first two years into the most clinically relevant things in order to create time for research. A few progressive-thinking schools are already doing this. Duke has had this idea for decades with its 1 year preclinical model. Vanderbilt is following in its steps. Many other schools have the 1.5 year, like Penn and Emory.
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You hinted at it but I don't think you fully understand that not everyone who goes to Med School becomes a clinical physician. They become teachers and researchers. Some pursue MD/PhD and that coursework is relevant to their field. Just like some people find the psychology portion of clinical medicine (which is kind of important), some people on here really don't understand that the reason these are harped on early in education is because there is nowhere else to teach that for people who want to do this. Are you going to deny someone who wants to become a physician scientist the ability to get an education in that aspect of medicine? Yes, one could argue that they should have gotten a PhD, but that's really not a fair call because MD's have a huge part in research with their combined knowledge of clinical and research-based education. I had the choice between a PhD and MD. I was told by many PhD's that there was a substantial benefit in doing an MD. That's true. You get a great overall education that prepares you for either clinical medicine or research.

People also need to realize that this mechanisms/pathways are not just for research. They're essential and important in oncology/hematology (I actually can't say 100% so an oncologist can chime here at any point) but I've seen the importance of MOA's and biochem in oncology medications. Not to mention that knowing the difference between why Von Willebrands and Hemophilia B can't both be treated with vasopressin deals with understanding the platelet/coag pathway. This is another pathway that is pretty much a macro-based signal transduction pathway.

But I'm not saying all of you guys are wrong in that you guys who want to pursue clinically oriented medicine find no real utility in these pathways. But some of us do. Some of us have an interest in pursuing oncology or research. Just be grateful that there isn't a heavy emphasis on physics because of radiation oncology 😉
 
Kaustikos said:
You hinted at it but I don't think you fully understand that not everyone who goes to Med School becomes a clinical physician. They become teachers and researchers. Some pursue MD/PhD and that coursework is relevant to their field. Just like some people find the psychology portion of clinical medicine (which is kind of important), some people on here really don't understand that the reason these are harped on early in education is because there is nowhere else to teach that for people who want to do this. Are you going to deny someone who wants to become a physician scientist the ability to get an education in that aspect of medicine? Yes, one could argue that they should have gotten a PhD, but that's really not a fair call because MD's have a huge part in research with their combined knowledge of clinical and research-based education. I had the choice between a PhD and MD. I was told by many PhD's that there was a substantial benefit in doing an MD. That's true. You get a great overall education that prepares you for either clinical medicine or research.

People also need to realize that this mechanisms/pathways are not just for research. They're essential and important in oncology/hematology (I actually can't say 100% so an oncologist can chime here at any point) but I've seen the importance of MOA's and biochem in oncology medications. Not to mention that knowing the difference between why Von Willebrands and Hemophilia B can't both be treated with vasopressin deals with understanding the platelet/coag pathway. This is another pathway that is pretty much a macro-based signal transduction pathway.

But I'm not saying all of you guys are wrong in that you guys who want to pursue clinically oriented medicine find no real utility in these pathways. But some of us do. Some of us have an interest in pursuing oncology or research. Just be grateful that there isn't a heavy emphasis on physics because of radiation oncology 😉
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You make good points. I really wanted to pursue the MSTP myself.

But I don't think chronicidal was trying to make an overarching assumption about everyone's intent in pursuing medicine. I think s/he just meant to bemoan the fact that those pursuing clinically oriented careers find the curricula somewhat overly deconstructed.

:shrug:
 
Guero said:
You make good points. I really wanted to pursue the MSTP myself.

But I don't think chronicidal was trying to make an overarching assumption about everyone's intent in pursuing medicine. I think s/he just meant to bemoan the fact that those pursuing clinically oriented careers find the curricula somewhat overly deconstructed.

:shrug:
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And that's what I meant to say in my conclusion. I never disagreed completely with his opinion, I was just shedding light on other people in medical school with a different agenda. He brought up great points and I did agree at times that what they taught us in certain classes were ridiculous or irrelevant.
I had no interest in psychiatry, which is why I rarely went to the classes or took it seriously. We had an exam write up at the end where we were supposed to do a patient writeup based on a video interview. I half-assed it. The professor responded that he wanted to fail me on that exam but that he couldn't because I "met the criteria of what to include in the write-up". He didn't like my conclusion at all and thought I hadn't understood psychiatry. I disagree - I know what psychiatry is. I just disagree with a lot of it. It just seems like you can diagnose anyone with a psychiatric problem based on the "diseases" they have. But that's an opinion. And then we discuss Anti-depressants in pharmacology and I got livid because of how little information they have on efficacy and the detrimental effects of the drugs.

So yeah, he brings up good points.
 
Kaustikos said:
And that's what I meant to say in my conclusion. I never disagreed completely with his opinion, I was just shedding light on other people in medical school with a different agenda. He brought up great points and I did agree at times that what they taught us in certain classes were ridiculous or irrelevant.
I had no interest in psychiatry, which is why I rarely went to the classes or took it seriously. We had an exam write up at the end where we were supposed to do a patient writeup based on a video interview. I half-assed it. The professor responded that he wanted to fail me on that exam but that he couldn't because I "met the criteria of what to include in the write-up". He didn't like my conclusion at all and thought I hadn't understood psychiatry. I disagree - I know what psychiatry is. I just disagree with a lot of it. It just seems like you can diagnose anyone with a psychiatric problem based on the "diseases" they have. But that's an opinion. And then we discuss Anti-depressants in pharmacology and I got livid because of how little information they have on efficacy and the detrimental effects of the drugs.

So yeah, he brings up good points.
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Agreed. When you find some coveted time, perhaps during a week's vacation where you just want to sit back, read, and vegetate, you should check out Our Daily Meds by Peterson. I think you'd really like it.
 
Guero said:
Agreed. When you find some coveted time, perhaps during a week's vacation where you just want to sit back, read, and vegetate, you should check out Our Daily Meds by Peterson. I think you'd really like it.
Click to expand...

Ugh. I read Deadly Monopolies and now you give me THIS?! :laugh:

I enjoyed the book I read, despite having a huge love for pharmacology. I read these books and tend to develop more of a distaste for certain things but I still find an understanding in why pharm companies do the things they do.

I'll have to read this AFTER boards.
 
Kaustikos said:
Ugh. I read Deadly Monopolies and now you give me THIS?! :laugh:

I enjoyed the book I read, despite having a huge love for pharmacology. I read these books and tend to develop more of a distaste for certain things but I still find an understanding in why pharm companies do the things they do.

I'll have to read this AFTER boards.
Click to expand...
:laugh: Word. GL! :luck:
 
Kaustikos said:
And that's what I meant to say in my conclusion. I never disagreed completely with his opinion, I was just shedding light on other people in medical school with a different agenda. He brought up great points and I did agree at times that what they taught us in certain classes were ridiculous or irrelevant.
Click to expand...

I'm glad we can all agree on a more or less nuanced version of this sentiment.

I get that not everyone going to med school has the same aims. One example is that my school technically does not require everyone to take any USMLEs. The language in the policy is along the lines of required of "students planning to pursue clinical medicine." The underlying philosophy is one of flexibility and maybe one student every three years decides that, in fact, they have no desire to become a licensed physician but still want to graduate with an MD. Usually they're doing an MD/PhD. However, the school's asking itself now, if we're not trying to train licensed physicians as a matter of course in order to be an MD graduate from this institution, what are we doing? Should this policy be updated to be a mandate? It's an interesting question to ponder.
 
chronicidal said:
You point out an important choice facing medical students and how they approach their preclinical education.

What is the purpose of learning knowledge that is deemed "interesting" by PhD researchers or by subspecialist clinicians but is otherwise irrelevant to the current clinical practice of medicine or is not something that you can expect every good doctor in any field to know?

Is it that there is a small chance (and it's small, because it's low-yield) that this knowledge-for-knowledge's-sake may BECOME relevant later and that learning it NOW will be EASIER than learning it LATER?

I don't think that's worthwhile, in terms of efficiency. Rather than learning how BID functions in apoptosis now in case there is a cancer drug 20 years from now that targets it, I would rather learn it in 20 years, if and only if there is that drug, when I have significantly more perspective on how important knowing this stuff is to my area of clinical expertise. You COULD learn it once now, at considerable difficulty because it lacks certain relevance and meaning in your life, and then you let that memory decay exponentially without any added meaning or repetition for the next 20 years. It doesn't come up on boards (because it's low-yield), it doesn't come up on the wards (because the drug doesn't exist yet), it doesn't come up in your research (because you choose to specialize in an area that, statistically, is highly unlikely to deal with this one tidbit of minutia). Then 20 years from now, the strength of that memory trace is <1% of its initial strength. Now you read about this new miracle drug, you have to almost essentially re-learn the entire concept to get that memory from 1% to 100%. I would rather learn it (go from 0% to 100%) in 20 years because it will have an added layer of MEANING and relevance. When items of knowledge are elaborated with meaning, they stick in your memory better, i.e. they are easier to learn. Further, I'll know that the effort I'm putting into it is going to be worth it because it will be relevant, rather than just knowledge for knowledge's sake.

Preclinical medical education is not like a liberal arts education. They're not trying to get us to open our minds and think about things in new ways across different disciplines and learn knowledge for knowledge's sake. Preclinical medical education is professional school. It's about dumping a ton of knowledge in a single domain on us, forcing us to create declarative memories for everything, hoping some of it sticks and that we can apply it in the clinical context.

You might object, "Remember you supposed to be a clinical scientist." meaning we are supposed to be advancing the field and that we are a step above the mid-levels, nurses, PAs, technicians. I get that. I don't think teaching us a broad variety of esoteric KNOWLEDGE is the way to cultivate the SKILLS it takes to be a clinical scientist who can advance the field. We can only be experts in a small slice of medicine and forge ahead there, and our success in that endeavor will not be determined by how much of it we learned in the first two years of medical school. My ideal curriculum would pare down the content of first two years into the most clinically relevant things in order to create time for research. A few progressive-thinking schools are already doing this. Duke has had this idea for decades with its 1 year preclinical model. Vanderbilt is following in its steps. Many other schools have the 1.5 year, like Penn and Emory.
Click to expand...

Yes. 👍
 
Locrian said:
Remember you supposed to be a clinical scientist.

When you know only what your supposed to know/enough to get by, you're not really going to advance our field are you?

It's like when I talk to my fellow classmates about medicine, most of the time im literally standing their with a face like -.-... like yeah, hmm you have a fundamental misunderstanding of how the human body works when questioned, but you can recite goljan to me like their your own words because you memorized what you need to know for step. I'm so impressed.
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I don't see myself as someone who wants to advance the field. I would leave that for others...

I see myself as a clinician who was educated in the basic sciences to understand the clinical aspects for clinic work.
 
KnuxNole said:
I don't see myself as someone who wants to advance the field. I would leave that for others...

I see myself as a clinician who was educated in the basic sciences to understand the clinical aspects for clinic work.
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yeah. I'm a lazy ass too.
 
Anastomoses said:
yeah. I'm a lazy ass too.
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32623703.jpg
 
LOL @ thinking that if you know what FLIP is in the apoptosis pathway it'll make you a better doctor.

You should know the basics (like glucocorticoids can cause apoptosis; +1 to that, b/c I didn't remember that, thanks for the refresher!), but don't lose yourself in the esoteric details otherwise you will absolutely lose yourself within this field (unless you're going down the MSTP path/mindset).

There is way too many things in medicine to remember. Focus on what is clinically relevant unless your research is going to be focused on minor molecular pathways.
 
evilbooyaa said:
LOL @ thinking that if you know what FLIP is in the apoptosis pathway it'll make you a better doctor.

You should know the basics (like glucocorticoids can cause apoptosis; +1 to that, b/c I didn't remember that, thanks for the refresher!), but don't lose yourself in the esoteric details otherwise you will absolutely lose yourself within this field (unless you're going down the MSTP path/mindset).

There is way too many things in medicine to remember. Focus on what is clinically relevant unless your research is going to be focused on minor molecular pathways.
Click to expand...

So agree with this. Being a scientist and being a physician are different things.
 
CDI said:
Then whats a 'physician scientist'? :naughty:
Click to expand...

A physician who conducts research. Generally this research is at a basic science level, although someone sending patients into a clinical trial may call themselves a physician scientist.

If you're a practicing physician who is doing esoteric research into molecular mechanisms, then sure, know your stuff for that specific research. Don't expect your purely clinical colleagues to know what the hell you're on about.
 
evilbooyaa said:
A physician who conducts research. Generally this research is at a basic science level, although someone sending patients into a clinical trial may call themselves a physician scientist.

If you're a practicing physician who is doing esoteric research into molecular mechanisms, then sure, know your stuff for that specific research. Don't expect your purely clinical colleagues to know what the hell you're on about.
Click to expand...
I believe the naughty face accompanying the question was intended to imply sarcasm. :d Nonetheless, a great answer for those that were unaware. 👍
 
Guero said:
I believe the naughty face accompanying the question was intended to imply sarcasm. :d Nonetheless, a great answer for those that were unaware. 👍
Click to expand...

I didn't see a naughty face next to the original question. Pons had a better answer than I did, but unfortunately sarcasm can sometimes be hard to decipher on the internet.
 
evilbooyaa said:
I didn't see a naughty face next to the original question. Pons had a better answer than I did, but unfortunately sarcasm can sometimes be hard to decipher on the internet.
Click to expand...
No worries. Were you on your phone? Some icons, along with the naughty face, don't show online. :/
 
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