Is early clinical experience bad for USMLE1 score?

[SpartyFan]

I am still deciding on which medical school to attend and was wondering if someone could answer this question.... I thought the USMLE 1 is basic science oriented versus clinical knowledge, Is this correct? If this is true, than wouldn't a curriculum in which you gain early clinical skills hurt your USMLE 1 score due to the fact that one will have less lecture time about basic science?

Sorry if this question is stupid!

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[psipsina]

I am still deciding on which medical school to attend and was wondering if someone could answer this question.... I thought the USMLE 1 is basic science oriented versus clinical knowledge, Is this correct? If this is true, than wouldn't a curriculum in which you gain early clinical skills hurt your USMLE 1 score due to the fact that one will have less lecture time about basic science?

Sorry if this question is stupid!

For me clinical experience reminds me of everything I'm here for and why I am spending these two years surrounded by mountains of notesets and textbooks trying to cram for an exam that scares the poop out of me. We don't have alot of mandatory stuff at my school but I actually volunteer (we can participate in a homeless clinic or the ER) at least once a block to reboot and reinvigorate my motivation to keep trudging through. I do think that if your clinical responsibilities were too great during the first years it could be a detriment to your step one prep, but I can't imagine being somewhere where there weren't any opportunities at all during the first two years. I also think its nice to know that I'm going to be somewhat clinically competent when I start getting graded on this stuff, since clinical grades are really only trumped by your step one score when it comes to residency apps.

 

[njbmd]

I am still deciding on which medical school to attend and was wondering if someone could answer this question.... I thought the USMLE 1 is basic science oriented versus clinical knowledge, Is this correct? If this is true, than wouldn't a curriculum in which you gain early clinical skills hurt your USMLE 1 score due to the fact that one will have less lecture time about basic science?

Sorry if this question is stupid!

USMLE Step I asks you to apply your basic knowledge to some clinical situations. You will likely encounter some clinical scenarios that require a knowledge of basic science in order to answer the question. Some USMLE Step I questions are purely basic science too. The material is intergrated which is why studying subject by subject is the least efficient manner to review for USMLE (any step).

You are NOT learning in lecture. You are bored, sleeping, day-dreaming, writing notes but definitely NOT LEARNING. This is why many folks stop attending lectures after a while and learn the material on their own with a measurable increase in their grades and time-management. Learning is an active process and listening to a lecture is pretty passive. You do your "learning" when you go home/library/bar/gym or where ever you do your studying.

One of the most useful characteristics to develop in medical school in learning to make the best use of your time. If a lecture is not the best use of your time, you go and do something else and utilize note-service, video lectures and audio tapes or whatever. I even stopped listening to the audio tapes. If the syllabus and handout were good, that was all that I needed.

Early exposure to clinicals allows you to intergrate your basic science material better. As other posters have stated, having some clinical exposure reminds you of why you came to medical school in the first place and you get to see the "whys" and "why-nots" of your pre-clinical coursework in action. If given a choice, opt for as much clinical exposure and less lecture time as possible. Sitting in lecture is the "least-efficient" means to learn anything.

 

[Pemulis]

I am still deciding on which medical school to attend and was wondering if someone could answer this question.... I thought the USMLE 1 is basic science oriented versus clinical knowledge, Is this correct? If this is true, than wouldn't a curriculum in which you gain early clinical skills hurt your USMLE 1 score due to the fact that one will have less lecture time about basic science?

Sorry if this question is stupid!

A lot of the basic science stuff does have a clinical slant to it. For example, a good part of what you'll do in the preclinical years is learn about different diseases: what causes them, what types of people get them, what symptoms they present with, etc. So having clinical experience can reinforce some of the "basic" science.

However, the bigger issue is that step 1 is a means to an end, not an end in itself. When analyzing schools, look at their match list. If the school in question has a good one, it's probably safe to assume that step 1 scores aren't generally a problem there.

 

[lord_jeebus]

Early clinical experience has very little effect on anything.

I would not choose one school over another because it offered (or lacked) such exposure.

 

[Uncle Izzy]

My school does all the basic sciences in one year and you go straight to your core clerkships in second year. We take Step 1 during 3rd year (dedicated to research) and it works out great.

You will notice on step 1 that the vast majority of questions are essentially a clinical scenario followed by a basic science aspect of the problem. Recognizing the clinical scenario is the first and most important step to answering the questions. Having a year of clerkships under my belt made recognizing the scenarios inifintely easier. I dont care how many times you read about pulmonary emboli in basic sciences, the bottom line is, the presentations of PE given in a Step 1 question is classic and mimics the real life scenarios you see and work up during clinical clerkships. It's a million times easier to remember clinical scenarios when you've actually seen them and not just read about it.

Also, for us, when it comes time to take Step 1, you have already seen the basic science at least three times...

1. When you learned it first year
2. When you reviewed and relearned it during clerkships
3. When you officially sat down to study for Step 1

Essentially, Step 1 and 2 CK have the same question stems (clinical scenarios). The difference is that the question is more clinical in Step 2. For example, they will present a pt with an infection. On Step 1, they ask for how the organism will stain. On step 2, they would ask you what antibiotic works best.

With this said, it's absolutely no coincidence that people generally find step 2 inifintely easier than step1. It's because the clinical question stems stay the same and you have seen them on the wards. It all comes down to recognizing the clinical scenario first.

 

[Law2Doc]

For me clinical experience reminds me of everything I'm here for and why I am spending these two years surrounded by mountains of notesets and textbooks trying to cram for an exam that scares the poop out of me.

Agree with this. Much of the early clinical exposure was added to the curriculum to keep the interest of students -- let them have a "taste" of what's to come, not for purposes of the test. It keeps you interested, maybe gives you a neat experience or two on top of a relatively dry diet of science.

There is no evidence that schools with more significant clinical exposure do better or worse on Step 1. It's likely pretty neutral. There is also no evidence that more lecture time contributes to a higher Step 1, which is why several schools have adopted half day curricula, replacing it with self study time. If the couple of hours a week you spend doing clinical stuff dramatically impacts how you are doing in school and on the boards, it is more an indictment of your study methods than the program.

I wouldn't worry about that test until you get past first year. If you are the type that is aching to get into the hospital, then go for a place with more clinical exposure. If not, then don't (although bear in mind that the clinical part more closely mimics what physicians do for a living than the classrooom stuff, so if you don't like it, you won't be enjoying 3rd year and beyond much).

 

[The Buff]

Early clinical experience has very little effect on anything.

I would not choose one school over another because it offered (or lacked) such exposure.

Agreed. People think it is all that and more, but my experience has been: meh. Everyone learns the same stuff by the time they are done anyway.

 

[Scottish Chap]

I am still deciding on which medical school to attend and was wondering if someone could answer this question.... I thought the USMLE 1 is basic science oriented versus clinical knowledge, Is this correct? If this is true, than wouldn't a curriculum in which you gain early clinical skills hurt your USMLE 1 score due to the fact that one will have less lecture time about basic science?

Sorry if this question is stupid!

I question the value of too many clinical experiences in MSI (and even MSII) at any medical school because you simply do not know enough to make it worthwhile and you definitely cannot contribute to the clinical management of the patient.

All this does is take away time from learning the mechanism of disease which is what MSI and MSII do for you and what you must know cold for the USMLE. We had a required rotation in family medicine in MSI and in something else (I chose cardiology). In MSII, we had a required short rotation in anything (I chose cardiac surgery). In addition, everybody where I am must complete a 4-hour shift in the E.R. in MSII. On top of that, I took an elective in internal medicine in MSI where I visited an internist's office for one afternoon out of every month. That was more than enough.

 

[yalla22]

My school does all the basic sciences in one year and you go straight to your core clerkships in second year. We take Step 1 during 3rd year (dedicated to research) and it works out great.

You will notice on step 1 that the vast majority of questions are essentially a clinical scenario followed by a basic science aspect of the problem. Recognizing the clinical scenario is the first and most important step to answering the questions. Having a year of clerkships under my belt made recognizing the scenarios inifintely easier. I dont care how many times you read about pulmonary emboli in basic sciences, the bottom line is, the presentations of PE given in a Step 1 question is classic and mimics the real life scenarios you see and work up during clinical clerkships. It's a million times easier to remember clinical scenarios when you've actually seen them and not just read about it.

Also, for us, when it comes time to take Step 1, you have already seen the basic science at least three times...

1. When you learned it first year
2. When you reviewed and relearned it during clerkships
3. When you officially sat down to study for Step 1

Essentially, Step 1 and 2 CK have the same question stems (clinical scenarios). The difference is that the question is more clinical in Step 2. For example, they will present a pt with an infection. On Step 1, they ask for how the organism will stain. On step 2, they would ask you what antibiotic works best.

With this said, it's absolutely no coincidence that people generally find step 2 inifintely easier than step1. It's because the clinical question stems stay the same and you have seen them on the wards. It all comes down to recognizing the clinical scenario first.

which school is this?

 

[spicedmanna]

which school is this?

Sounds like Duke.

 

[yalla22]

it seems like having a system liek that gives people an enormous advantage on step 1 - wonder why then more schools dont adopt this system?

 

[spicedmanna]

it seems like having a system liek that gives people an enormous advantage on step 1 - wonder why then more schools dont adopt this system?

Agree. I like Duke's method, too. However, I think many schools are afraid to cram 2 yrs worth of basic sciences into only 1 yr. I mean it's tough enough already... I honestly don't know how those kids do it. They must be smart as hell.

 

[psipsina]

My school does all the basic sciences in one year and you go straight to your core clerkships in second year. We take Step 1 during 3rd year (dedicated to research) and it works out great.

You will notice on step 1 that the vast majority of questions are essentially a clinical scenario followed by a basic science aspect of the problem. Recognizing the clinical scenario is the first and most important step to answering the questions. Having a year of clerkships under my belt made recognizing the scenarios inifintely easier. I dont care how many times you read about pulmonary emboli in basic sciences, the bottom line is, the presentations of PE given in a Step 1 question is classic and mimics the real life scenarios you see and work up during clinical clerkships. It's a million times easier to remember clinical scenarios when you've actually seen them and not just read about it.

Also, for us, when it comes time to take Step 1, you have already seen the basic science at least three times...

1. When you learned it first year
2. When you reviewed and relearned it during clerkships
3. When you officially sat down to study for Step 1

Essentially, Step 1 and 2 CK have the same question stems (clinical scenarios). The difference is that the question is more clinical in Step 2. For example, they will present a pt with an infection. On Step 1, they ask for how the organism will stain. On step 2, they would ask you what antibiotic works best.

With this said, it's absolutely no coincidence that people generally find step 2 inifintely easier than step1. It's because the clinical question stems stay the same and you have seen them on the wards. It all comes down to recognizing the clinical scenario first.

I also find that when I have a real patient to connect to a concept it sticks better. And even with only having had < 1/2 the preclinical curriculum I see something we've learned about every time I'm in the ER or on a preceptorship.

 

[Uncle Izzy]

It is the Duke curriculum. The first year was really no more difficult than any other school from what I've heard talking to my friends in other tradition 2+2 programs around the country. We definitely dont cover as much but we definitely cover enough.

I can't speak for how much having some little bits of clinical exposure during yrs 1 and 2 affects Step 1 scores, but I do know that the mean Step 1 scores at duke are in the 235 range cosistently with a full year of clerkships before the exam. The reason for the high scores may be due a variety of factors such as repeated presentation of the material, more time to study during 3rd yr, or maybe that the students are just highly motivated and very smart to begin with... I'm not sure what the answer to that is...

With that said, I couldn't imagine doing med school with any other curriculum. Duke has had theirs in place since the early 70's and has the resources to place 100 students into strong, well mentored research for a year or give them the opportunity to pursue a variety for dual degrees. There are definitely some other schools that can pull it off, but their happy with how their students learn already.

Although I have little knowledge about it, Penn has a nice research experience and I think they start clinicals early as well. I'm not sure when they take Step 1 though.

 

[Critical Mass]

The quality and extent of my clinical experience before getting here was far more fruitful than the stuff that my school gives me as an M1. With that said, I would have preferred it if they would have done away with it altogether and let me study the science. If they would actually require me to execute some procedures, I'd likely change my mind; but my school is still living in the past. This was the first year that M1's were actually required to perform a physical exam.

I am a big supporter of the curricula used at Duke and Baylor.

 

[TommyGunn04]

Agree. I like Duke's method, too. However, I think many schools are afraid to cram 2 yrs worth of basic sciences into only 1 yr. I mean it's tough enough already... I honestly don't know how those kids do it. They must be smart as hell.

This is a gross misconception that I've heard countless times on these forums, and it's just not true. Duke does not "cram 2 yrs worth of basic sciences into only 1 yr." At most, the Duke curriculum covers what other schools do in about 1.25 years in just 1 year, and that's possible because the first year is about 11 months long, without the 2-3 month summer vacation that most medical schools provide. Furthermore, Duke simply does not teach certain topics didactically that other schools spend a great deal of time covering, as it's felt that students will learn this material on the wards and through reading during the clinical year. For example, while other students spend their 2nd year doing coursework in specific disciplines like radiology, dermatology, ophthalmology, etc., we simply don't do extensive didactic work in these areas. And there's good reason for not spending much time on them, as they're not very prominent on the boards. Duke students just focus on the most important aspects of basic science that will be tested on Step 1, and then learn the rest in a more hands-on fashion, on the wards. For many of us, it's a MUCH better way to learn, and as our average Step 1 scores demonstrate, we're certainly not any worse-off for it (and arguably even better prepared!).

I hope that helps clear things up a bit. Clear as mud, right?

 

[pagemmapants]

I can't speak for whether it prepares you for the USMLE, but I can't fathom taking another year of this kind of stuff and I'm grateful that I only have 3 more months of didactic learning. It really hasn't been as bad as it could have been, although I gotta say, once you hit this point in the year spring break can't come fast enough. Having exams almost every week gets just a leeeetle tiring and right now I feel like I'm drowning in drug names. The board scores speak for themselves, though.

 

[soeagerun2or]

In my experience Step I and clinical experience are two entirely unrelated things. I found myself studying for Step I and finding what I was told/practiced in clinic was different from what was asked for Step I questions. Perhaps this isn't always the case, but generally didactic courses are somewhat behind actual practices.

 

[AmoryBlaine]

Early clinical exposure is pretty meaningless in the long run. You can have all the shadowing/mentoring you can stomach in the first two years and you're still going to feel/look/act like a fool for your first 3 months of third year.

Alot of people think that getting alot of exposure is going to put them ahead of their classmates come M3, this advantage will last for about 3 days and then everyone will be on the same playing field.

"Early clinical exposure" is just another buzzword that gets thrown around at every med school. In much the same way every school is going to tell you that their students have "an excellent clinical reputation" and that they "shine compared to students at other schools."

 

[Doctor Bagel]

"Early clinical exposure" is just another buzzword that gets thrown around at every med school. In much the same way every school is going to tell you that their students have "an excellent clinical reputation" and that they "shine compared to students at other schools."

Hmm, every school I applied to did tell me this. I actually like some of our clinical exposure just because it makes things more interesting, and it gives me an earlier idea of what I might like or not like for a specialty. Yeah, I doubt I'm learning anything that will make me more prepared for 3rd year.

 

[Law2Doc]

Hmm, every school I applied to did tell me this. I actually like some of our clinical exposure just because it makes things more interesting, and it gives me an earlier idea of what I might like or not like for a specialty. Yeah, I doubt I'm learning anything that will make me more prepared for 3rd year.

People get burnt out on the sciences, and start wondering why they are going into medicine. Clinical exposure helps give a tiny window into actual medicine -- a reminder of where this path ends up. It helps people keep the eye on the prize. It also probably helps some folks overcome any issues they may have with talking to strangers about their sexual histories and bodily functions, and palpating and auscultating them. But as for actually being better prepared, I kind of doubt it.

 

[EBI831]

when i visited baylor this was one of their selling points. they said that a later step 1 and a schedule that allowed for earlier clinical experience allowed them to do better on step 1. so in this case, i wouldn't see it as a detriment.