I thought getting in was the hard part

[longhaul3]

Reminds me of the time an intern errantly dilated the carotid artery during an IJ CVC placement my own intern year. Apparently the kid held pressure for an hour waiting for vascular to arrive and take over.

Subclavian lines all day. One of my top 3 most satisfying bedside procedures. Pneumothorax, who cares, the patient has two lungs (if I remember correctly from M1 anatomy).

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[operaman]

I’m an M1 as well so take this with a grain of salt but I would place trust in the systems that are in place, which ensure that medical students are trained to a high standard (licensing entities, accrediting bodies, faculty committees, etc), that have found anatomy to be a significant and important component of preclinical medical education. We, as students, aren’t in a position to evaluate what is and is not important in our own development. Trust the entities that are in place, and find ways to get the work done. Sometimes we just have to do the thing.

Med school, really any endeavor in life, is going to be quite challenging if you must be convinced of something’s relevance at each turn...

Good luck to you!

This is an excellent point and one that gets missed amid the typical lamentations on the rigors of Med ed. For all its shortcomings, the current system has trained literally every great physician we know. As someone freshly on the other side of it, I’m amazed at how I’m able to think now and how I’m able to competently do some pretty complex operations all by myself. As a non trad who never set foot in a science classroom until 9 months before getting accepted to Med school, it still blows my mind that I’m allowed to do this now! With minimal prior knowledge, everything I know clinically began with that first day of biochem lectures on the most basic building blocks of cellular metabolism and that first day in anatomy lab making the first incision into our cadaver.

Any time I’m talking about changes in Med ed, I’m painfully aware that I have personally not trained anyone to become a physician while the faculties of medical schools have done it thousands of times.

 

[IMGASMD]

Would love to see someone that isn’t a neurologist or an anatomy instructor draw out the brachial plexus into its entirety from memory, label each root, trunk, division, cord, branch, every nerve that branches off of it, what muscles each nerve innervates, and explain how a superior root injury would present vs injury to the inferior roots as well as how those injuries to the brachial plexus would commonly occur. First correct response gets a steak dinner on me should we ever cross paths.

Let’s be real. It sucks. Yeah, everyone goes through it and I’ll suck it up and do the same, but I’m not going to pretend to enjoy the volume dump and mindless rote memorization that goes along with it. Some of it can be reasoned through, a lot of it really can’t and must be memorized. Memorizing facts means nothing if you can’t apply those facts to draw conclusions.

The only gift surgeons and procedural specialists have is the ability to operate potentially for hours on end and rinse and repeat the same monotonous procedures year after year while keeping their sanity. Y’all deserve every penny y’all get paid. It ain’t for me.

Anesthesiologist here. I bet if you press us hard, even the guys/gals like me in private practice (not big academic centers) can do it. We probably have pretty good ideas which muscles/regions those nerves innervate.

We don’t “need” to know where “exactly” the nerves terminate; however, We do need to have a good sense of how to terminate pain and/or suffering in certain regions of the body. Which I hope is one of your reasons to pursue a career in medicine.

Yes it sucks. Call it rite of passage, call it a weed out, call it whatever you want. YOU still have to do it, even if you never use it or don’t like it. Those things you need to know or should know will keep on coming back in your life.

Best thing you can do would be get the rant out of your system now and move on. Stop procrastinating on the interweb, and just do it.

Good luck, op.

Edit: grammar and clarification

 

[stickgirl390]

That you’d likely refer out to a neurologist in your family practice should you suspect upper extremity nerve damage in a patient of yours. Just find it extremely hypocritical when people espouse the importance of gross anatomy while not being able to name structures outside what they routinely work with/encounter in their own field.

What about rural docs who can’t refer because the closest neurologist is over 2 hours away? Are you just going to tell your patient, “sorry, that anatomy wasn’t important for me to land this job”?

 

[operaman]

No, first I'd figure out what nerve is causing trouble and why it's causing said trouble. It matters because a) lots of that I can treat myself and b) if not, I need to know where to send it.

Seriously now, you've got several actual doctors saying this stuff matters. Not sure how that's up for debate.

Admittedly none of us use every single thing from preclinical years, but most of us use lots of it.

As someone in a specialty field, you can definitely tell which referring docs paid attention in Med school and which thought they wouldn’t need to know something! The knowing where to send someone and what workup/management to do first is so vitally important to patient care. The patients themselves know when they’re being jerked around and just pan-referred and you can see their frustration as they recount the umpteen docs they’ve already been sent to for what are truly routine issues that don’t need specialty care. They’ll wait months for an appointment with a specialist only to start at square one in the management algorithm.

Contrast this with good PCPs who know their stuff. You see a referral from them and the person is basically walking in the door to discuss surgery or in need of some specialized exam to answer a key question. They’re well educated by their primary doc and know why they’re there and after I discuss a surgical plan they’ll even say “yeah my primary doc pretty much said the same thing.” Makes care soooooo much better and saves so much time and money for the patient.

 

[whataschool_classof24]

Fellow current m1. I’m enjoying anatomy but am really struggling/hating histology. I’m just gonna suck it up and memorize the crap out of it until I’m blue.

 

[deleted1005514]

Fellow current m1. I’m enjoying anatomy but am really struggling/hating histology. I’m just gonna suck it up and memorize the crap out of it until I’m blue.

You need a study buddy who loves histology and hates anatomy.

 

[iqe2010]

finding a good study group is so important. Find someone who’s smarter than you and who perhaps has a different background.

I have an exercise science background so a lot of the muscle stuff comes easy for me. My buddy majored in biochem so we compliment each other.

 

[solitarius]

Ha ha!

Med school sucks.

By design.

 

[deleted804295]

Gross anatomy has been more soul crushing than MCAT prep. Seriously, what’s the point memorizing such a huge volume of **** in such a small timeframe that we’ll forget as soon as the block is over? I get that we need to know the body, but every intricate tendon, ligament, artery, nerve in the hand/fingers? Hard to stay positive when you don’t see the point and suck at memorizing large volumes of information you see little utility in learning. It’s mindless. There’s nothing conceptual other than clinical correlates. I could easily refer to an atlas for anatomy that is unrelated to whatever field I end up specializing in.

I'm sorry it sucks! Everything we learn is so important.

The nerves in the hand are important for surgeons that work with hands. When we learn pathology everything will be pieced together. A tendon that might've seemed useless to understand prior will be important to know certain diseases. Keep strong! You got this!

 

[deleted804295]

Biochem was the worst imo, anatomy can at least come in handy but I hated needing to memorize every stupid little cofactor, nadh, kinases, blah blah blah

That's also so important!!! Understanding diseases at the molecular level requires understanding metabolic pathways.

 

[deleted804295]

Our first anatomy test is in less than a week and I don’t feel prepared at all even though all I do is study.

I have a professor that will spend 15 minutes explaining a single PowerPoint slide and will say “now do you need to know this for the test, absolutely not but I thought it was interesting.”

Skip lecture and only use lecture slides.

 

[deleted804295]

Much like Organic 2 or BioChem for undergrad, the volume that is taught vs what is tested on, is disparate.

I think its a weed out course in the sense that if you can’t handle the sheer volume of inane minutiae, then the other subjects become that much harder.

We had to learn approx 100 points just on the head.... no one can tell me that that is in any way useful, other than to warn you.. “More of this is coming your way”

I mean this is what ANKI is designed for.

Speaking of which I'm going to spend the next 3 hours coding my ANKI to make it look all pretty

 

[TwoHighways]

Validation is always nice.

An MD's thoughts on medical education

Here’s an email I received from a surgeon who asked that his name be withheld. I have edited it for length. I practiced general sur...

skepticalscalpel.blogspot.com

 

[Sephirakra]

Validation is always nice.

An MD's thoughts on medical education

Here’s an email I received from a surgeon who asked that his name be withheld. I have edited it for length. I practiced general sur...

skepticalscalpel.blogspot.com

So is confirmation bias.

 

[Matthew9Thirtyfive]

So is confirmation bias.

Can’t say I disagree with the blog post.

 

[Sephirakra]

Can’t say I disagree with the blog post.

And? Neither you, nor I, nor @TwoHighways is a practicing physician, much less a surgeon. Our opinions on best practices for medical education aren't terribly well-formed. And hunting down a blog post from 7 years ago from an anonymous surgeon on some random blog isn't exactly the silver bullet his argument was lacking.

 

[TwoHighways]

Did it ever occur to anyone that the current structure of med Ed has little to do with the success of great future physicians and that it’s simply the selection bias towards hard working, highly intelligent people that would do well in any number of fields? Sorry, still not seeing the value or clinical relevance in a lot of the crap I’m supposed to be “learning” (memorize and dump, rinse and repeat). Whatever, I’ll grind it out for another two years and look forward to clinical rotations and actual relevant learning that will be reinforced with a human being.

 

[Sephirakra]

Did it ever occur to anyone that the current structure of med Ed has little to do with the success of great future physicians and that it’s simply the selection bias towards hard working, highly intelligent people that would do well in any number of fields?

Yes, you're the first person in the history of medicine to ever have that thought...

Sorry, still not seeing the value or clinical relevance in a lot of the crap I’m supposed to be “learning” (memorize and dump, rinse and repeat). Whatever, I’ll grind it out for another two years and look forward to clinical rotations and actual relevant learning that will be reinforced with a human being.

Good luck, kid. You don't know what you don't know.

 

[Osminog]

And? Neither you, nor I, nor @TwoHighways is a practicing physician, much less a surgeon. Our opinions on best practices for medical education aren't terribly well-formed. And hunting down a blog post from 7 years ago from an anonymous surgeon on some random blog isn't exactly the silver bullet his argument was lacking.

Being a US-educated attending physician doesn't necessarily make someone more qualified to judge the quality of the American system of medical education. This is the sort of fallacy that underlies many of the complaints we hear from disgruntled parents about Common Core. For years, we've heard parents say things like, "I learned multiplication perfectly in elementary school when it was taught in a straightforward way—so it's ridiculous that my child is being taught weird, counterintuitive approaches to multiplication!" What these parents are conflating is a knowledge of math concepts and a knowledge of the theory behind how people best learn math concepts. On top of that, there is a sort of selection bias at play, in that these parents learned multiplication in a certain way and couldn't have learned it in any other way, and so they are biased toward the way they learned multiplication while remaining ignorant of what would have happened if they had had the opportunity to learn multiplication differently.

You can be a great doctor and yet totally lack an understanding of how people best learn to become great doctors. (Have you ever had a professor who seemed to be a master in his subject but was awful at teaching it to students? That's a case in point.) Moreover, the opinions of doctors who rely on their personal experiences are strongly tainted with selection bias, since there's no way they can accurately imagine what the outcome would have been if they had received a different medical education from the one they actually did receive.

Bottom line: Experiencing something first hand doesn't mean that you fully understand what you experienced or that you're able to effectively compare it to alternatives.

So if we can't just appeal to the authority of US-educated attendings, how can we evaluate the effectiveness of the current US medical education system? In my opinion, the most sensible approach is to compare it to the medical education systems in other developed countries with equally successful or superior healthcare systems. Let's take Germany as an example. A German high schooler takes a standardized test and gains admission into a medical university. He then spends two years doing basic sciences (what we do in four or five years through our undergraduate science education and then basic sciences in medical school) and then four years studying subjects and gaining skills that are directly clinical. Compared to a US medical education, a German medical education requires substantially less time spent on the basic sciences and substantially more time spent on clinical elements. And as you probably know, Germany has one of the best healthcare systems in the world and a reputation for excellent quality of care. Perhaps TwoHighways has a point?

 

[Matthew9Thirtyfive]

Just putting these side by side.

And? Neither you, nor I, nor @TwoHighways is a practicing physician, much less a surgeon. Our opinions on best practices for medical education aren't terribly well-formed.

Good luck, kid. You don't know what you don't know.

Being salty isn’t really an argument technique. Do you actually have an argument that PhDs teaching things that are not clinically relevant is useful for medical students? Because I worked with surgeons from almost every specialty for just short of a decade, and any time I asked about anatomy in med school, they all said it was basically a rite of passage but they learned what they actually needed to know in the OR.

Now don’t get me wrong, I think anatomy is important and I appreciate the rite of passage part of it. But making me memorize every single tendon and ligament in the body on the chance it will be on the practical is such a waste of time.

 

[VA Hopeful Dr]

Just putting these side by side.


Being salty isn’t really an argument technique. Do you actually have an argument that PhDs teaching things that are not clinically relevant is useful for medical students? Because I worked with surgeons from almost every specialty for just short of a decade, and any time I asked about anatomy in med school, they all said it was basically a rite of passage but they learned what they actually needed to know in the OR.

Now don’t get me wrong, I think anatomy is important and I appreciate the rite of passage part of it. But making me memorize every single tendon and ligament in the body on the chance it will be on the practical is such a waste of time.

I'm primary care so my perspective will be different than a surgeons.

M1 anatomy was a foundation. I won't claim to remember everything from that stupid anatomy lab, but in residency when I was working on getting my shoulder exam down the anatomy came back a decent bit. Like most of preclinical its getting a foundation down to draw upon later.

 

[Matthew9Thirtyfive]

I'm primary care so my perspective will be different than a surgeons.

M1 anatomy was a foundation. I won't claim to remember everything from that stupid anatomy lab, but in residency when I was working on getting my shoulder exam down the anatomy came back a decent bit. Like most of preclinical its getting a foundation down to draw upon later.

Yeah I don’t think most people would argue that you can just get rid of the preclerkship stuff. Like you said, it sets the foundation for clerkship learning and beyond. And that deeper knowledge is part of what makes physicians different than midlevels and everyone else.

But that doesn’t mean there aren’t inefficiencies or things that could be improved.

 

[GadRads]

I am a senior radiology resident and I never stop learning anatomy. I was not as enthusiastic about in medical school, but I worked hard at it. Medical school created an excellent foundation for radiologic anatomy.

 

[Fatalis]

Gross anatomy has been more soul crushing than MCAT prep. Seriously, what’s the point memorizing such a huge volume of **** in such a small timeframe that we’ll forget as soon as the block is over? I get that we need to know the body, but every intricate tendon, ligament, artery, nerve in the hand/fingers? Hard to stay positive when you don’t see the point and suck at memorizing large volumes of information you see little utility in learning. It’s mindless. There’s nothing conceptual other than clinical correlates. I could easily refer to an atlas for anatomy that is unrelated to whatever field I end up specializing in.

Like in all stages in medical training; it gets tougher but you will get better. Anatomy, although memorization heavy, comes in handy. I was placing a chest tube in a patient [rural hospital, closest "big" hospital is 2hrs away, and no back up, not even gen surg], so knowing where to put the nerve block and where to insert the chest tube required some anatomy knowledge lol... ended up draining 5L of fluid from his chest. Case and point; everyone will ask themselves "why the **** am I learning this!?", yes some is useless but I promise you, it will all come to you at the right time.

 

[Sephirakra]

Just putting these side by side.


Being salty isn’t really an argument technique. Do you actually have an argument that PhDs teaching things that are not clinically relevant is useful for medical students? Because I worked with surgeons from almost every specialty for just short of a decade, and any time I asked about anatomy in med school, they all said it was basically a rite of passage but they learned what they actually needed to know in the OR.

Salty or not, I expect better than strawmanning from you. In no way did I say that we should tolerate anyone teaching things not clinically relevant. What I said was that at our stage in training we lack the necessary experience to determine what is clinically relevant. And anyone can make the same "I worked with doctors who said blah blah blah" argument, so it really doesn't get us anywhere.

Now don’t get me wrong, I think anatomy is important and I appreciate the rite of passage part of it. But making me memorize every single tendon and ligament in the body on the chance it will be on the practical is such a waste of time.

When I said "you don't know what you don't know," I wasn't excluding myself from that statement. I don't know if something will be clinically relevant ten years down the line, but I think it's pretty myopic to start making the determination now.

 

[Osteosaur]

Me, watching in third year:

oh, it gets worse.

I made it through IM and surgery and I'm actually liking third year a lot more.

 

[TwoHighways]

It would be foolish to assume that everyone entering medicine doesn’t have actual clinical experience and have an idea about what’s relevant versus what’s useless minutiae. My bias is geared towards what’s going to kill my patient prior to receiving definitive care. Knowledge of underlying physiology, discerning between different forms of shock, and correcting that to the extent possible is far more important than being able to positively identify a gelatinous blob of tissue or some urogenital fold on a cadaver that a PhD anatomist feels is important to know. This is why so many medical students are completely useless in rotations. We’re literally producing encyclopedias that can’t apply what they know to actual patient care. We need earlier exposure to actual patients with actual conditions that reinforces what we’re learning about, not two years of rote memorization because it’s the status quo.

 

[NITRAS]

It would be foolish to assume that everyone entering medicine doesn’t have actual clinical experience and have an idea about what’s relevant versus what’s useless minutiae. My bias is geared towards what’s going to kill my patient prior to receiving definitive care. Knowledge of underlying physiology, discerning between different forms of shock, and correcting that to the extent possible is far more important than being able to positively identify a gelatinous blob of tissue or some urogenital fold on a cadaver that a PhD anatomist feels is important to know. This is why so many medical students are completely useless in rotations. We’re literally producing encyclopedias that can’t apply what they know to actual patient care. We need earlier exposure to actual patients with actual conditions that reinforces what we’re learning about, not two years of rote memorization because it’s the status quo.

Medical students knowledge of anatomy (or lack of knowledge) is not why they are useless on rounds.

 

[blockrudder1]

I love when facilitators ask anatomy questions referencing that we "learned this last year." Cramming and regurgitation isn't learning - if I didn't use Anki and keep up with old reviews, I'm not confident I would remember any smaller details.

 

[TwoHighways]

Medical students knowledge of anatomy (or lack of knowledge) is not why they are useless on rounds.

I don't disagree. A lack of patient interaction/clinical experience prior to starting rotations is. Discerning between what's relevant information as to why a patient is in the hospital and what isn't. The inability to perform a focused assessment and not get caught in the weeds with crap that does not matter. I dunno. Maybe getting exposure to all of the mostly irrelevant details is what separates a physician from a mid level, but that doesn't change the fact that we ought to reinforcing what we learn with actual patient contacts and that rote memorization doesn't make a great physician, it makes you potentially a great jeopardy contestant.

 

[RealHumanBean1]

I think it helps to think about it as a test of your grit in the short-term. In the long-term, you'll slowly reinforce this first pass as you re-learn the same information over and over and over through various experiences/lectures/etc. Just study with the intention to understand, memorize as best you can for the test, and don't stress about long-term retention - you'll see the same material time and time again!

 

[Neopolymath]

I think it helps to think about it as a test of your grit in the short-term. In the long-term, you'll slowly reinforce this first pass as you re-learn the same information over and over and over through various experiences/lectures/etc. Just study with the intention to understand, memorize as best you can for the test, and don't stress about long-term retention - you'll see the same material time and time again!

I just viewed the first two years as a legit break from having an actual job. It was chill and I met the challenges with grit. I told myself I'm tough/stubborn and I'm not going to let some loser phd with an axe to grind get under my skin. It worked. I don't think med students need to "pull themselves up by the bootstraps" like some insufferable boomer but I do think conscious mindset and gritty mentality make a big difference.

 

[j4pac]

Much of medicine is soul crushing. It gets even more difficult and soul crushing as time goes on. The good thing is that each challenging and soul crushing event prepares you to better handle an even more challenging and soul crushing event.

 

[Matthew9Thirtyfive]

Salty or not, I expect better than strawmanning from you. In no way did I say that we should tolerate anyone teaching things not clinically relevant. What I said was that at our stage in training we lack the necessary experience to determine what is clinically relevant. And anyone can make the same "I worked with doctors who said blah blah blah" argument, so it really doesn't get us anywhere.

It was hard to know what your argument actually was, since almost the entire substance of it was sarcastic comments. Your one actual point that we are too early in our training to know what is relevant is legitimate, but you followed that up by implying that anyone who disagrees with your opinion is just wrong. So maybe take your own point to heart?

Anyone can make that argument, but when the overwhelming majority of physicians a person works with agree on something, that will have an influence.

When I said "you don't know what you don't know," I wasn't excluding myself from that statement. I don't know if something will be clinically relevant ten years down the line, but I think it's pretty myopic to start making the determination now.

If your argument is just none of us can really say, then I would agree with you. But you are also dismissing the opinions of physicians who disagree that most of it is relevant, so I feel like you actually do have an opinion despite claiming we shouldn’t.

 

[Sephirakra]

It was hard to know what your argument actually was, since almost the entire substance of it was sarcastic comments. Your one actual point that we are too early in our training to know what is relevant is legitimate, but you followed that up by implying that anyone who disagrees with your opinion is just wrong. So maybe take your own point to heart?

Anyone can make that argument, but when the overwhelming majority of physicians a person works with agree on something, that will have an influence.



If your argument is just none of us can really say, then I would agree with you. But you are also dismissing the opinions of physicians who disagree that most of it is relevant, so I feel like you actually do have an opinion despite claiming we shouldn’t.

"Neither you, nor I, nor @TwoHighways is a practicing physician, much less a surgeon. Our opinions on best practices for medical education aren't terribly well-formed." That's my main point without any sarcasm. Everything else you're claiming is your inference.

 

[kepler16b]

You need to cover the minutiae in med school not because you may need to recall it at some point in the future, but because if you need to learn it again for your clinical practice you're not learning it for the first time.

 

[blockrudder1]

You need to cover the minutiae in med school not because you may need to recall it at some point in the future, but because if you need to learn it again for your clinical practice you're not learning it for the first time.

Why does everytime I "learn" glycolysis its like seeing it for the first time

 

[Neopolymath]

Just putting these side by side.


Being salty isn’t really an argument technique. Do you actually have an argument that PhDs teaching things that are not clinically relevant is useful for medical students? Because I worked with surgeons from almost every specialty for just short of a decade, and any time I asked about anatomy in med school, they all said it was basically a rite of passage but they learned what they actually needed to know in the OR.

Now don’t get me wrong, I think anatomy is important and I appreciate the rite of passage part of it. But making me memorize every single tendon and ligament in the body on the chance it will be on the practical is such a waste of time.

Same experience with surgeons about anatomy. The other benefit was never missing pimp questions in the OR because I had heard them all before

 

[Raryn]

Looking back I do wish there had been a way to make lots of M1 more clinically relevant at the time. But even now I'm not sure how you would do that. You really need a fairly decent knowledge base for even basic clinical correlations that you just don't really have for most of 1st year.

Its why I hated PBL that first year, but that's a whole other thread.

I think I'd appreciate a good physiology course more now than I did as an M1. But I also wouldn't do that to myself.

 

[stickgirl390]

I made it through IM and surgery and I'm actually liking third year a lot more.

Agreed. Funny you say this; I posted that while I was on surgery lol

 

[VA Hopeful Dr]

I think I'd appreciate a good physiology course more now than I did as an M1. But I also wouldn't do that to myself.

And that's part of the problem. I feel like I've said this before (but maybe I just thought it), it would be great to have more clinical correlation during preclinical years but you need a certain amount of knowledge to make the clinical stuff actually make sense in the larger scheme of everything.

I don't know if that can be really fixed.

 

[Cornfed101]

And that's part of the problem. I feel like I've said this before (but maybe I just thought it), it would be great to have more clinical correlation during preclinical years but you need a certain amount of knowledge to make the clinical stuff actually make sense in the larger scheme of everything.

I don't know if that can be really fixed.

Every lecture at my school has at least one clinical correlation, which definitely keeps it interesting. Even if the conditions are zebras just to make sure we know why some random substrate is important in a biochem pathway

 

[Osteosaur]

Agreed. Funny you say this; I posted that while I was on surgery lol

I had great residents and I was miserable during surgery too. You just need to make it over the hill.

 

[Giovanotto]

Me, watching in third year:

oh, it gets worse.

Me, watching in intern year:

Oh, it gets much much worse.

 

[Tangerine123]

The hardest part is convincing yourself daily that you made the right career choice.

 

[You shall know the Truth]

Our anatomy professor used to joke about keeping a list of students from whom he would never get surgery from.

Proud to say, I was near the top of that one

Anatomy is a weed out course, for no reason.

Once you’re in, they should be doing everything to help you excel.

Basic anatomy is fine but WTF, does anyone need to know the mylohyoid groove on the skull!!!

Additionally, the phsyio, BioChem, pathology, micro does have quite a bit of logic thrown in there, whereas anatomy is pure memorisation.

Yes, some specialties need to know it. Head and neck surgeons

 

[FutureInternist]

Yes, some specialties need to know it. Head and neck surgeons

Right..... IN their residency

 

[readmypostsMD]

Omg I’m finally unbanned after 1 month of not being allowed to post

I don’t find M1 hard at all. It’s easier than undergrad and lower stress

 

[emergentmd]

Anatomy was the worst. Much worse b/c undergrad was cake for me and then they load double the amount of work while studying the same as I did in Undergrad. By far my worse class academically.