MD Is the point of preclinicals to pass step 1??

[Hzreio]

Question as posted. Anything else I should focus on during preclinical? My school is P/F FYI

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[Jeff0302]

Learn all you can. Preclinicals are what they say - to prepare you for MS3-MS4. USMLE Step 1 is also now pass/fail, but you still have to pass, so yes of course you need to be preparing for it along the way by using resources like UWorld, USMLE RX, KaplanTest, AMBOSS, ANKI, and Pathoma.

 

[Goro]

Question as posted. Anything else I should focus on during preclinical? My school is P/F FYI

Not just to prepare you for Boards, but for wards as well.

 

[Redpancreas]

They're supposed to prepare you for clinical rotations and USMLE Step 1 but they do a pretty poor job of the former. If they really wanted you prepare you for the wards, they would put you on rotations in M1-2 and tailor didactics to what you're seeing instead of teaching you abstract information in M1 and expecting you to recall one clinically pertinent fact when you're an M3. Some schools are starting to doing this, most don't though. Also BnB/OME are not wards-based resources. OnlineMedEd is a basically a collection of chalk-talks/advanced organizers to simplify concepts you need to know at a USMLE level. BnB is USMLE material with some clinical pearls mixed in. There is no substitute to actual clinical experience. P/F Step 1 is a step in the right direction IMO.

 

[Type2Fiber]

Board review = Clinical rotations prep. BnB is the level of depth you'll need for wards

you should do your best to decide on specialty and get to know the faculty at your school in your desired specialty. life is much easier as a third year if you know what you want to do

 

[Lawpy]

Question as posted. Anything else I should focus on during preclinical? My school is P/F FYI

Preclinicals usually have no value unless you're in a good school that truly emphasizes early clinical exposure. Grades however can matter depending on how your school determines AOA

 

[Lucca]

the point is to learn medicine. studying for step 1 is like learning medicine but a version of medicine that is more like a bar trivia game than real life. With P/F preclin and step 1, I wouldn't focus too much on boards but try to get a good foundation in everything. Agree that BnB or Pathoma are a good way to supplement / build the foundation you need for boards alongside school.

Everything else: evidence based physical exam, taking a good history, developing bedside manner, learning how to present a patient, building a foundation of clinical reasoning and evidence based medicine / diagnostics should also be part of your first two years but is stuff you really learn on the wards.

Also second shadowing and exploring as much as you can, it's much more valuable as a med student than it was as a premed.

 

[Hzreio]

the point is to learn medicine. studying for step 1 is like learning medicine but a version of medicine that is more like a bar trivia game than real life. With P/F preclin and step 1, I wouldn't focus too much on boards but try to get a good foundation in everything. Agree that BnB or Pathoma are a good way to supplement / build the foundation you need for boards alongside school.

Everything else: evidence based physical exam, taking a good history, developing bedside manner, learning how to present a patient, building a foundation of clinical reasoning and evidence based medicine / diagnostics should also be part of your first two years but is stuff you really learn on the wards.

Also second shadowing and exploring as much as you can, it's much more valuable as a med student than it was as a premed.

I hear about these things pathoma, bnb, ome, etc. what exactly are they and how do you get/use them?

 

[Redpancreas]

I hear about these things pathoma, bnb, ome, etc. what exactly are they and how do you get/use them?

They’ll all shorthand for various commercial Step 1 USMLE Prep materials. When I got into medical school the competition for Step 1 was heating up. There were targeted ads on social media for test prep, Sketchy had become a thing, there was this unknown guy named Brosephelon who had made this deck using this strange thing called Anki. Etc. Etc. Anyways, we were told Step 1 determined our future and if we got a 220 we were relegated to less competitive fields and 240+ gave us a shot at things like Ortho, etc. In this environment a couple resources stood out known as UFAP

UWorld: An online test bank subscription that did a really good job emphasizing the core principles tested on Step 1. It was not only a QBank but a textbook with all the information we supposedly needed for Step 1 and we poured over the questions and explanations for hours on end.

First Aid: Basically a giant review non-prose compilation filled with acronyms/tables/charts to help us memorize the high volume of information tested on Step 1

Pathoma: A pathology review book with audio series that covers high yield pathology principles on Step 1. Many critics say he dumbs down pathology concepts but he really is doing this to hit board exam material so who cares.

Boards and Beyond: This came out right after I finished the Step 1 craze but I’ve seen M1-2/s using it. It basically is a series of lectures covering all topics. I think it’s one stop shop contributes to its appeal.

Sketchy: A lecture subscription where basically they draw these caricatures of various medical entities (bacteria, drugs) giving them a look and personality to make them stick in students heads better. People loved it, but quality had declined since they moved from Micro to Pharm (less appealing) down to IM/etc.

OnlineMedEd: Step 2 CK resource. One of the only ones that covers everything which is why it's so popular...plus the fact that the videos are free which is a huge plus, but it's basically the Fischer-Price (not sure if everyone is old enough to remember what that is) version of medical education where he has this website he thinks is a one stop shop to medical education when it reality it's overkill. None of the paid content is useful. Quite a lot of useful content is free so I'm not going to rail on it but it's basically a bunch of chalktalks about various medical topics (microcytic anemia, macrocytic anemia) etc. where he draws out diagrams, makes advanced organizers, and sometimes outlines content content. The material lacks depth necessary for USMLE Step 2 CK to the point where I'd recommend seeking additional resources but listening to his lecture first will provide a roadmap for the content. Use it but I anticipate better resources on the horizon now that CK is the new game. I feel Williams should stick to USMLE Step 2 CK and master that arena especially given the stakes, but he seems keen on expanding to everyone from premeds/faculty and trying to target everyone in medicine which I think is a mistake because while I think his original Step 2 CK lectures are decent, his educational model doesn't apply across the board.

 

[mmchick]

It's probably not an ideal set-up, but imo you have to start somewhere. I can't imagine much utility in just throwing brand new M1s into wards and expecting them to understand the pathophysiology + mechanisms of disease + treatment/management choices without any didactic context. Plus, not all M1s are created equal with clinical experience; obviously 99.9% of M1s have been in some form of clinic before, but experience working with patients and understanding the nuances of handling a management plan + working through diagnostic process varies wildly from student to student. As such, again if M1s were thrown directly into wards, the experience + utility of this "learn as you go" model would vary extremely between individuals. I'd agree there is a lot of extra nonsense we learn in preclinical years, a lot of which will realistically never get recalled in a clinical setting, but again, I think it has to start somewhere and didactic years really helps get everyone on the same page with level of critical thinking + background knowledge I think would be useful to have before seeing/managing real patients.

 

[Redpancreas]

It's probably not an ideal set-up, but imo you have to start somewhere. I can't imagine much utility in just throwing brand new M1s into wards and expecting them to understand the pathophysiology + mechanisms of disease + treatment/management choices without any didactic context. Plus, not all M1s are created equal with clinical experience; obviously 99.9% of M1s have been in some form of clinic before, but experience working with patients and understanding the nuances of handling a management plan + working through diagnostic process varies wildly from student to student. As such, again if M1s were thrown directly into wards, the experience + utility of this "learn as you go" model would vary extremely between individuals. I'd agree there is a lot of extra nonsense we learn in preclinical years, a lot of which will realistically never get recalled in a clinical setting, but again, I think it has to start somewhere and didactic years really helps get everyone on the same page with level of critical thinking + background knowledge I think would be useful to have before seeing/managing real patients.

I disagree with this, but thanks for posting it. I have heard this argument from PhDs who have argued against an integrative model. The first thing that should happen is a year covering a strictly the principles. We have gone through tough undergrad courses and the MCAT. Basic science knowledge isn’t that complicated. Most of us have taken things like Calculus and Organic Chemistry. Those are things that are hard to grasp. Human biology is pretty discrete and has motifs that repeat themselves. Teach students those things and the basics for organ systems and get them to the wards immediately as early as second year.

I do agree that you can’t suddenly make this change right away to guinea pig M1s. The intermediate would be unstable. We have to gradually change things like making Step 1 P/F. Step 1 was what was causing a lot of bloat for M1/2 as students focused on memorizing basic science factoids to do marginally better than their colleagues had real life implications for their career. Now the stage is set to change the curriculum without harming students and start emphasizing doctoring in M1/2 instead of Step 1.

Then maybe medical students will be more useful on the wards and midlevels will start to become less needed entities.

Edit: I also liked the point you made about clinical experience. It takes a while to develop clinical reasoning. A lot of people have it inherently having experience in healthcare more so than others. To throw people onto wards right away and ask them to fly is basically selecting for those with prior healthcare experience to succeed...the whole judge a fish by its ability to fly thing. Instead, we need to find ways to formally teach clinical reasoning. How do you form a differential? What is dangerous? What is likely? Give them a hypoxia patient. What should be ordered? Should this patient have a CT P/E ordered? Why not? It can be done. This is what should be taught in M2 after the basic principles in M1. Lecture them and teach them clinical pearls and all that information clinical MDs teach us in M1/2 that we ignore because we know it won’t be relevant for Step 1. Rotations should be done concurrently and they will go hand in hand.

 

[mmchick]

I disagree with this, but thanks for posting it. I have heard this argument from PhDs who have argued against an integrative model. The first thing that should happen is a year covering a strictly the principles. We have gone through tough undergrad courses and the MCAT. Basic science knowledge isn’t that complicated. Most of us have taken things like Calculus and Organic Chemistry. Those are things that are hard to grasp. Human biology is pretty discrete and has motifs that repeat themselves. Teach students those things and the basics for organ systems and get them to the wards immediately as early as second year.

I do agree that you can’t suddenly make this change right away to guinea pig M1s. The intermediate would be unstable. We have to gradually change things like making Step 1 P/F. Step 1 was what was causing a lot of bloat for M1/2 as students focused on memorizing basic science factoids to do marginally better than their colleagues had real life implications for their career. Now the stage is set to change the curriculum without harming students and start emphasizing doctoring in M1/2 instead of Step 1.

Then maybe medical students will be more useful on the wards and midlevels will start to become less needed entities.

Edit: I also liked the point you made about clinical experience. It takes a while to develop clinical reasoning. A lot of people have it inherently having experience in healthcare more so than others. To throw people onto wards right away and ask them to fly is basically selecting for those with prior healthcare experience to succeed...the whole judge a fish by its ability to fly thing. Instead, we need to find ways to formally teach clinical reasoning. How do you form a differential? What is dangerous? What is likely? Give them a hypoxia patient. What should be ordered? Should this patient have a CT P/E ordered? Why not? It can be done. This is what should be taught in M2 after the basic principles in M1. Lecture them and teach them clinical pearls and all that information clinical MDs teach us in M1/2 that we ignore because we know it won’t be relevant for Step 1. Rotations should be done concurrently and they will go hand in hand.

Well we can certainly agree that the amount of time spent in didactic years is far too long. I have always felt medical school should only be 3 years and it would be totally doable - teach the relevant didactic information that helps with establishing a solid human biology + physiology foundation in one year, then move onto clinical experiences 2nd year with lots of diagnostic structuring/guidance through clinical reasoning, then 3rd year is solely what would be done in 4th year. I think what should be especially prudent is this 2nd year idea of mine, or something similar, where new clinical students are not only on the wards, but are specifically being taught clinical reasoning + diagnostic skills that you otherwise have to glean during traditional clerkships. All I've heard about clerkships is it seems incredibly variable depending on your preceptor and a lot of certain rotations are totally squashed by arrogant or negligent preceptors that push med students aside, let alone do anything that resembles formal instruction in how to be a clinician.

I agree, clinical pearls and applicable "real life" nuances are oftentimes in one ear and out the other in preclinical years because "well this won't be on Step 1" - it's pretty sad that is the way things go. We should be utilizing and banking all pieces of clinical info considering that's what is the most relevant over some random factoid or stereotyped pathognomonic for a disease that's seen once in a clinician's lifetime. It does seem a P/F Step 1 is a step in that direction. It will be interesting to see how things continue to change over time if there really is a larger orchestration to transition medical education as a whole towards something more acutely focused on clinical skill.

 

[aldol16]

The purposes of pre-clinical is to build the scientific base for the clinical years. It doesn't teach you clinical medicine. But it teaches you the underlying concepts that will help you when you get to the clinical years. The RAAS is a great example of this (other stuff may be less relevant).

 

[aldol16]

Well we can certainly agree that the amount of time spent in didactic years is far too long. I have always felt medical school should only be 3 years and it would be totally doable - teach the relevant didactic information that helps with establishing a solid human biology + physiology foundation in one year, then move onto clinical experiences 2nd year with lots of diagnostic structuring/guidance through clinical reasoning, then 3rd year is solely what would be done in 4th year. I think what should be especially prudent is this 2nd year idea of mine, or something similar, where new clinical students are not only on the wards, but are specifically being taught clinical reasoning + diagnostic skills that you otherwise have to glean during traditional clerkships. All I've heard about clerkships is it seems incredibly variable depending on your preceptor and a lot of certain rotations are totally squashed by arrogant or negligent preceptors that push med students aside, let alone do anything that resembles formal instruction in how to be a clinician.

Several med schools already have effective 3-year curricula. Harvard and Duke come up as examples. The fourth year is just spent doing other things that the student wants to pursue.

I agree, clinical pearls and applicable "real life" nuances are oftentimes in one ear and out the other in preclinical years because "well this won't be on Step 1" - it's pretty sad that is the way things go. We should be utilizing and banking all pieces of clinical info considering that's what is the most relevant over some random factoid or stereotyped pathognomonic for a disease that's seen once in a clinician's lifetime. It does seem a P/F Step 1 is a step in that direction. It will be interesting to see how things continue to change over time if there really is a larger orchestration to transition medical education as a whole towards something more acutely focused on clinical skill.

A lot of zebras on CK too. As humans, we all have biases and we all tend to give higher weight to information that we know we will need (for instance, for a board exam) than information that we might never need. We're all hardwired to try to make sense of the information coming at us every day (why QAnon is such a strong conspiracy theory) and when there's a clear exam that you need to pass, that offers an easy way to organize that information and prioritize it. Once Step 1 goes P/F, the same will happen for Step 2 CK.

 

[Redpancreas]

Several med schools already have effective 3-year curricula. Harvard and Duke come up as examples. The fourth year is just spent doing other things that the student wants to pursue.



A lot of zebras on CK too. As humans, we all have biases and we all tend to give higher weight to information that we know we will need (for instance, for a board exam) than information that we might never need. We're all hardwired to try to make sense of the information coming at us every day (why QAnon is such a strong conspiracy theory) and when there's a clear exam that you need to pass, that offers an easy way to organize that information and prioritize it. Once Step 1 goes P/F, the same will happen for Step 2 CK.

That needs to get filtered down to our lowly MD schools and DO schools as well. It's not. I think that if we keep it 4 years (I'd be cool with just having it be 3 years), the second year should integrate didactics and rotations (experience based - let students try what they like, lecture them on differentials of chest pain and discuss clinical reasoning in didactic sessions). Third year should be focused more on assessment of competency in the hospital (grading presentations, notes, procedures). Fourth year should be an internship. Step 3 should be taken before medical school ends. This way medical schools would be more accountable for their finished product as they actually know their students can do the job required in residency. Tons are just getting by with glorified shadowing on rotations and getting evals from people who liked them and passing shelf exams...Then intern year comes and it's like they don't know how to do a lot of practical things. Maybe this isn't the case at Harvard, but it certainly is at many other US medical schools.

In terms of Zebras, yes, there are rare conditions but the sheer amount of foundational knowledge on CK vs. Step 1 is less. A lot more questions are based on reasoning and what you would do and you're choosing between two diagnostic tests...but it's weird sometimes. I don't know how to explain it. The minutiae that does get tested can be pretty useless too like how many blocks a 3 year old can stack. I just ignored that whole child development lecture. I did get a question on it on the real Step 2 CK and I just guessed.

 

[mmchick]

Several med schools already have effective 3-year curricula. Harvard and Duke come up as examples. The fourth year is just spent doing other things that the student wants to pursue.

Yea lol but you still have to pay for your 4th year. I'm suggesting an actual model where you graduate in 3 years and do not waste a full year's medical school tuition to do electives + basically interview all year.

 

[Redpancreas]

Yea lol but you still have to pay for your 4th year. I'm suggesting an actual model where you graduate in 3 years and do not waste a full year's medical school tuition to do electives + basically interview all year.

It should be internship. Give students fixed days off. When they hear the days they are interviewing, they let their teams know and that's their 1 day off in 7. If they need more in a week, adjust accordingly.

The problem is that in order for this to work, ALL schools need to do it because we all apply to the same match.

 

[mmchick]

It should be internship. Give students fixed days off. When they hear the days they are interviewing, they let their teams know and that's their 1 day off in 7. If they need more in a week, adjust accordingly.

Well that sounds lovely for mental health.

 

[Redpancreas]

Well that sounds lovely for mental health.

I mean what I mentioned above are ideas, but if needed we can give all students a month or two off their internship strictly for interviewing.

 

[catnip12]

Having a strong understanding of preclinical material will help you understand disease process better which will help you understand how things can go wrong, which might make you a better physician. Or it might make it easier for you to become a physician.

Perhaps some minutiae are not important long term, but you learn what is important after you build a strong enough foundational base. As an M1 it’s hard to gauge what you should and shouldn’t know. Which is why sometimes M1s calling things “useless minutiae” is laughable because they more likely than otherwise don’t have enough knowledge to know what is and isn’t important long term.

 

[deleted966164]

Also, the whole pre-clinical being P/F... our school also has MS1 and MS2 on a P/F basis but when you dig deeper, all grades are retained and recorded and used for graduation ranking.

 

[mmchick]

Also, the whole pre-clinical being P/F... our school also has MS1 and MS2 on a P/F basis but when you dig deeper, all grades are retained and recorded and used for graduation ranking.

That's only true for some schools. Mine explicitly states they do not use preclinical grades for any sort of ranking or purpose. A "grade" is recorded in our gradebooks, but it's not put on record anywhere outside of that.

 

[Gilakend]

In my opinion, pre-clinical medicine is so far removed from clinical medicine it isn't even funny. If all you got out of pre-clinical was enough to pass step 1, you'll be just fine. Literally, you just need to have heard the words before and have some idea of what they mean so when you are learning clinical medicine you aren't starting from square 1 when someone says "bilirubin" or "mitral valve".

Some may disagree, but I would say literally the bare bones from pre-clinical most places is all you really need to begin learning clinical medicine and the barebones is all most average med students actually remember and retain after 2 years. Clinically you'll learn the rest.

 

[calivianya]

It's probably not an ideal set-up, but imo you have to start somewhere. I can't imagine much utility in just throwing brand new M1s into wards and expecting them to understand the pathophysiology + mechanisms of disease + treatment/management choices without any didactic context. Plus, not all M1s are created equal with clinical experience; obviously 99.9% of M1s have been in some form of clinic before, but experience working with patients and understanding the nuances of handling a management plan + working through diagnostic process varies wildly from student to student. As such, again if M1s were thrown directly into wards, the experience + utility of this "learn as you go" model would vary extremely between individuals. I'd agree there is a lot of extra nonsense we learn in preclinical years, a lot of which will realistically never get recalled in a clinical setting, but again, I think it has to start somewhere and didactic years really helps get everyone on the same page with level of critical thinking + background knowledge I think would be useful to have before seeing/managing real patients.

I just wanted to add that this is exactly how a previous clinical degree went, and I thought it was far superior to the current medical education model.

When we were in our cardiac block, we spent three days a week in the classroom and were on the cardiac floor for two days, as an example. So we had immediate, real-life enforcement of what we had just seen in class. So it was never abstract - when I was taking my tests, I could recall the patients with those diagnoses and what we did.

It takes really intense small group dividing of a single graduating class to work. If you have 100 people in the class, you break them up into groups of 10–25 and learn different things at the same time. You also divide the people, say, doing ob/gyn at the same time into multiple groups as well - some are gonna be in the hospital Monday and Tuesday one week, another group will be in on Wednesday and Thursday, and another will just have Friday that week - then they’ll switch days so everyone has the same amount of clinical days in the end. It does require the faculty to teach the same lecture more than once a week so that everyone can see the lectures.

The other thing is it takes a lot of highly involved clinical faculty to make sure everyone’s learning is pretty standardized... what we’d do is show up the night before to get all the info on our assigned patients, look up diagnoses, and complete a write up that we were going to turn in every morning. Then we’d meet in the early AM before shift change to go over everyone’s patient assignments and what we’d be learning from each. We’d spend all morning with preceptors, and double back maybe by about 12pm to meet with our clinical faculty to discuss everything we learned and do presentations on different things, so we had several hours of afternoon learning after spending all morning in the hospital.

I retained material far better during that degree than I have in my DO degree so far.