How Would You Reimagine Med-School Education?

[Brain Bucket]

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My parents knew I was going to be a physician when I was born.

See Jane suture.
See Dick cut the suture.
Dick cut the tails too short.
Rectals, rectals, rectals.

 

[Arkangeloid]

Remove Embryology from the curriculum completely and make it a fourth year elective or something for the few people who will ever make use of it in their careers.

 

[Arkangeloid]

They have no incentive to tell you this information. Look at medical school admissions tours now. They're done by the ***-kissers of the administration. Do you think they would want word getting around about how bad things are when they have yet to go thru the match?

Wait, really? That would explain a lot. They asked for volunteers to give a tour, so I offered to give one. I woke up early to go, but when I got to the requested location (the admin office), the admin told me it was canceled (without any prior notice). I was confused and annoyed.

Later, I asked the student in charge (and my friend) what the deal was. He was also confused, saying he hadn't heard of any cancellations. I think that they may have directed me to an incorrect location where I was then informed of the cancellation, while sending out the real location to the other volunteer, and asking another student to take my spot.

I wish they would just be upfront and tell me "we hate you, and we don't want you involved in our school." I could have slept in on that morning. Hell, I could have saved time applying for those random leadership things, all of which I was either rejected at, or had my position revoked by the school admins lol.

 

[Psai]

Wait, really? That would explain a lot. They asked for volunteers to give a tour, so I offered to give one. I woke up early to go, but when I got to the requested location (the admin office), the admin told me it was canceled (without any prior notice). I was confused and annoyed.

Later, I asked the student in charge (and my friend) what the deal was. He was also confused, saying he hadn't heard of any cancellations. I think that they may have directed me to an incorrect location where I was then informed of the cancellation, while sending out the real location to the other volunteer, and asking another student to take my spot.

I wish they would just be upfront and tell me "we hate you, and we don't want you involved in our school." I could have slept in on that morning. Hell, I could have saved time applying for those random leadership things, all of which I was either rejected at, or had my position revoked by the school admins lol.

I can't say that I blame them

 

[Arkangeloid]

I can't say that I blame them

From their perspective (to try to sell their school and try to show off amazing students), neither do I. Nevertheless, as a student paying them a fortune, I at least deserve the courtesy of prior notice.

 

[DermViser]

From their perspective (to try to sell their school and try to show off amazing students), neither do I. Nevertheless, as a student paying them a fortune, I at least deserve the courtesy of prior notice.

I think Psai is more talking about your negativity.

 

[Arkangeloid]

I think Psai is more talking about your negativity.

I still deserved prior notification that I did not need to wake up early to get there on Friday.

Rest assured I will remember the discourtesy I received at this institution when they come asking for donations.

 

[redpanda]

I don't know the answer myself.

We would need a student from Duke or Vanderbilt to chime in and testify to if they are competent on the wards during their second year.

I know a Duke student quite well, and she was exceedingly competent on the wards in second year and her shelf exams reflected that. However, her Step 1 score (taken at the end of MS2) was not what I would've expected for someone who usually kills exams with little effort.

 

[DermViser]

I still deserved prior notification that I did not need to wake up early to get there on Friday.

Rest assured I will remember the discourtesy I received at this institution when they come asking for donations.

You're 100% sure it wasn't cancelled?

 

[DermViser]

I know a Duke student quite well, and she was exceedingly competent on the wards in second year and her shelf exams reflected that. However, her Step 1 score (taken at the end of MS2) was not what I would've expected for someone who usually kills exams with little effort.

Shelf exams are quite different from USMLE Step 1, IMHO.

 

[Arkangeloid]

You're 100% sure it wasn't cancelled?

I trust this friend, and the look on his face when I told him was genuine confusion. I didn't think much of it until I saw your post, and then I correlated it with the school's other actions against me, and it makes perfect sense.

The school has never been open about this stuff with me, they've just been firing these insults from the shadows, and I have to hear about them second-hand from my older friends. Then I find out the truth.

 

[SouthernSurgeon]

I know a Duke student quite well, and she was exceedingly competent on the wards in second year and her shelf exams reflected that. However, her Step 1 score (taken at the end of MS2) was not what I would've expected for someone who usually kills exams with little effort.

I asked the Duke residents and faculty about this when I interviewed there for my surgery residency.

They said the second years are virtually useless on the wards, have no responsibilities, and mostly disappear to study. It's not until they come back as fourth years that they get any "real" experience.

Now that is just the perspective of a few people, and an obviously biased crowd (surgeons have a notorious tendency of thinking most med students are useless). But it is an interesting counterpoint.

And shelf exams in no way indicate that someone is "exceedingly competent" on the wards.

 

[DermViser]

I asked the Duke residents and faculty about this when I interviewed there for my surgery residency.

They said the second years are virtually useless on the wards, have no responsibilities, and mostly disappear to study. It's not until they come back as fourth years that they get any "real" experience.

Now that is just the perspective of a few people, and an obviously biased crowd (surgeons have a notorious tendency of thinking most med students are useless). But it is an interesting counterpoint.

And shelf exams in no way indicate that someone is "exceedingly competent" on the wards.

So then how do Duke students get "Honors" on rotations? Or is it grade inflated there as well? Must be nice going to a school like Duke that caters to medical students.

 

[SouthernSurgeon]

So then how do Duke students get "Honors" on rotations? Or is it grade inflated there as well? Must be nice going to a school like Duke that caters to medical students.

I dunno. I don't work there, just had a couple of brief conversations about it because I was curious about how their curriculum worked and what the perception of it was.

 

[DermViser]

I dunno. I don't work there, just had a couple of brief conversations about it because I was curious about how their curriculum worked and what the perception of it was.

The reason why I ask is bc in theory it shouldn't make a difference. The only difference is the basic science portion being cut to 1 year (I'm assuming they do their Physical Diagnosis course that year too, or students would truly be utterly useless on the wards).

 

[Brain Bucket]

And shelf exams in no way indicate that someone is "exceedingly competent" on the wards.

For obvious reasons, I'd think that anyone who rocks the shelves is more likely to be competent. If I'm wrong, educate me please.

 

[SouthernSurgeon]

For obvious reasons, I'd think that anyone who rocks the shelves is more likely to be competent. If I'm wrong, educate me please.

I think there is probably a correlation in that good students tend to be good students in multiple domains.

But preparing for and rocking the shelves is much more similar to M1-M2 and USMLE studying than it is to actual clinical competence on the wards. We frequently will have students who are totally clueless in a clinical setting and yet get high shelf scores.

 

[DermViser]

For obvious reasons, I'd think that anyone who rocks the shelves is more likely to be competent. If I'm wrong, educate me please.

Ark, is that you?

 

[DermViser]

I think there is probably a correlation in that good students tend to be good students in multiple domains.

But preparing for and rocking the shelves is much more similar to M1-M2 and USMLE studying than it is to actual clinical competence on the wards. We frequently will have students who are totally clueless in a clinical setting and yet get high shelf scores.

Yes. Exactly. Happens much more often than you think - esp. the ones that are missing when clinical stuff needs to be done and are hiding studying for their shelf exam.

 

[Brain Bucket]

I think there is probably a correlation in that good students tend to be good students in multiple domains.

But preparing for and rocking the shelves is much more similar to M1-M2 and USMLE studying than it is to actual clinical competence on the wards. We frequently will have students who are totally clueless in a clinical setting and yet get high shelf scores.

How would you recommend attaining this competence other than reading up on your patients, doing as many procedures as possible, and taking an active interest in the decision-making process?

Ark, is that you?

lol. I'm just a little confused, because I'd think reasonable intelligence and a good work ethic go a long way towards competence in any field. The students with the best evals in MS-3(now 4), were also the ones with the highest shelf scores at our school.

There are some very smart people who can rock a shelf exam, who have no bedside manner or ability to work well with others, or are simply clueless in a clinical setting. There are also some people always think zebras instead of horses and miss the "big picture".

That's just a matter of training, isn't it? How can you be clueless in a clinical setting? Just people who 'freeze'?

 

[Smurfette]

For obvious reasons, I'd think that anyone who rocks the shelves is more likely to be competent. If I'm wrong, educate me please.

There are some very smart people who can rock a shelf exam, who have no bedside manner or ability to work well with others, or are simply clueless in a clinical setting. There are also some people always think zebras instead of horses and miss the "big picture".

 

[DermViser]

There are some very smart people who can rock a shelf exam, who have no bedside manner or ability to work well with others, or are simply clueless in a clinical setting. There are also some people always think zebras instead of horses and miss the "big picture".

Yes, it takes all the power in the world not to laugh when they answer pimp questions from the attendings with zebras they learned in MS-1/MS-2. Some people are awesome study machines and can rock multiple choice exams, but couldn't do an H&P to save their lives.

 

[Brain Bucket]

What's so hard about a H&P? Just find a good template and follow it. Then list ddx in order from most to least likely. You guys are freaking me out! I start rotations in under a month.

 

[ChEMD]

What's so hard about a H&P? Just find a good template and follow it. Then list ddx in order from most to least likely. You guys are freaking me out!

The problem is the answers patients give don't always follow templates. It's also knowing what follow up questions to ask when a patient gives you a certain answer. Also, you can study all you want, know exactly what your supposed to ask for a given set of symptoms, but sometimes people get nervous when having to communicate with an actual person and they forget things that they should have done. Now you may not be one of those people, so it seems like a foreign idea that someone could struggle with it, but it definitely happens to other people.

 

[Brain Bucket]

The problem is the answers patients give don't always follow templates. It's also knowing what follow up questions to ask when a patient gives you a certain answer. Also, you can study all you want, know exactly what your supposed to ask for a given set of symptoms, but sometimes people get nervous when having to communicate with an actual person and they forget things that they should have done. Now you may not be one of those people, so it seems like a foreign idea that someone could struggle with it, but it definitely happens to other people.

So, we're pretty much just talking about the socially inept here?

 

[ChEMD]

So, we're pretty much just talking about the socially inept here?

That might be it for some, but I think for a lot of people it's just lack of practice.

 

[Mass Effect]

For obvious reasons, I'd think that anyone who rocks the shelves is more likely to be competent. If I'm wrong, educate me please.

You're wrong. Others have done a good job of replying to this, so I'll just repeat that how you do on the shelf exams has little correlation to how you perform on the wards. Most of the time, doing a good with your patients has less to do with what zebras you're tested on and more to do with how good you are at getting the information and putting it together to piece together a reasonable and accurate clinical profile.

The students with the best evals in MS-3(now 4), were also the ones with the highest shelf scores at our school

How could you possibly know that? If it's because the administration told you, I'd just advise you to take it with a huge grain of salt. Some students do well on the shelf and get excellent evals too, yes, but many students who have excellent evals score merely average on the shelf and vice versa. One has little to do with the other.

That's just a matter of training, isn't it? How can you be clueless in a clinical setting?

Most M3s are clueless on their first rotation. It takes a little while to adjust to applying all the book knowledge you have. The ones who are still clueless by the end of M3 are the ones who either didn't get a good clinical education or the ones who didn't cheated themselves out of a good clinical education.

What's so hard about a H&P? Just find a good template and follow it. Then list ddx in order from most to least likely. You guys are freaking me out! I start rotations in under a month.

If you simply follow a template for your H&P, you will most likely miss huge chunks of relevant information.

 

[Brain Bucket]

You're wrong. Others have done a good job of replying to this, so I'll just repeat that how you do on the shelf exams has little correlation to how you perform on the wards. Most of the time, doing a good with your patients has less to do with what zebras you're tested on and more to do with how good you are at getting the information and putting it together to piece together a reasonable and accurate clinical profile.

Agreed. I don't see what I'm wrong about. http://forums.studentdoctor.net/thr...school-education.1082913/page-2#post-15421245

I'm clearly missing something since so many of you are trying to correct me.

How could you possibly know that? If it's because the administration told you, I'd just advise you to take it with a huge grain of salt. Some students do well on the shelf and get excellent evals too, yes, but many students who have excellent evals score merely average on the shelf and vice versa. One has little to do with the other.

We receive awards for different things. Medals (gold, silver, bronze) for the three highest grades, other honors for those who've excelled in different ways. We also have inter-school competitions between teams of students dealing with diagnosis/treatment/management of mock patients (paid actors) in various scenarios.

Most M3s are clueless on their first rotation. It takes a little while to adjust to applying all the book knowledge you have.

Obviously. Like I've said earlier, it just appears to be a matter of training/practice. We really aren't talking about people who've just finished MS-2 vs MS-4s. We're talking about people who rocked the shelves vs. those who didn't.

The ones who are still clueless by the end of M3 are the ones who either didn't get a good clinical education or the ones who didn't cheated themselves out of a good clinical education.

Yep. See post linked above. work ethic+intelligence+active interest.

If you simply follow a template for your H&P, you will most likely miss huge chunks of relevant information.

Certainement. The way I understand it, you have to start with a detailed (good) template. As you gain experience, you can adapt. In the beginning, you're far better off following a template than winging it.

 

[notbobtrustme]

Honestly if I had the magic wand and absolute control this is how I'd do it.

Condense the first 2 years into a single year. The second year is clinic based much like the current 3rd year. At the end of the first two years, you take a combination Step 1 and Step 2 exam. The 3rd year is structured much like the current 4th year, with a bigger emphasis on doing stuff rather than jerking around. 4th year functions essentially as your intern year and everyone takes Step 3 at the end at the end of medical school.

It would make graduates not worthless when they graduate.

 

[DermViser]

Honestly if I had the magic wand and absolute control this is how I'd do it.

Condense the first 2 years into a single year. The second year is clinic based much like the current 3rd year. At the end of the first two years, you take a combination Step 1 and Step 2 exam. The 3rd year is structured much like the current 4th year, with a bigger emphasis on doing stuff rather than jerking around. 4th year functions essentially as your intern year and everyone takes Step 3 at the end at the end of medical school.

It would make graduates not worthless when they graduate.

Or remove Step 3 altogether and replace it with specialty boards, although I guess people want to moonlight.

 

[Mass Effect]

Agreed. I don't see what I'm wrong about. http://forums.studentdoctor.net/thr...school-education.1082913/page-2#post-15421245

I'm clearly missing something since so many of you are trying to correct me

We're trying to correct you on your statement that "anyone who rocks the shelves is more likely to be competent." That has nothing to do with the post you linked me to.

We receive awards for different things. Medals (gold, silver, bronze) for the three highest grades, other honors for those who've excelled in different ways. We also have inter-school competitions between teams of students dealing with diagnosis/treatment/management of mock patients (paid actors) in various scenarios

Wow. Your school is big on awards. I still don't see how you know that the highest scorers on the shelf exams were the ones with the best evaluations.

Obviously. Like I've said earlier, it just appears to be a matter of training/practice. We really aren't talking about people who've just finished MS-2 vs MS-4s. We're talking about people who rocked the shelves vs. those who didn't

Again, you're assuming a correlation where there isn't one. Someone who scored average on the OB shelf exam could be the superstar on the OB wards. Meanwhile, someone who scored in the 99th percentile could have gotten nothing but satisfactory marks on the rotation itself. Just because the average scorer didn't know book facts doesn't mean that he/she didn't rock the H&P and physical exam, write an excellent note, do a great presentation, and come up with viable differentials. It's quite easy to rock the rotation (at an honors level) and still score average on the shelf and vice versa.

Certainement. The way I understand it, you have to start with a detailed (good) template. As you gain experience, you can adapt. In the beginning, you're far better off following a template than winging it.

No one said anything about winging it. You should never wing it.

Honestly if I had the magic wand and absolute control this is how I'd do it.

Condense the first 2 years into a single year. The second year is clinic based much like the current 3rd year. At the end of the first two years, you take a combination Step 1 and Step 2 exam. The 3rd year is structured much like the current 4th year, with a bigger emphasis on doing stuff rather than jerking around. 4th year functions essentially as your intern year and everyone takes Step 3 at the end at the end of medical school.

It would make graduates not worthless when they graduate.

This is quite possibly the worst suggestion I've heard yet.

 

[Mass Effect]

Or remove Step 3 altogether and replace it with specialty boards, although I guess people want to moonlight.

Specialty boards? After 3 years of med school and nothing else, you think people will know enough about a specialty to take specialty boards? Or was that sarcasm?

 

[DermViser]

Specialty boards? After 3 years of med school and nothing else, you think people will know enough about a specialty to take specialty boards? Or was that sarcasm?

No, I mean specialty boards after residency.

 

[Brain Bucket]

We're trying to correct you on your statement that "anyone who rocks the shelves is more likely to be competent." That has nothing to do with the post you linked me to.

That post had to do with my references to it further down.

Wow. Your school is big on awards. I still don't see how you know that the highest scorers on the shelf exams were the ones with the best evaluations.

Same people, different awards. The awards are given during a ceremony every year. I won't go into specifics, because that id's my school. That, and actually talking to attendings/deans.

Again, you're assuming a correlation where there isn't one. Someone who scored average on the OB shelf exam could be the superstar on the OB wards. Meanwhile, someone who scored in the 99th percentile could have gotten nothing but satisfactory marks on the rotation itself. Just because the average scorer didn't know book facts doesn't mean that he/she didn't rock the H&P and physical exam, write an excellent note, do a great presentation, and come up with viable differentials. It's quite easy to rock the rotation (at an honors level) and still score average on the shelf and vice versa.

Again, I'm talking about the correlation between intelligence+work ethic and performance. If you're arguing that there's no correlation there, we're at an impasse.

No one said anything about winging it. You should never wing it.

So what did you mean by 'If you simply follow a template for your H&P, you will most likely miss huge chunks of relevant information.'? What better way is there while starting out than following a template?

 

[operaman]

@New World... Symphony! - agree wholeheartedly about the music major being extremely helpful. I actually think that what I learned in the arts has helped me immensely in med school and been largely responsible for my successes thusfar. Unfortunately, I have a really hard time articulating why exactly that is the case, but I know it's true (at least for me). It's some combination of developing the study skills needed -- you know how well you have to learn a piece of music where all the notes are "high yield" -- combined with the interpersonal skills and overall awareness you develop on the stage. There's also an element of being able to face something overwhelming and not give up -- the sense the piano soloist gets during those first few chords of the Rachmaninoff 2nd concerto before all hell breaks loose, or being offered a last minute job in another country that starts in 3 days and requires you memorize 500 pages of music (happened!). I think there's also an element -- the one that led to Senator McCarthy's famous anti-communist line: "Be wary of artists - the mix well with all levels of society" -- that allows artists to feel comfortable with anyone.

As for how to improve education, I think my thought would be how to cover more rather than less. I like the idea of going to all-recorded lectures for preclinical and then using the class time for doing things you can't do on a computer. I remember thinking how we could skip anatomy lectures and put them on video and use those hours working with faculty watching/helping them do pro-sections before we dissected our own. You could add in the PBL kind of the stuff. I think institutions with the right infrastructure could develop some longitudinal outpatient experiences that would go all 4 years; maybe a one morning a week in an outpatient clinic where students carry they "own" panel of patients. I think the key would be to make sure the activities tied in and reinforced the lectures so students were well prepared for boards, etc.

 

[Brain Bucket]

Your school gives awards for the best evals???? Okayyy. By the way, if deans are talking to you about specific students' evals, there are some major breaches in professionalism at your school.

Things are done differently here. There is no privacy. Until recently, grades were posted on a bulletin board. That particular award is essentially an eval. I'm an IMG, if that clears things up.

Well sure, that's what you're talking about now, but the majority of us were replying to your post about shelf exams and rotation evals.

I've been talking about the same thing from the start. Let me break it down:

For obvious reasons, I'd think that anyone who rocks the shelves is more likely to be competent. If I'm wrong, educate me please.

I then went on the explicitly state those (what I thought were) obvious reasons, since the general consensus appeared to be against me.

lol. I'm just a little confused, because I'd think reasonable intelligence and a good work ethic go a long way towards competence in any field.

See? intelligence+work ethic. same words. Nothing changed.

I meant exactly what it says. Following only the template is sure to make you miss a lot. The point is to think about what you're asking and why that's relevant. Students who simply go line by line without understanding the significance of the questions usually screw up.

I said pretty much the same thing in my second post. I really don't see what you're disagreeing with.

How would you recommend attaining this competence other than reading up on your patients, doing as many procedures as possible, and taking an active interest in the decision-making process?

 

[Kahreek]

lolipops, lolipops for everyone

 

[Brain Bucket]

lolipops, lolipops for everyone

*lollipops. yeah, it's been that kind of night.

 

[DermViser]

What's so hard about a H&P? Just find a good template and follow it. Then list ddx in order from most to least likely. You guys are freaking me out! I start rotations in under a month.

Patients don't follow textbooks or review texts. You could have all symptoms memorized and still not be able to function on the wards. Doing an H&P and then doing an Assessment/Plan is much harder in real life, as a lot of the work is cognitive (ruling things in and out, being able to go from question of which the answer changes what you ask next, etc.)

 

[DermViser]

What I'm disagreeing with is "For obvious reasons, I'd think that anyone who rocks the shelves is more likely to be competent. If I'm wrong, educate me please" as I've said numerous times. Doing well on shelf exams means that you've most likely read a review book, answered some UWorld questions, and taken a practice shelf. None of that correlates to competence on the floors. Yes, intelligence and hard work make for a competent person on the floors. But just because someone is a hard worker, don't assume they apply it to their clinical rotations. At times, those working the hardest for their shelf exam are the ones hiding out in some corner of the hospital where no one from their team can find or page them. Same goes for intelligence (i.e. someone can be extremely book smart and ace the shelf, but don't assume they'll know a damn thing when the patient "doesn't read the textbook")

THIS. THIS. THIS. The problem is that these skills can't really be "taught". Nearly all of MS-1/MS-2 is learning "classic" presentations. The problem is in real life, nothing is ever "classic", it's always a ruling in and ruling out of symptoms. If everything presented "classically" then hospitals wouldn't pay doctors, they would just hire midlevels, and I guarantee you that they've tried.

The skills to be successful in MS-1/MS-2 are just quite different than those needed to be successful in MS-3. And bc med schools are fearful of what their match lists look like - they cover up up real failings in medical students, and how residency can fix the flaws. Hence why PDs look closely at what med school that person is graduating from.

 

[starstarie]

The reason why I ask is bc in theory it shouldn't make a difference. The only difference is the basic science portion being cut to 1 year (I'm assuming they do their Physical Diagnosis course that year too, or students would truly be utterly useless on the wards).

Yes they do it over a week or two (as a block) in the spring of MS1, from what I understand

 

[DermViser]

Yes they do it over a week or two (as a block) in the spring of MS1, from what I understand

Wow, only 2 weeks of a Physical Diagnosis course? No wonder they would be utterly useless when they enter rotations. Most schools at least break up the course as you cover things in Organ Systems: CV block -- CV Physical Exam, etc. Of course, the only reason they can get away with this is bc of being Duke.

 

[starstarie]

For clarification, they probably (hopefully?) have some other incorporation throughout the year... not 100% sure about that. I just know they do this week or two in the spring.

 

[PL198]

You know the students dread those 2 weeks and probably try to weasel out of doing anything.

 

[DermViser]

You know the students dread those 2 weeks and probably try to weasel out of doing anything.

Well if it's a block, then they have nothing else going on.

The entire reason they probably shaved down basic sciences to 1 year is so they can put in a research year where 1) they can pump out more publications, and with students they don't have to pay them and 2) students chances of matching to their specialty of choice go up. Who cares if students are clinically incompetent on the wards. That's the residency programs' problem.

 

[Brain Bucket]

What I'm disagreeing with is "For obvious reasons, I'd think that anyone who rocks the shelves is more likely to be competent. If I'm wrong, educate me please" as I've said numerous times. Doing well on shelf exams means that you've most likely read a review book, answered some UWorld questions, and taken a practice shelf. None of that correlates to competence on the floors.

Doing well is different from rocking a shelf. Either way, our definitions definitely vary. Those of us who ace the shelves here only look at the review books towards the end of a course. Much of our time during the course is spent with texts. You must have some truly brilliant people in your class if they 'likely read a review book, answered some UWorld questions, and taken a practice shelf.' and then proceeded to score in the high 90th percentile on the pre-clinical shelves.

Yes, intelligence and hard work make for a competent person on the floors. But just because someone is a hard worker, don't assume they apply it to their clinical rotations.

Why not? It's less of a leap to to assume that a person with a good worth ethic will continue it into the clinical years, than assuming that someone without a similar work ethic will suddenly develop one.

At times, those working the hardest for their shelf exam are the ones hiding out in some corner of the hospital where no one from their team can find or page them. Same goes for intelligence (i.e. someone can be extremely book smart and ace the shelf, but don't assume they'll know a damn thing when the patient "doesn't read the textbook")

Again, this should not be a common occurrence.

Patients don't follow textbooks or review texts. You could have all symptoms memorized and still not be able to function on the wards. Doing an H&P and then doing an Assessment/Plan is much harder in real life, as a lot of the work is cognitive (ruling things in and out, being able to go from question of which the answer changes what you ask next, etc.)

I'd think this is just a matter of practice.

THIS. THIS. THIS. The problem is that these skills can't really be "taught".

Why not?

 

[DermViser]

Doing well is different from rocking a shelf. Either way, our definitions definitely vary. Those of us who ace the shelves here only look at the review books towards the end of a course. Much of our time during the course is spent with texts. You must have some truly brilliant people in your class if they 'likely read a review book, answered some UWorld questions, and taken a practice shelf.' and then proceeded to score in the high 90th percentile on the pre-clinical shelves.


Why not? It's less of a leap to to assume that a person with a good worth ethic will continue it into the clinical years, than assuming that someone without a similar work ethic will suddenly develop one.

Again, this should not be a common occurrence.


I'd think this is just a matter of practice.


Why not?

If you read Harrison's during the MS-3 clerkship - you would a) likely not finish and b) fail the shelf. There's a reason why every U.S. med student is carrying Step Up to Medicine and Case Files when it comes to the shelf. It's something you can easily finish and do well on the shelf.

Some people are just better at answering a standardized multiple choice question than working up an undifferentiated patient. The thinking involved in answering a multiple choice question vs. working up a patient are completely different. Some people are able to do it, and some can't and you only get a limited time to practice before you become an intern and are paid for education and service. That's why there is this thing called remediation both in med school and in residency.

If you're falling behind, depending on the resources of the program, they may or not be able to fully invest in you to bring you up to speed. Just see the many threads on SDN in which the person felt like they weren't given adequate shots at remediation.

 

[DermViser]

How are you judging their hard work? It appears you're judging it based on their grades. If so, then don't assume they will work hard on the wards just because they work hard when studying for exams. They could easily channel all their energy into acing the shelf and put in very little effort to clinical duties. In other words, they could contribute the absolute minimum to their team and then use all the time they just freed up for themselves to study for the shelf. Many med students do this and they end up doing great on the shelf, but believe me, they don't get glowing evals.

Then take someone who's an average test-taker to begin with. Say their MCAT was only a 30, their class rank is only average, etc. Some may assume this person doesn't have a good work ethic because of his/her grades and test scores. Yet, when that person is out on the wards, he works his tail off, always shows up early, fetches all the labs before the resident gets there, knows all his patients, refers to Up To Date on an hourly basis to figure out differentials and treatment plans, is a natural at presentations, and spends any and all time writing notes and asking the team how to help. This person gets NO shelf studying in during the day and at the end of the day, this person is the last one to leave so he's exhausted from a long day on the floors. He doesn't study when he gets home and by the end of the rotation has put in only an hour or two actual reading for the shelf. Guess what? This person will most likely not score well on the shelf, but he will almost surely get an honor-level evaluation.

You'd be surprised.

Exactly. This should be stickied. MS-3 clerkships (as they are now) can be gamed. If you peruse through SDN way back, people were complaining about how when they first started they didn't realize how much the NBME shelf played into getting Honors. Once they figured that out, they released the pedal on the effort they put in so they weren't exhausted when studying for the shelf to get Honors.

Of course, you'll always have some oddballs who put so much effort into the shelf that they forget that evals also play a role in their grade. Hard to break a habit, I guess.

 

[SouthernSurgeon]

@Brain Bucket

I'm going to try for just a general response to some of your concerns. Here is, from my experience, some common behaviors of BAD medical student on our clerkship. **Please note, that I would guess a substantial number of the students who fell into this pattern probably still received a high pass. The med school affiliated with my residency program is one of those ones where a P is a scarlet letter.

The first and foremost way to be a bad student is to not care, or more accurately give off the perception of not caring. I don't mean that you should be a kiss ass. But some people, likely due to nerves or social awkwardness or whatever, will naturally gravitate to the back of the crowd on rounds, or hesitate to make eye contact and speak up assertively. People who legitimately don't care get bad evaluations deservedly; people who lack the awareness of how their behavior is perceived by others get bad evaluations undeservedly.

The next way to be a bad student is to be late. Don't ever be late. In fact...being on time is late. Be early.

Another way to be a bad student is to be disorganized. This will come across in your presentations, your ability to assess a patient, your interactions with the team.

Next up: bad students don't progress. I understand that on day one your presentation is going to be far from perfect, will probably include too much information, and you won't really know the plan for a postop patient. But by your fourth week with us? You still can't make a decent assessment and plan? That is not acceptable.

Lack of anticipation. Same patient has the exact same wound on rounds every day. Every day we have to change the dressing. Every day I have to push and remind the student to put gloves on and get the dressing supplies. What happened? Did you forget? Did you think the wound healed overnight? We have been changing this same dressing. Similar thing happens in the OR. How many sutures in a row does the attending have to specifically ask you to cut before you start just doing it without being asked?

There are I am sure a million more things I could think of if . But what you'll notice is that these examples have very little to do with medical knowledge. They are all more about interpersonal skills, understanding and interacting with a team dynamic, and emotional intelligence.


----

That said, I have said it before and I will say it again. I think this SDN notion that the bell curve switches from M1-M2 and M3-M4, and that all the "average" pre-clinical student will become a clinical rockstar is largely a myth. It is also a defense mechanism for the M1-2 who is average or below average and can't accept it - they reassure themselves that when they reach the clinical years the gunners will get their comeuppance and they will magically get honors due to their superior interpersonal skills.

The majority of students who do well in M1-M2 year still do well as M3s, because they are smart and hard working. Sure, some of them have a personality disorder and drop off a bit, but that's not that common.

Does it happen to some? Certainly.

And as others just posted - you also see the gung-ho students who absolutely dive in on the clinical side thinking it will pay off in their evals. The residents love those students because they help out the team and they generally seem like the kind of person you'd want to work with. But they get so tired from working that they don't study enough, so they don't get honors on the clerkship because they had a middling shelf score.

 

[Brain Bucket]

@Brain Bucket

I'm going to try for just a general response to some of your concerns. Here is, from my experience, some common behaviors of BAD medical student on our clerkship. **Please note, that I would guess a substantial number of the students who fell into this pattern probably still received a high pass. The med school affiliated with my residency program is one of those ones where a P is a scarlet letter.

The first and foremost way to be a bad student is to not care, or more accurately give off the perception of not caring. I don't mean that you should be a kiss ass. But some people, likely due to nerves or social awkwardness or whatever, will naturally gravitate to the back of the crowd on rounds, or hesitate to make eye contact and speak up assertively. People who legitimately don't care get bad evaluations deservedly; people who lack the awareness of how their behavior is perceived by others get bad evaluations undeservedly.

The next way to be a bad student is to be late. Don't ever be late. In fact...being on time is late. Be early.

Another way to be a bad student is to be disorganized. This will come across in your presentations, your ability to assess a patient, your interactions with the team.

Next up: bad students don't progress. I understand that on day one your presentation is going to be far from perfect, will probably include too much information, and you won't really know the plan for a postop patient. But by your fourth week with us? You still can't make a decent assessment and plan? That is not acceptable.

Lack of anticipation. Same patient has the exact same wound on rounds every day. Every day we have to change the dressing. Every day I have to push and remind the student to put gloves on and get the dressing supplies. What happened? Did you forget? Did you think the wound healed overnight? We have been changing this same dressing. Similar thing happens in the OR. How many sutures in a row does the attending have to specifically ask you to cut before you start just doing it without being asked?

There are I am sure a million more things I could think of if . But what you'll notice is that these examples have very little to do with medical knowledge. They are all more about interpersonal skills, understanding and interacting with a team dynamic, and emotional intelligence.


----

That said, I have said it before and I will say it again. I think this SDN notion that the bell curve switches from M1-M2 and M3-M4, and that all the "average" pre-clinical student will become a clinical rockstar is largely a myth. It is also a defense mechanism for the M1-2 who is average or below average and can't accept it - they reassure themselves that when they reach the clinical years the gunners will get their comeuppance and they will magically get honors due to their superior interpersonal skills.

The majority of students who do well in M1-M2 year still do well as M3s, because they are smart and hard working. Sure, some of them have a personality disorder and drop off a bit, but that's not that common.

Does it happen to some? Certainly.

And as others just posted - you also see the gung-ho students who absolutely dive in on the clinical side thinking it will pay off in their evals. The residents love those students because they help out the team and they generally seem like the kind of person you'd want to work with. But they get so tired from working that they don't study enough, so they don't get honors on the clerkship because they had a middling shelf score.

Thanks. I agree with all of that. Bookmarked this thread for re-reading in a few months, once I have better perspective. If I find I'm not getting the evals I need, I'll definitely ask you guys for help again.