how useful or useless are the first 2 years?

[neurotrancer]

What do you think of the following points?

1) My cousin (a medical graduate of university of buffalo), now a very, very successful internal med doc mentioned to me that were he to take my 1st physio exam (basic stuff) now, he'd probably score a whopping 10%.

2) The majority of what you learn you forget.

3) most students follow the binge and purge model of studying...I ask a 2nd year student where the pectoralis major inserts and they look at me like a deer in headlights and respond..."uh...on the arm?"

4) if you are a good multiple choice test taker you can ace without knowing anything really.

5) There is very little 2nd order thinking. Only rote memorization. The exams seem not to be an exercise in thinking deeply at all about material as much as they are an elaborate memory game.

How does the thinking in medical school compare to the type of thinking you do in graduate science school? Do you think being more analytic is better for being a physician or is it more important to be able to memorize massive quantities of info?

if i'm more analytically minded, do you suppose that I can expect to have an easier time with things in 3rd year onwards? I was a very good student (obviously good enough to get into an M.D. school) before getting here, and now I'm struggling to barely get by. What the diddley?

I got an 88% on my recent physio exam, but I am barely getting by in all my other classes. I believe it is because I am not so good at rote memorization. I am better at remembering processes and understanding systems with interrelated working parts that require that you understand them before you can start to memorize. Molecular bio just seems like a lot of alphabet soup. I hated alphabet soup when I was young and I hate alphabet soup now. I study more than most people but I'm still getting quite below average grades. Med school was a dream come true when I got in, but at times it seems like a nightmare...

Why is it so difficult now? I just used to put in the time and get good grades in college. What happenned all of a sudden? I was looking at my college physio book. It seemed hard back then. It seems so easy now. Grrrr....

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[jed2023]

The first and second years of medical school differ quite a bit in the subjects covered and perspective (basic science/clinical relevance). Most first year material (besides physiology and some biochem/mol bio) is anatomical: gross anatomy, histology, embryology, and neuroanatomy. These subjects "favor" people with highly developed visual memories and those with great memorization skills in general. Can anyone really "understand" the brachial plexus? Not really. It just has to be memorized. Which is a royal pain for those of us that like to think through things in learning material.

Second year, however, is different. There's still lots of memory work but it's more conceptual in nature. (It's also all clinically related: path, pharm, micro, immuno.) The difference in the focus from 1st year to 2nd year has allowed me to consistently score 1-2 standard deviations above the mean, whereas in first year I was usually scoring around the mean. My brain surely hasn't gotten any bigger and my studying habits are similar. So, I can only attribute it to the different nature of the 2nd year curriculum, where thinking is actually an aid and not a hindrance.

 

[mongoose]

totally agree with jed. it has been truly fun in 2nd year to watch those idiots that can memorize everything and understand nothing flounder at the back of the pack while those of us that have a hard time memorizing but can think through anything have started to move to the forefront. sweet justice. just hang in there. i felt exactly like you did in 1st year. i went from having all my chemistry professors try to convince me to do a grad program in chem because i was such a conceptual thinker to struggling in 1st year to the point of having to repeat a class over the summer break. now in 2nd year i am doing much much better with little to no difference in time spent studying.

 

[DW]

this sounds like the "former engineering/chem/physics/math students in med school" commiseration thread. I feel you guys

 

[thackl]

Ex-engineer feelin' ya on this one. Whenever something requires thought or goes conceptual (in my undergrad prereq's) I can see, and hear, the majority of premeds having panic attacks. I just don't relate, because this is what I'm good at. Give me a couple hundred body parts/structures to memorize in a day or two and I'll be panicing😀

 

[Entei]

I like "figuring things out" over memorizing too, but I was a bio major.

Does that just make me lazy and dumb?

 

[scootad.]

I disagree somewhat with the previous posters. There is still plenty of useless memorization in the 2nd year of med school. While subjects like pathophys are more concept based, there is good ole' path which is basically chock full 'o memorizing ridiculous details which one will forget the second one steps out of the exam. Pharm is all memorization but at least applicable memorization (you will need to know pharm for the 3rd year).

 

[neurotrancer]

An interesting point was made to me by a second year student I hadn't thought of...by the time we hit residency or post residency and are ready to practice, most of what we learn in pharm will be obsolete. Don't you think it would make more sense then to make learning in this class and other classes whose material is subject to becoming obsolete by the time we are ready to practice more conceptual than factual?

No one seems to have addressed my question of whether or not the thought process of a physician is more conceptual/analytical than factual/rote memorization based. I don't know the answer to this. Is being a family practitioner a matter of measuring causal flow charts? Or is generating a differential diagnosis instinctual, based in hands on experience and 2nd order thinking?

Another q...

Also, as an undergraduate, examination within my science major was 90% essay based. Do you suppose the type of thinking that is needed for that type of examination is different from the mindset that allows one to be successful for mcq exams? Do you suppose the mindset you end up developing in preparing for essay based science exams is different than that which would have been helpful for now - the first year of med school? In what ways may it or may it not be any different? If it is different, then how might one make the transition towards becoming a better mcq test-taker and consequently 1st year medical school student?

I appreciate any responses. I guess I started this thread only half as curiosity, and really the other half as venting.

 

[jed2023]

Originally posted by neurotrancer


No one seems to have addressed my question of whether or not the thought process of a physician is more conceptual/analytical than factual/rote memorization based. I don't know the answer to this. Is being a family practitioner a matter of measuring causal flow charts? Or is generating a differential diagnosis instinctual, based in hands on experience and 2nd order thinking?

It seems like you are looking for a "yes or no" answer when no such answer exists. Yes, there is a lot of memorization that goes into medical school and being a physician but I think that making the leap from this to making the statement, "Being a doctor is all about memorization" is a bogus generalization.

In fact, it seems to me that many physicians after practicing for a while do forget many of the details they learned (which you corroborate in your initial post) but they have an amazing sense for pattern recognition and for thinking through clinical problems. They surely do not run through some formalized computer-like algorithm involving a calculus optimization type problem.

As far as your friend who said that most of the pharm we learn will be obsolete when we get into our residencies, that sounds like hyperbole, if I ever heard it. Have you heard of aspirin? Its modern form, the acetylated version, was invented over a hundred years ago (late 1800's) and is still in use. The salicylate form has been used for more than 2000 years, reportedly as far back as 400 BC, in the form of white willow bark.

There will no doubt be changes in pharm over the next 4 or 5 years due to shifting drug resistance (in the case of drug resistance for antimicrobials) and design of better drugs (for most other drug classes) but this process takes time.

 

[Whisker Barrel Cortex]

Although most physicians forget much of what they learn the first two years, they often relearn and must know certain aspects depending on their specialty. They must then take this knowledge and use it to critically think through a clinical situation and apply this knowledge appropriately. Of course you can also look things up to refresh your memory, but its much easier to refresh than the learn from scratch.

Depending on specialty, you have to know different aspects:

Radiology: Normal and abnormal anatomy is essential. When reading shoulder MRI for example, we DO have to know all of the insertions of muscles and tendons. We DO need to know all of the vascular anatomy for MRA or angio. We DO need to know the segmental anatomy of the lung for chest CT. We DO need to know all of the bony lankmarks for plain film interpretation. The neuro anatomy knowledge of neuroradiologists is amazing. In addition, we have to know pathology and how pathologic processes can appear on imaging. We don't need to know much pharmacology, psych, biochem. A little bit of physio helps (ultrasound doppler, nuclear medicine studies).

Ortho: Muscle, bone, tendon, and ligamentous anatomy emphasized. Minimal pharmacology use. Pathology helpful (tumors etc).

G.Surg: Need to know abdominal/pelvic anatomy, vascular anatomy, physiology, pharmacology (to a lesser extent than medicine), pathology, microbiology.

Internal Medicine: Pharmacology is vital. Physiology is essential. Less emphasis on anatomy and pathology. Microbiology is important.

ENT: Anatomy, some path, some pharm and micro.

Psych: I guess just psych and some pharmacology.

I could go on and on. This base knowledge, even if initially forgotten, will be relearned and portions of this information will be highly useful in practice.
If you don't have the basic facts, you can't reason through to the correct answer. This background allows physicians to think through complex problems much more effectively than people such as mid level providers (PAs and NPs). It what sets MD/DO as the "top" of the health care chain.

 

[rxfudd]

Not to mention micro, which is the most random collection of information to be memorized that I have yet to see in med school. In general, I feel like most of second year (even path) is at least 50% useful - but if there's anything that makes me feel like I'm back in college learning useless junk, it's micro...

Originally posted by scootad.
...there is good ole' path which is basically chock full 'o memorizing ridiculous details which one will forget the second one steps out of the exam. Pharm is all memorization but at least applicable memorization (you will need to know pharm for the 3rd year).

 

[Doctor Octopus]

Originally posted by neurotrancer
Oh yes, and before I forget...please don't misunderstand me and think I'm disgruntled about the medical school educational process...my admission was a dream come true and I really am very excited about my future. I'm just interested in developing as clear a conception of my situation as possible and was interested in any insights people may have to offer...especially any insights from people who are farther down the road than I am.

Thanks!

BT

What medschool are you at?

 

[BPKurtz]

This is an interesting thread.

As a 4th year med student, I have to say that pharm does not become obsolete in 3 years (by the time you are a resident). The vast majority is the same. And the new stuff is tacked on to the old. Yes, they come out with a new antibiotic every now and then. And you should learn about it. But you will be giving patients TMP/Sulfa or good ol' penicillin and its derivatives many many more times than you use the fancy newer drugs. The classics never go out of style.

Somebody said about half of second year is useful. That's probably about right. It might be more correct to say that it's *all* useful for specialists in various fields (e.g. ID docs actually have a use for micro) but by the time you start intern year only half of it (or probably less) will be available to you from recall. That half is the stuff you either 1) see firsthand 3rd and 4th year, 2) get taught again and it is re-emphasized during 3rd and 4th year, or 3) teach yourself again for a clerkship exam or step 2, or just happen to remember from a really good lecture or book 2nd year. In addition you will supplement it with stuff you never even thought about during 1st and 2nd year (everything from "If I pick up this 800 gram NICU baby will it break?" to "How do I conduct an interview with this floridly psychotic patient?").

Since you brought up micro, let me give you an example of how micro comes in handier than you would think. Patient spikes a fever, you send a patient's blood for culture, and the next day the lab report on the computer says "coagulase negative Staphyloccocus". From this you determine whether the patient has S. aureus bacteremia requiring vigorous treatment or whether some S. epidermidis contaminant got in the bottle, and you should probably just ignore it. When the attending asks you, "what do you want to do?", you have an answer.

Just the opinion of a fellow med student.

bpkurtz

 

[jed2023]

Originally posted by rxfudd
Not to mention micro, which is the most random collection of information to be memorized that I have yet to see in med school. In general, I feel like most of second year (even path) is at least 50% useful - but if there's anything that makes me feel like I'm back in college learning useless junk, it's micro...

People are going to differ on which med subjects they think are "the most random collections of information." For myself, I can say that pharm and micro are far easier to memorize and more "conceptual" than first year anatomy and embryo. When I learn pharm or micro, I learn it based on classes and on generalizations about bugs or drugs within classes. I then learn exceptions to the rules, which often follow a weird logic of their own, and unique properties, and that's about it.

Anatomy to me is close to about as pure a memory-based subject as you can get. It's comparison to learning pharm or micro doesn't ring a bell with me, although people approach these subjects in different ways. I think in the end it boils down to how you process different types of information. People that talk about "conceptual" thinking often are those who emphasize induction in their thinking, that is, making patterns and generalizations about information. This is very difficult, sometimes impossible to do with much of the information in anatomy and related subjects.

 

[rxfudd]

I suppose what I meant is that the information itself (not how you learn it) is my biggest annoyance for second year. Learning what types of agar to use to culture this bug, or what type of capsule is on that bug, or what shape you would see on this fungus, or temperature to incubate that microbe at, is completely random and useless junk. It makes me feel like I'm back in college learning how to draw sugars and proteins from memory in biochem. Micro makes me feel like I'm taking a lab class as a grad student.

Originally posted by jed2023
People are going to differ on which med subjects they think are "the most random collections of information." For myself, I can say that pharm and micro are far easier to memorize and more "conceptual" than first year anatomy and embryo. When I learn pharm or micro, I learn it based on classes and on generalizations about bugs or drugs within classes. I then learn exceptions to the rules, which often follow a weird logic of their own, and unique properties, and that's about it.

Anatomy to me is close to about as pure a memory-based subject as you can get. It's comparison to learning pharm or micro doesn't ring a bell with me, although people approach these subjects in different ways. I think in the end it boils down to how you process different types of information. People that talk about "conceptual" thinking often are those who emphasize induction in their thinking, that is, making patterns and generalizations about information. This is very difficult, sometimes impossible to do with much of the information in anatomy and related subjects.

 

[jed2023]

Originally posted by rxfudd
I suppose what I meant is that the information itself (not how you learn it) is my biggest annoyance for second year. Learning what types of agar to use to culture this bug, or what type of capsule is on that bug, or what shape you would see on this fungus, or temperature to incubate that microbe at, is completely random and useless junk. It makes me feel like I'm back in college learning how to draw sugars and proteins from memory in biochem. Micro makes me feel like I'm taking a lab class as a grad student.

Well, if that's what you're talking about, then I agree for the most part. These details are sometimes necessary for identification and culturing but the hospital lab generally does the ID and culture. Not too many physicians bust out their microscopes and agar plates after they have obtained specimens from a patient. (I'd venture to say that it would probably be malpractice for docs in most specialties, if they decided to do such a thing instead of sending their specimens to the lab.) But I guess they think we should at least know the basics and be exposed to the information.

This brings up another point, which is the difference between testing at different medical schools. At Columbia we are generally not tested on minutiae like that, except for instances where it is clinically relevant (which is up to the prof's judgment). Our micro exams are in boards format with most questions in the form of clinical vignettes. The prof who is our course director for micro has written questions for the USMLE, so I assume he knows what he's doing in designing the course and writing our exam questions.