Is Med School all memorization?
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yeah I don't even really differentiate between "memorizing" and "conceptual learning". It's all the same: study study.
how can you learn the clotting cascades without understanding the underlying concepts and connecting it with the big picture? Sure, you can learn to draw it and know nothing else, but that's pointless.
it's absurd to learn without incorporating that knowledge into relevant situations.
I think that the idea that medical school is all memorization is what gets people into a lot of trouble on exams. Med school exams often go beyond the level of detail and understanding that was presented in the notes. If you understand the overall concepts being tested, you can guess and do very well. If you've only memorized the notes and cannot connect what you have learned with the exam question, you're screwed.
how can you learn the clotting cascades without understanding the underlying concepts and connecting it with the big picture? Sure, you can learn to draw it and know nothing else, but that's pointless.
it's absurd to learn without incorporating that knowledge into relevant situations.
I think that the idea that medical school is all memorization is what gets people into a lot of trouble on exams. Med school exams often go beyond the level of detail and understanding that was presented in the notes. If you understand the overall concepts being tested, you can guess and do very well. If you've only memorized the notes and cannot connect what you have learned with the exam question, you're screwed.
Whatever. who cares. How are you doing in your school? I go to a top 10 med schools, and I finished my first year ranked top 10 in the class. YES,TOP 10!!!
How about you, Sir?
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Well, I'd imagine you very likely will get pimped on this at some point. I've seen the bones in the hand come up in two rotations and an elective so far. And it's exactly the kind of very basic anatomy that seems to irk attendings when you don't know it. Some of what you are saying makes me question the methodology of your program. Medical school isn't about just learning what is interesting to you, or important on the boards. In fact, most schools talk of "teaching to the boards" as if it's a dirty word only done by the offshore crowd. You are supposed to have a broad medical education in a US allo med school, and know the basics -- it's the non-basics that are supposed to be the things you will look up. But the basics really ought to include skeletal anatomy -- it will come up over and over again in many specialties. If your clinical year rotations are anything like other schools, some ortho/plastics/FM/PM&R/rads attending is going to consider you the village idiot if you can't identify for him which hand bone is most likely fractured. And for this kind of thing, mnemonics are useful. I'd say the bones in the hand, and the cranial and facial nerves are the couple of mnemonics most doctors carry to their graves.
But on the upside, the bones of the wrist are easy with a mnemonic. I know many radiologists that still use it.
It is entertaining to me to talk to doctors that are 15-20 years removed from medical school and don't remember a thing outside of their speciality. The amount of information one is privileged to forget is awe inspiring!
It is entertaining to me to talk to doctors that are 15-20 years removed from medical school and don't remember a thing outside of their speciality. The amount of information one is privileged to forget is awe inspiring!
That's interesting, because at my school all the engineering and liberal arts majors are scoring at the bottom of the class. They spend most of the time bitching about how their superior problem solving skills don't seem to be helping them in school.
It actually kinda funny, but after he bombed our first anatomy practical one of the engineers who graduated from MIT just kept pacing back and forth saying, "Me no understand! Why I can't reverse deduce the artery names?"
It's alright though, I'm sure he'll kick my ass third year when we finally start applying this information. No matter that he neverl learned it in the first place, I'm sure he'll be able to deduce it from context. At least that's what I gather from all the Dilbert cartoons I've been reading lately.
Don't fall into the pbl trap!
Yes it seems awesome when you're a premed and you're interviewing. They tell you how innovative their school is and how they're instituting a "new form of medical education for the 21st century." But, trust me, it's all a load of $hit. PBL means spending triple the time to learn the same information, and it is frustrating as hell. After a week of it, you'll be having nightmares about pointless discussions and wierd-as-hell facilitators, waking up in a cold sweat and screaming out "Just give me a lecture already!"
That's the impression I get of PBL-based programs. I recently made a few friends at Mercer, and they reported doing ungodly amounts of pointless work because they were simply given topics and told to read about them. There was little to no direction, so they wound up taking in a whole bunch of irrelevant information to get what little they needed for their PBL sessions. I understand Mizzou makes the PBL curriculum work wonders, but it sounds like a bad plan to me.
same here. That is why I advocate not accepting non biological or medical science majors to top schools. They under perform. Like I said, applying things, such as is it acidosis or alkalosis or whatever, isn't that hard. Trust me. I have taken harder engineering and physical chemistry classes during my undergrad. If you know all the things that are taught in your schools, you won't have much problem applying them to clinical situations... I am guessing people that don't know the content will have harder time applying than what they are good at... For example, if you didn't know that ulnar nerve comes from the last rami of the brachial plexus, how da heck you would know which part of the fingers lose sensation and which muscles lose functions when you over-extend the lower axial area? I wil ljust apply and say that this nerve was injured... not so smart, isn't it?
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Only tenth in your class? Wow, what a slacker. 😀 I'm doing fine, thanks, although I can't tell you my ranking since we don't have any grades or rankings at CCLCM. But, considering your response and the fact that you are now on probation, I think it's safe to conclude that I was right about you being a troll.
To be fair, I do know that the scaphoid bone is the most likely wrist bone to be broken. That is an example of information that has a clinical context. In other words, it is relevant for more reason than just that every medical student in the past has had to memorize it, so I should have to as well. It may seem amazing to you, but I made it through both my FM and surgery rotations without ever being pimped on any wrist bones. I did get pimped on other skeletal anatomy things, especially knees and shoulders. The first time that happened, I had to go back and review. So I learned more than I would have cared to about knee and shoulder anatomy, but that's what was emphasized on my rotations for whatever the reason. But if someone held a gun to my head right now and demanded that I name every single wrist bone in order, I wouldn't be able to do it.
I think I've given you the wrong impression about my program, so I apologize for that. We don't "just learn things that are interesting to us or important on the boards." As you have suggested, med students have to spend a lot of time learning things of low interest to the students, and CCLCM has its share of that kind of learning just like any other med school. In addition, my school definitely does not teach to the boards. If anything, it's the opposite because we spend a lot of time during our first two years on clinical and research coursework that will never come up on the boards. I also need to point out that our anatomy curriculum is different than what most other schools do. It's not just a one semester or even a one year class. Instead, we keep taking anatomy all during second year, and we also have a few anatomy sessions in third year. Even with all of that, it's probably fair to say that we spend less total time in the anatomy lab than most med students do, but it's not like we don't have to learn anatomy at all.
I also didn't mean to deny the usefulness of mnemonics for things that you simply must commit to memory. As much as a I had a hate-hate relationship with First Aid, the mnemonics it has were very useful for memorizing things like cranial nerves and the brachial plexus that medical students just have to know. Again, I'm sorry for giving you the wrong impression that we never had to learn these things. We did go over them and learn them, but my point was more that we never had to MEMORIZE them for any tests.
I understand that you're exaggerating to make your point, and I get what you're saying. But I think we can probably agree that having a good knowledge base AND being able to apply it in a clinical context are BOTH necessary to do well on the wards. 🙂 If my last post was a little light on paying dues to the importance of learning enough information, it was mainly in response to GoLakers310's ridiculous statement that applying information is easy but memorizing enough facts is the difficult part. Maybe other people have had a different experience, but I've never heard a doctor say, "oh, we could have saved this guy if I had only memorized a few more facts during med school." Not to mention that some of the so-called facts you learn as a med student will wind up being out of date by the time you're an attending.
I can't say I'm a big fan of the all PBL curriculum but I think that 1 hour of PBL for every 10 hours of lecture is helpful.
I don't like PBL a whole lot, but it does help you learn how to think about problems in clinical scenarios.
I honestly think memorization does have a role. You can't problem solve until you have a basic foundation of knowledge to know where things could go wrong.
I'm also a very detail/mechanism oriented person. I can't understand a general trend without knowing the molecular mechanism behind it. I know that not everyone is like that though.
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What's wrong with "teaching to the boards"? Isn't that an amazing trait? You can focus those two years on prepping for the boards to ensure that everyone gets top scores! Besides, when you memorize all that stuff, and when Step 1 comes, you have to remember everything from scratch! If you teach to the boards, you'll get it in no time. If only that worked with the MCAT...teachers teach their own ways, and b/c you forget everything for the MCAT, have to cram all science for the entire time studying.
right, but if I understand correctly, you need to know more than just what's on the boards to be a good doctor. having a broad knowledge beyond board material is what will help you out in practice.
You have to realize that the boards universally are agreed not to be a good measure of how good a physician you are, and thus the better schools prefer not to be bound to mere board teaching and try to focus on the other things they also think are important as a physician. It is important to pass them, but because they are a crummy measure of physician quality the NBME is going to do away with Step 1 altogether in a number of years; this is also why schools don't release board score info. The places that teach to the boards, particularly the caribbean schools, don't care that much about medical education -- their goal is to have students who have a fighting chance to land US residencies. Thus it's basically a vocational school -- teach the students what they need to know for that test, not what makes them a better physician. If there were a test that was a good proxy for what constituted a good physician, then perhaps you could teach to that test. But this particular test was designed to test the minimum level of knowledge a person who completed two years of med school should know, and doesn't do that particularly well, and was originally designed merely to be a P/F test. As a result of misuse of their admittedly misused test, the NBME is going to merge it into Step 2 in about 5 years, and residencies are going to have to find another source of comparison of students. But the med schools will be better off because they can ignore board scores and focus on the teaching methodologies THEY feel make you the best physician. Things like increased clinical exposure, perhaps PBL, and other such things. But currently, you can learn to pass the boards and to be a good physician, or you can double down on the boards stuff. The offshore places do the latter. The US allo places thus turn their noses up at places that "teach to the boards". You don't want to go to a 4 year Kaplan prep version of med school, prepared to handle a single test and little more -- you want to learn to be a better doctor.
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Has this been confirmed? I thought it was just an unsubstantiated rumor.
Edit: Not that I'm doubting you, I just remember seeing a thread where everyone was calling BS on this.
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Only tenth in your class? Wow, what a slacker. 😀 I'm doing fine, thanks, although I can't tell you my ranking since we don't have any grades or rankings at CCLCM. But, considering your response and the fact that you are now on probation, I think it's safe to conclude that I was right about you being a troll.
To be fair, I do know that the scaphoid bone is the most likely wrist bone to be broken. That is an example of information that has a clinical context. In other words, it is relevant for more reason than just that every medical student in the past has had to memorize it, so I should have to as well. It may seem amazing to you, but I made it through both my FM and surgery rotations without ever being pimped on any wrist bones. I did get pimped on other skeletal anatomy things, especially knees and shoulders. The first time that happened, I had to go back and review. So I learned more than I would have cared to about knee and shoulder anatomy, but that's what was emphasized on my rotations for whatever the reason. But if someone held a gun to my head right now and demanded that I name every single wrist bone in order, I wouldn't be able to do it.
I think I've given you the wrong impression about my program, so I apologize for that. We don't "just learn things that are interesting to us or important on the boards." As you have suggested, med students have to spend a lot of time learning things of low interest to the students, and CCLCM has its share of that kind of learning just like any other med school. In addition, my school definitely does not teach to the boards. If anything, it's the opposite because we spend a lot of time during our first two years on clinical and research coursework that will never come up on the boards. I also need to point out that our anatomy curriculum is different than what most other schools do. It's not just a one semester or even a one year class. Instead, we keep taking anatomy all during second year, and we also have a few anatomy sessions in third year. Even with all of that, it's probably fair to say that we spend less total time in the anatomy lab than most med students do, but it's not like we don't have to learn anatomy at all.
I also didn't mean to deny the usefulness of mnemonics for things that you simply must commit to memory. As much as a I had a hate-hate relationship with First Aid, the mnemonics it has were very useful for memorizing things like cranial nerves and the brachial plexus that medical students just have to know. Again, I'm sorry for giving you the wrong impression that we never had to learn these things. We did go over them and learn them, but my point was more that we never had to MEMORIZE them for any tests.
I understand that you're exaggerating to make your point, and I get what you're saying. But I think we can probably agree that having a good knowledge base AND being able to apply it in a clinical context are BOTH necessary to do well on the wards. 🙂 If my last post was a little light on paying dues to the importance of learning enough information, it was mainly in response to GoLakers310's ridiculous statement that applying information is easy but memorizing enough facts is the difficult part. Maybe other people have had a different experience, but I've never heard a doctor say, "oh, we could have saved this guy if I had only memorized a few more facts during med school." Not to mention that some of the so-called facts you learn as a med student will wind up being out of date by the time you're an attending.
First of all, I think that you are greatly overestimating how much the rest of us care about your school. Not everyone thinks the Cleveland Clinic is the end-all be-all of medicine, and most people couldn't care less about how they do things at the "Learner College". Frankly, aside from Lebron James, I couldn't give less of a rat's ass about that dump of a city.
Ok, maybe that's a little harsh. But please stop talking about cclcm, nobody cares.
But the point that you're missing is that, for most students, the memorization is the difficult part about med school, at least in the preclinical years. When people say that med school is all memorization, they mean that what they spend their time on is memorizing stuff. Most of us are pretty smart people and are able to apply that information once we know it.
PS For you more sensitive people, I was being facetious about the cleveland clinic. Obviously it's a great place to learn and practice medicine, as well as to be treated there.
I've also heard that step 1 and 2 are being merged from a number of people at my school (attendings, professors)
Thanks.
It's been confirmed that it will happen eventually -- the applicable committee (CEUP) met and reportedly passed this resolution. You can find it on the NBME website someplace, and I think it's been cited in the SDN USMLE Step 1 board. But debatable as to when. Some people say 4 years. Most people suggest that it will involve a somewhat longer period of time, because residencies will also have to revamp how they make decisions, and probably will insist on one or more uniform tests to spring up and take it's place. (In other words, I wouldn't plan on getting off easy by not having a board -- I suspect you will end up with a different standardized test. Which is why this is going to take some time).
At any rate, the point is that the current Step 1 is agreed upon to be garbage in assessing "quality" (as opposed to a minimum standard), and thus even the test creators want it (in its current formulation) gone (or at least not part of the residency selection process). So I wouldn't think too highly of a school devoted to teaching to this test.
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I don't think that's enough PBL to make it useful. PBL is not the kind of thing you can do once in a while if you want to get any good at it (and get much out of it). If you ask people at a lot of schools why they hate PBL, it's usually one of three reasons (or a combination of them). Either they get grades that are basically subjective, or they don't feel like they get anything out of their PBL sessions because everyone is just fumbling around with no sense of direction, or the PBL sessions take time away from studying for their exams. All of these are perfectly reasonable objections, and I probably would not like PBL very much under those circumstances either. So I think PBL has to be done consistently, a few times a week, in order for it to be worthwhile, and people should not get letter grades for PBL. There also should be some way to make sure that PBL doesn't affect people's ability to study for exams, but I don't have a good suggestion for how to solve that problem at schools that give exams. I don't know if the entire curriculum has to be PBL necessarily like nlax30 suggested, but at least a substantial part of it should be if you want it to work like it's supposed to. Just my opinion.
Yes, it's true. The change is supposed to start affecting med students around 2011. You can follow the progress of the CEUP (committee to evaluate the USMLE program) on the USMLE website: http://usmle.org/General_Information/CRU/review-2007-08-15.html
Obviously, I've hit a nerve with you, so sorry. I wasn't trying to say that my school was the end-all, be-all of anything. But I like the curriculum we have here, mainly because it's NOT memorization-based. So I do think it's relevant to the discussion.
Ok, maybe I didn't make my point very clear. I never said you or other students at schools with more traditional curriculums weren't smart. In fact, I said the exact opposite, that med students ARE smart enough to learn to apply the info they memorized during the first two years, but the transition from preclinical years to third year is a big adjustment for a lot of people. For third year, people can't just memorize a bunch of info and expect to do well on the wards like they can during the first two years at schools with more traditional curriculums. Med schools are trying to help students adjust to third year by instituting preclinical curriculum features like PBL and early clinical experience. Whether those things really help prepare people for the wards or not is certainly open to debate. A lot of medical educators think they do, and that's why so many med schools are jumping on the PBL bandwagon. Obviously, I've only ever attended one medical school, so I can't say if my adjustment was easier or harder than anyone else's. But theoretically it should have been easier if you buy the argument that PBL and early clinical experience help to prepare people for the wards. If you're a third or fourth year at a traditional school, do you think I'm wrong about the difficulty of adjusting to third year after two years of mainly memorization?
No offense taken, and no hard feelings. I know everyone gets passionate about what they love and hate about med school, including me.
I spent 10 years as a "facilitator" for PBL in a place where it was done once a week so I want to comment here a bit....😉.
In terms of learning pre-clinical material, once a week PBL is almost useless. It can, for some folks, in some situations, be helpful but generally, not much so I agree with your assessment.
However, I figured this out by the second year of doing it.🙂 The reason I stuck with it for 10 years was that I thought that getting small groups of students together once a week to discuss cases and work through diagnostic approaches was valuable independent of the "facts" being learned. It helps (a lot) when the cases are linked to the didactics, but the value was, in my experience, about the group interactions and approaches to patient care. Now, obviously, this was highly dependent on the facilitator and somewhat dependent on the group itself. I learned over the years that some med students REALLY don't like some of their classmates and that was always an issue.
Also, more than once, I was able to identify a med student that needed personal mentoring, or whom I thought would have trouble in the clinics. Heck, I even found a med student who is now an SDN mod! These experiences made it worthwhile. Finally, although it shouldn't be this way, sometimes preclinical students can be or feel very separate from the faculty or have severe personal problems that get otherwise missed. PBL with a clinical faculty helps decrease this I think and serves a chance to make sure that students are "seen" in a small group setting weekly.
So, in the end, I thought PBL once weekly was useful. Just not useful for the purpose of learning pre-clinical material.
Oh yes, prior to the 1990's we took the NBME exams - three parts at about the same time as the current USMLE's (of course, we had no CS). Parts 1 and 2 were very fact based, part 3 had some clinical scenerios. We got scores on each subsection, not just an overall score, but passing was based on the overall score.
That's alright, you didn't hit a nerve. This is just the way I write, perhaps you didn't notice, but I was making fun of you. Did you think I was serious about "reverse deducing the cranial nerves"?
And, no, I never thought that you were calling students at "traditional" schools dumb (traditional as opposed to what? pbl-heavy private schools that cater to students with rampant superiority complexes?).
I assume that a lot of people are going to have difficulty transitioning from the preclinical to clinical years irrespective of the type of curriculum to which they were previously exposed. By it's very nature, it's going to be a transistion, but I suspect that a lot of the difficulty is in getting used to the way a hospital, and the different services in the hospital, are run, while working long, stressful hours with poorly laid out expectations from attendings.
What I was told is that they are going to be merging Step 1 with a toned down step 2 about 2 - 2.5 years into the cirriculum, which is going to force med schools to compress their academic cirriculum to 18 months or less so that they can get in the fundamental rotations to prepare everyone for the test. The plan is that this test will still be used to evaluate people for residencies. Standardized testing isn't going anywhere.
I actually doubt this will happen because then you will not be able to use the summer after second year to study for the test, and most schools are cramming rotations into too short a period of time as is. The exposure to the various cores is too short to make a particularly strong decision as is, and so it's unlikely anyone sane would want to compress them. I actually heard that most likely Step 1 and 2 would be pushed back to 4th year (possibly as a P/F test), and something new would be introduced earlier (not through NBME). Some have actually proposed letting each specialty create their own test focusing on what they consider important, such that someone undecided about specialty might actually have to take multiple tests. Others have suggested that residencies would just put added emphasis on the shelfs. So while I don't think what you suggest above is going to happen for logistical reasons, I would anticipate more, not less testing. But the current Step 1 is not long for this world -- I give it 5-6 more years.
A lot of it varies from school to school. A school that has tests every 2 weeks is VERY different from one that is every 6 weeks or none at all.
I also feel that it's less about memorization and MUCH more about time management. When you have so many lectures in a day, it is very easy to simply not study that night. It all builds on you.
And the material itself is not hard, I'd say. But the amount is what makes a difference.
I also feel that it's less about memorization and MUCH more about time management. When you have so many lectures in a day, it is very easy to simply not study that night. It all builds on you.
And the material itself is not hard, I'd say. But the amount is what makes a difference.
That makes sense. My school does use PBL to help teach basic science, so I wasn't thinking about the usefulness of small group sessions for other purposes.
No, it was obvious that you were being sarcastic. Your post was pretty funny, actually. 🙂
Traditional curriculums are lecture-based as opposed to PBL or small group-based. I didn't make the name up. That's what they call it in the med education lit. Here's an example: http://www.ncbi.nlm.nih.gov/pubmed/3747871
I'd agree that is a lot of it. What I like least about third year is how little control you have over your schedule, and yeah, you spend a lot of time trying to figure out what exactly you're supposed to be doing. But one of the things that helped me the most was already knowing how to use the computer system. They made us learn how to use it last year. Even though a lot of that clinical stuff we had to do during second year was a pain at the time, I think it did make the transition easier. But I'm not going to start over at another med school to try to compare the experience!
Good points. With the way the knowledge base keeps growing, just imagine what it will be like for med students in another twenty or fifty years!
our school was tough. We finished our anatomy in 8 weeks - mind bugling, why they do that us... Along with it, we took four other courses, including histology, medical psych and biochem, 😱. No wonder people got depressed from the beginning...
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