Is there any point to learning the basic sciences at the depth that we do?

[Brahnold Bloodaxe]

At my school we learn the basic sciences in excruciating detail. All the steps of heme synthesis, all the specific sugars added to proteoglycans and the sequence they are added in, etc. I'd say 80% of my study time is devoted to absorbing all this minutiae.

But at the end of the day, what do I remember about heme synthesis? I know it's got a bunch of steps and that depending on which enzyme is messed up, you can have different diseases which manifest with different symptoms. I have completely forgotten the names of the enzymes and of the diseases and am just left with this high level understanding that I could have as easily achieved if somebody had told me, verbatim: "yo, heme synthesis involves a bunch of enzymes and messing up an enzyme gives you a different disease." In other words, hours and hours of my life wasted on temporarily storing useless information that I have no hope in hell of retaining more than a week after the exam, let alone recalling years down the line when starting residency.

So what is the point of medical school? We cover the same stuff as the PAs do but in much more detail. But it is precisely that detail that we completely purge our minds of in just a few weeks after each exam. By the time I start my surgery (or whatever) residency, I will probably remember less basic sciences crap than your typical PA does at the end of PA school since I will be further removed from my basic sciences years at that point than the PA.

Agree? Disagree?

---

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[IslandStyle808]

And best of all is the fact that a large chunk of it is either already wrong, will be proven wrong by the time you graduate/practice, or become obsolete knowledge by time you graduate/practice. Unfortunately you won't know whats wrong until you practice. Have fun knowing this.

 

[Giovanotto]

And best of all is the fact that a large chunk of it is either already wrong, will be proven wrong by the time you graduate/practice, or become obsolete knowledge by time you graduate/practice. Unfortunately you won't know whats wrong until you practice. Have fun knowing this.

I don't agree with this, or find it to be true. But to the OP, I agree, I'm not sure what the deal is. Way too much non-relevant info and not enough physio so far, it's really frustrating.

 

[ConfusedChemist]

For the micro/biochem stuff, I would say no.

In Canada we learn none of the details of those things that US schools cover (although most of us have to learn it for Step1 anyway, since there's no jobs in surgery, etc here) and we do just fine. Fine enough that the LMCC considers our education equivalent

 

[dadaddadaBATMAN]

At my school we learn the basic sciences in excruciating detail. All the steps of heme synthesis, all the specific sugars added to proteoglycans and the sequence they are added in, etc. I'd say 80% of my study time is devoted to absorbing all this minutiae.

But at the end of the day, what do I remember about heme synthesis? I know it's got a bunch of steps and that depending on which enzyme is messed up, you can have different diseases which manifest with different symptoms. I have completely forgotten the names of the enzymes and of the diseases and am just left with this high level understanding that I could have as easily achieved if somebody had told me, verbatim: "yo, heme synthesis involves a bunch of enzymes and messing up an enzyme gives you a different disease." In other words, hours and hours of my life wasted on temporarily storing useless information that I have no hope in hell of retaining more than a week after the exam, let alone recalling years down the line when starting residency.

So what is the point of medical school? We cover the same stuff as the PAs do but in much more detail. But it is precisely that detail that we completely purge our minds of in just a few weeks after each exam. By the time I start my surgery (or whatever) residency, I will probably remember less basic sciences crap than your typical PA does at the end of PA school since I will be further removed from my basic sciences years at that point than the PA.

Agree? Disagree?

A lot of the detail you learn will be irrelevant to your particular specialty, but will be relevant to someone else's. Heme onc will not use the intimation you mentioned on a daily basis, but it's useful background for an expert in those fields.

all that derm path bs is useless to me, but knowing about various histological features of skin (cadherens, hemi-desmisomes, etc) might be important to a dermatologist or to a pathologist.

For you it will be vaguely important when you talk to those people so you have some idea what the hell they are talking about. And while it's healthy to question our education, I don't really know what criteria pre-clinical students can use to determine what's "important."

 

[Domperidone]

What's minutiae to you, is significant and spectacularly interesting to someone else. Most likely the lecturer on the given subject and everyone in class who wants to be her/him later.

Jokes aside, what Batman said.

When you start doing rotations or residency later, there's always the possibility you will end up managing patients with seemingly random conditions. The "co-morbidities", that while aren't directly relevant to your field on a particular day, are still important for the home team to sort out.

You may have to refer to specialties and subspecialties eventually, and unless they take over care, you may even have to action some of the plans they give you. You don't have to know things in depth like they do, but you have to have some concept to keep up or at least have the ability retained to look up the appropriate resources to understand. (I liked batman's words better on this -

For you it will be vaguely important when you talk to those people so you have some idea what the hell they are talking about.

the following was told to me before (when I was contemplating the mysteries of the universe as a pre-clinical year student) - they throw a lot of crap at you, and hope something sticks. Also the hope is that when you go practice and see something 'different', at least some vague memory will be triggered from your basic science days.

It is challenging to guzzle down all that you're learning the first two years of medical school, without the full context. But that will come eventually later.

 

[feather421]

So I remember taking physicis and O-chem as an undergrad and thinking, "This is ridiculous; I'm never going to use this."

And I hate to admit it, but it did come up in medical school. Not directly, of course, but having learned fluid dynamics made a big difference in cardio. Having learned gas laws helped me understand respiration. The intensity with which I studied carboxyl groups helps me with the vocabulary of biochem and metabolism.

I think, like our undergrad classes, these basic science classes inundate us with information so that, when it becomes relevant, we have a framework to understand the important stuff. In M2 when we learn about diseases, we will be able to look back at our M1 knowledge and get to a more complete understanding much more quickly. It's like learning a foreign language--M1 is learning all the words and M2 is putting them into sentences. Sure, you could memorize the sentences right away and save some time, but you wouldn't be able to think as critically about what you were saying.

 

[Jabbed]

It's just a bad attitude to have when approaching the material. You'll find that the volume of material continues to increase through M2 and M3 and you'll always be looking to chalk things up as minutiae so you don't have to focus attention on it. Sure the intricacies of heme synthesis are not the most important thing in the world, but you better recognize that latent TB patient with anemia actually has sideroblastosis, what the significance of an elevated ALA is if it pops up on a lab, when to do a BM biopsy for your alcoholic patient with microcytosis, etc. And the fact that the clinical manifestations of the porphyrias (cutaneous vs visceral) depends on whether or not the photosensitive uroporphyrin ring has been formed is just plain neat.

Truly, the best thing that you can do is force yourself to see the parts of it that are interesting and nerd out about it. You never know what you'll need to know one day.

Of course, board examinations are another primary motivator.

 

[OnePunchBiopsy]

It's sad but true, however little bits of minutia are what separate physicians from mid-levels.

 

[Rekt]

It's sad but true, however little bits of minutia are what separate physicians from mid-levels.

Yeah, you're right, it can't possibly be the multi-years of supervised high level clinical reasoning, medical decision making, procedures, didactics, CME, multiple board exams, etc (i.e. residency, where you actually learn real medicine). It's definitely learning and maintaining the steps of glycolysis or the purine and pyrimidine salvage pathways that separate physicians from mid-levels.

 

[Jabbed]

Yeah, you're right, it can't possibly be the multi-years of supervised high level clinical reasoning, medical decision making, procedures, didactics, CME, multiple board exams, etc (i.e. residency, where you actually learn real medicine). It's definitely learning and maintaining the steps of glycolysis or the purine and pyrimidine salvage pathways that separate physicians from mid-levels.

Naw, pyrimidine salvage pathway is #LY.

 

[Mad Jack]

It comes in handy when you least expect it, and allows you to understand research much more easily. If you want to stay on the cutting edge of medicine, those details really do matter.

 

[mimelim]

How else will we maintain our superiority complex with NPs?

 

[Azete]

That's sort of the problem with learning tons of enzymes or other random minutiae like transcription factors and genes; eventually they all blend together and you don't know what goes with what. Sure, you'll have it all in your head for step 1 -- but will you really remember this stuff when you start practicing (or even the start of 3rd year for that matter)? Hell no. Some of these things are very relevant depending on your specialty, but I personally think it's waste of time forcing everybody to memorize things they have no chance of remembering.

 

[mistafab]

The basics help you read the science of your future specialty. After about wrapping up first year, I looked at a pretty complex immuno paper in the field and understood the principles of what they hell they were talking about. All this basic science minutia that you and some of my classmates gripe about is giving you a basis to understand the work of scientists, which you should be able to understand. Doctors are scientists first and foremost (unlike other practitioners), so we should be able to hold a conversation with scientists and know what they are talking about.

Besides, don't you like the feeling of being completely and un-apologetically superior in the realm of science? We match many PhDs in a basic understanding of bioscience topics by the time we graduate. Sure, they do a dissertation later on an extremely specific subject, but we master the basics in a condensed 1 year gig while we party and gloat about being future doctors.

Edit: TL;DR - the minutia you gripe about let's us talk to scientists - no one else understands them or what the hell they are saying. We are needed for translational research and for decoding science language for patients.

 

[mistafab]

Also - If we aren't the ones keeping the basic science of the human body in medicine, who is? Pharmacists?

Seriously, stop whining. Remove basic human science from medical school and then we are just glorified nurses with longer training. Be proud that doctors are rooted in science.

 

[shouldvestudied]

How else will we maintain our superiority complex with NPs?

Residency?

 

[Azete]

Also - If we aren't the ones keeping the basic science of the human body in medicine, who is? Pharmacists?

Seriously, stop whining. Remove basic human science from medical school and then we are just glorified nurses with longer training. Be proud that doctors are rooted in science.

I don't think anyone is griping about basic sciences, at least I hope not. I think people are griping about the excessive focus on minutiae memorization instead of going more in depth with things that will better help us understand the human body, like physio. It's honestly a little embarrassing how med students can recite the enzymes of the krebs cycle but don't understand simple concepts like osmosis.

 

[IslandStyle808]

I don't agree with this, or find it to be true. But to the OP, I agree, I'm not sure what the deal is. Way too much non-relevant info and not enough physio so far, it's really frustrating.

Fine if you don't, but information does change and it changes quickly. The article below is proof of what I am stating.

A decade of reversal: an analysis of 146 contradicted medical practices. - PubMed - NCBI


A decade of reversal: an analysis of 146 contradicted medical practices.

To identify medical practices that offer no net benefits.

METHODS:
We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether results were positive or negative. Articles were then classified as 1 of 4 types: replacement, when a new practice surpasses standard of care; back to the drawing board, when a new practice is no better than current practice; reaffirmation, when an existing practice is found to be better than a lesser standard; and reversal, when an existing practice is found to be no better than a lesser therapy. This study was conducted from August 1, 2011, through October 31, 2012.

RESULTS:
We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested an established practice. A total of 947 studies (70.5%) had positive findings, whereas 397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical practice constituted replacement, 165 were back to the drawing board, 146 were medical reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%) reaffirmed it.

CONCLUSION:
The reversal of established medical practice is common and occurs across all classes of medical practice. This investigation sheds light on low-value practices and patterns of medical research.

 

[aalamruad]

I don't think anyone is griping about basic sciences, at least I hope not. I think people are griping about the excessive focus on minutiae memorization instead of going more in depth with things that will better help us understand the human body, like physio. It's honestly a little embarrassing how med students can recite the enzymes of the krebs cycle but don't understand simple concepts like osmosis.

Who doesn't understand osmosis?

 

[Azete]

Who doesn't understand osmosis?

You'd be surprised. I tutored during our renal block and was pretty blown away.

 

[Goro]

And best of all is the fact that a large chunk of it is either already wrong, will be proven wrong by the time you graduate/practice, or become obsolete knowledge by time you graduate/practice. Unfortunately you won't know whats wrong until you practice. Have fun knowing this.

So you don't think it's important to know what oncogenes do? Or how about the function of the masseter? How about how ion channels work?

They're all Legos. They're the building blocks of your knowledge. Bedrock.

 

[IslandStyle808]

So you don't think it's important to know what oncogenes do? Or how abut the function of the masseter? How about how ion channels work?

They're all Legos. They're the building blocks of your knowledge. Bedrock.

Nope, I agree that it needs to be learned. They are important however you don't know what is still correct and what will be wrong. There was a medical student who found an extra connection to the brachial plexus in our class that was in a neurology text, but was taught differently during lecture. Information changes and we don't know what will be right or wrong in the future.

 

[Azete]

So you don't think it's important to know what oncogenes do? Or how abut the function of the masseter? How about how ion channels work?

They're all Legos. They're the building blocks of your knowledge. Bedrock.

All of the things you mentioned are very important and I wish our curriculum emphasized them.

Memorizing the chromosome of the genes for all the leukodystrophies is not. They're just letters and numbers to med students and don't contribute to a greater understanding.

 

[RogueBanana]

Also - If we aren't the ones keeping the basic science of the human body in medicine, who is? Pharmacists?

Seriously, stop whining. Remove basic human science from medical school and then we are just glorified nurses with longer training. Be proud that doctors are rooted in science.

Agreed.

Those white coats aren't for show. They were originally lab coats.

 

[W19]

For the micro/biochem stuff, I would say no.

In Canada we learn none of the details of those things that US schools cover (although most of us have to learn it for Step1 anyway, since there's no jobs in surgery, etc here) and we do just fine. Fine enough that the LMCC considers our education equivalent

It's LCME... I thought med school in Canada was structured just like US med school. How come you don't cover these minutiae?

Basic science have its purpose IMO, but boy! US med school take that to another level... speaking about heme synthesis pathway and the 8 or 9 porphyrias, a heme/onc doc told me she has not seen or treated one in her 30+ years of practice.

 

[Goro]

Medicine and science are human endeavors. therefore, they are both flawed. The beauty of the two is that they are self-correcting. Part of the training you are getting is to be able to say "hmmm...that doesn't work like it's supposed to."

As an example, it took over sixty years for surgeons to realize that a lumpectomy is just as good as a radical mastectomy for the treatment of breast Ca.

So there's a reason you engage in continuing medical education, and that there is a huge emphasis into turning you into life long learners.

Nope, I agree that it needs to be learned. They are important however you don't know what is still correct and what will be wrong. There was a medical student who found an extra connection to the brachial plexus in our class that was in a neurology text, but was taught differently during lecture. Information changes and we don't know what will be right or wrong in the future.

 

[sovereign0]

It can definitely feel trivial when we're spending all our time in the weeds, but I do think that a rigorous and detailed basic science curriculum is beneficial for when we start adding pathology into the mix. It's not necessarily that we're meant to have long-term retention of all the minutiae, but we get exposed to the material and that contributes to our foundation in a subconscious way. It's not really something that I can prove, but I feel like learning these things changes our thought processes over time, and we approach a problem differently when re-exposure occurs.

For example, I personally feel like I'd think about the pathophysiology of an anemia a little differently if I had learned all the little steps at one point (even though I've since forgotten them) versus if I had just learned that "heme synthesis is complicated with lots of enzymes". Again, the feeling isn't something I can measure or even explain in clear terms. Just my 2 cents.

 

[IslandStyle808]

Medicine and science are human endeavors. therefore, they are both flawed. The beauty of the two is that they are self-correcting. Part of the training you are getting is to be able to say "hmmm...that doesn't work like it's supposed to."

As an example, it took over sixty years for surgeons to realize that a lumpectomy is just as good as a radical mastectomy for the treatment of breast Ca.

So there's a reason you engage in continuing medical education, and that there is a huge emphasis into turning you into life long learners.

Sorry I think we are saying the same thing but differently.

I agree with this. However, we are also learning it while its flawed (and we know is flawed) because it is how both our class and boards test us. My message is to say that medicine is constantly changing and its important to know that this stuff changes and cannot be taken as gospel. We are life long learners, and as life long learners we should always be questioning and ponder whether what we are learning is correct.

 

[Dagrimsta1]

How else will we maintain our superiority complex with NPs?

That's enough reason for me

 

[tennischamp822]

It's LCME... I thought med school in Canada was structured just like US med school. How come you don't cover these minutiae?

Basic science have its purpose IMO, but boy! US med school take that to another level... speaking about heme synthesis pathway and the 8 or 9 porphyrias, a heme/onc doc told me she has not seen or treated one in her 30+ years of practice.

I think Canada focuses on clinical diagnosis instead (which ultimately saves $$$ on imaging/testing)

 

[tennischamp822]

That's sort of the problem with learning tons of enzymes or other random minutiae like transcription factors and genes; eventually they all blend together and you don't know what goes with what. Sure, you'll have it all in your head for step 1 -- but will you really remember this stuff when you start practicing (or even the start of 3rd year for that matter)? Hell no. Some of these things are very relevant depending on your specialty, but I personally think it's waste of time forcing everybody to memorize things they have no chance of remembering.

Preach brother

 

[OnePunchBiopsy]

Yeah, you're right, it can't possibly be the multi-years of supervised high level clinical reasoning, medical decision making, procedures, didactics, CME, multiple board exams, etc (i.e. residency, where you actually learn real medicine).

I always thought this was assumed. Did you also know that the sky is blue?

BTW, I would absolutely LOVE to hear about your experience going through all that training you mentioned.

 

[phonyreal98]

The basics help you read the science of your future specialty. After about wrapping up first year, I looked at a pretty complex immuno paper in the field and understood the principles of what they hell they were talking about. All this basic science minutia that you and some of my classmates gripe about is giving you a basis to understand the work of scientists, which you should be able to understand. Doctors are scientists first and foremost (unlike other practitioners), so we should be able to hold a conversation with scientists and know what they are talking about.

Besides, don't you like the feeling of being completely and un-apologetically superior in the realm of science? We match many PhDs in a basic understanding of bioscience topics by the time we graduate. Sure, they do a dissertation later on an extremely specific subject, but we master the basics in a condensed 1 year gig while we party and gloat about being future doctors.

Edit: TL;DR - the minutia you gripe about let's us talk to scientists - no one else understands them or what the hell they are saying. We are needed for translational research and for decoding science language for patients.

In my experience, the thought processes to be successful at being a scientist versus being a doctor are very different. Scientists are not doctors and doctors are not scientists (well...usually at least).

 

[deleted689233]

I completely understand and appreciate learning most basic science, from the myriad of cellular structure and function, to ion channels, to oncogenes, to the heme degradation pathway, to lipid metabolism.. I enjoy learning all of that stuff, and can't imagine learning the clinical applications without those basics.

BUT, I will never understand for the life of me why we have to learn embryology in such extensive detail. I will never enjoy or see the purpose of most of it.

 

[dadaddadaBATMAN]

I completely understand and appreciate learning most basic science, from the myriad of cellular structure and function, to ion channels, to oncogenes, to the heme degradation pathway, to lipid metabolism.. I enjoy learning all of that stuff, and can't imagine learning the clinical applications without those basics.

BUT, I will never understand for the life of me why we have to learn embryology in such extensive detail. I will never enjoy or see the purpose of most of it.

Peds. Path. Ob. Some surgical sub specialties.

 

[Goro]

The whole point of American medical curricula for the past 110+ years has been to train doctors AS scientists!

The first people who figured out that there was an AIDS epidemic were doctors (not PhDs) who wondered why previously healthy gay young men were all of sudden having these weird opportunistic infections seen only in the heavily immunosuppressed. That and clinicians at the CDC who wondered "why all these requests for aerosol pentamidine (the treatment for Pneumocystis)?" I remember this vividly because I lived through that time. It strongly influenced my career choice.

OP was wondering "what's the point of med school?" The point is to get you to think clinically.

Every school has people who teach minutiae. But all faculty still struggle with "what does an MS1/2/OMSI/II need to know????" Then again, just because it seems like minutiae, that doesn't mean it is minutiae.

I do get appalled at my colleagues who teach their research, instead of what you need to know. The only solution to that is to continually bend the ear of the curriculum deans and don't let up.

It could be worse...there was a time where med schools had wet micro, path, and physiology labs. You had to learn how to culture bugs, H&E stain tissue samples and do experiments on, say dogs and rabbits!

Great thread, kids!

In my experience, the thought processes to be successful at being a scientist versus being a doctor are very different. Scientists are not doctors and doctors are not scientists (well...usually at least).

 

[aalamruad]

The whole point of American medical curricula for the past 110+ years has been to train doctors AS scientists!

The first people who figured out that there was an AIDS epidemic were doctors (not PhDs) who wondered why previously healthy gay young men were all of sudden having these weird opportunistic infections seen only in the heavily immunosuppressed. That and clinicians at the CDC who wondered "why all these requests for aerosol pentamidine (the treatment for Pneumocystis)?" I remember this vividly because I loved through that time. It strongly influenced my career choice.

OP was wondering "what's the point of med school?" The point is to get you to think clinically.

Every school has people who teach minutiae. But all faculty still struggle with "what does an MS1/2/OMSI/II need to know????" Then en again, just because it seems like minutiae, that doesn't mean it is minutiae.

I do get appalled at my colleagues who teach their research, instead of what you need to know. The only solution to that is to continually bend the ear of the curriculum deans and don't let up.

It could be worse...there was a time where med schools had wet micro, path, and physiology labs. You had to learn how to culture bugs, H&E stain tissue samples and do experiments on, say dogs and rabbits!

Great thread, kids!

This is a fantastic typo. Perhaps the best I've ever seen

 

[mistafab]

How?

If you understand embyro, front to back, you can understand how an insult at any developmental stage will result in XYZ sequela. Of all the fields of basic science to have a bone to pick with, human development/embryology seems like the least minutiae-based.

Edit: I mean sure, my peers complain about understanding the whole of the jak/stat pathway. But how can you be annoyed with learning the science behind how humans come to be? If ever a science was relevant to human life, it is how it began (especially with embryonic stem cell stuff going on) that is very relevant. Sure, I am drinking wine and typing furiously, but how did mistafab come to be? You would know if you understood embryo.

Edit2: This wine too good. Git gud bruh.

I completely understand and appreciate learning most basic science, from the myriad of cellular structure and function, to ion channels, to oncogenes, to the heme degradation pathway, to lipid metabolism.. I enjoy learning all of that stuff, and can't imagine learning the clinical applications without those basics.

BUT, I will never understand for the life of me why we have to learn embryology in such extensive detail. I will never enjoy or see the purpose of most of it.

 

[Goro]

This is a fantastic typo. Perhaps the best I've ever seen

100% true for my generation.

 

[username456789]

Sounds like a bunch of kids who should've gone to PA school posting here.

 

[ConfusedChemist]

It's LCME... I thought med school in Canada was structured just like US med school. How come you don't cover these minutiae?

Basic science have its purpose IMO, but boy! US med school take that to another level... speaking about heme synthesis pathway and the 8 or 9 porphyrias, a heme/onc doc told me she has not seen or treated one in her 30+ years of practice.

opps...LMCC is the exam.

They are regulated, even more tightly it seems because we don't have 'tiers' so there's very little variation between schools. But we learn basic sciences to the extent that we need to in order to understand disease processes/drugs. So we would learn the urea cycle, but not have to memorize a bunch of the random genetic disorders that are associated with enzymes that first aid has.

That said, most of us write the USMLE anyway so we have to memorize it for that

 

[Brahnold Bloodaxe]

I have no gripe with the basic sciences and understand the importance of knowing the fundamental concepts. My point is that the level of detail that is taught is useless because it can never be retained! In fact, I'd argue that the level of detail is counterproductive to learning the things we actually need to have a solid understanding of. I can't focus and hammer down a perfect understanding of concepts to the extent that I'd like because I have to move on to the next 50 slides of minutiae, and at the end of the day I will have forgotten all the minutiae while being less comfortable with the concepts than I otherwise would have been if I had more time to devote to the things that actually matter.

 

[phonyreal98]

The whole point of American medical curricula for the past 110+ years has been to train doctors AS scientists!

The first people who figured out that there was an AIDS epidemic were doctors (not PhDs) who wondered why previously healthy gay young men were all of sudden having these weird opportunistic infections seen only in the heavily immunosuppressed. That and clinicians at the CDC who wondered "why all these requests for aerosol pentamidine (the treatment for Pneumocystis)?" I remember this vividly because I lived through that time. It strongly influenced my career choice.

OP was wondering "what's the point of med school?" The point is to get you to think clinically.

Every school has people who teach minutiae. But all faculty still struggle with "what does an MS1/2/OMSI/II need to know????" Then again, just because it seems like minutiae, that doesn't mean it is minutiae.

I do get appalled at my colleagues who teach their research, instead of what you need to know. The only solution to that is to continually bend the ear of the curriculum deans and don't let up.

It could be worse...there was a time where med schools had wet micro, path, and physiology labs. You had to learn how to culture bugs, H&E stain tissue samples and do experiments on, say dogs and rabbits!

Great thread, kids!

You can be a good scientist without a PhD and there are MD's that are fantastic scientists. However, med school, as it stands right now, does not teach you how to be a good scientist. The only lab that we had in med school was anatomy dissection- everything else was lecture and we were to essentially memorize what the lecturers told us and answer test questions. We learned a lot of facts based in science, but we didn't learn how to do science.

I can regurgitate a lot of the basic facts that we learned in medical school about my field, but medical school didn't give me the skillset to be a successful independent scientist in my field- the ability to design original studies, how to appropriately analyze data for studies I am involved in, anticipate potential problems with my research, to know what my data means in the larger context of my field, to write journal articles, how to write IRB/IACUC protocols, and most importantly, how to write grants. Those are the nuts and bolts of what a scientist does and that's why I'm getting a PhD. MD's can make great scientists too- but every MD I know that primarily does research has put in the time and effort at some point in their career to pick up those skills because those skills aren't taught in medical school.

 

[Goro]

Ok, I think you missed the point of my post.

Med school is not training you to be a bench researcher; it is training you to think like a scientist in terms of being able to assess clinical data, and more importantly, to be able to apply it.

You can be a good scientist without a PhD and there are MD's that are fantastic scientists. However, med school, as it stands right now, does not teach you how to be a good scientist. The only lab that we had in med school was anatomy dissection- everything else was lecture and we were to essentially memorize what the lecturers told us and answer test questions. We learned a lot of facts based in science, but we didn't learn how to do science.

I can regurgitate a lot of the basic facts that we learned in medical school about my field, but medical school didn't give me the skillset to be a successful independent scientist in my field- the ability to design original studies, how to appropriately analyze data for studies I am involved in, anticipate potential problems with my research, to know what my data means in the larger context of my field, to write journal articles, how to write IRB/IACUC protocols, and most importantly, how to write grants. Those are the nuts and bolts of what a scientist does and that's why I'm getting a PhD. MD's can make great scientists too- but every MD I know that primarily does research has put in the time and effort at some point in their career to pick up those skills because those skills aren't taught in medical school.

 

[Lawpy]

What's minutiae to you, is significant and spectacularly interesting to someone else. Most likely the lecturer on the given subject and everyone in class who wants to be her/him later.

Jokes aside, what Batman said.

When you start doing rotations or residency later, there's always the possibility you will end up managing patients with seemingly random conditions. The "co-morbidities", that while aren't directly relevant to your field on a particular day, are still important for the home team to sort out.

You may have to refer to specialties and subspecialties eventually, and unless they take over care, you may even have to action some of the plans they give you. You don't have to know things in depth like they do, but you have to have some concept to keep up or at least have the ability retained to look up the appropriate resources to understand. (I liked batman's words better on this -

the following was told to me before (when I was contemplating the mysteries of the universe as a pre-clinical year student) - they throw a lot of crap at you, and hope something sticks. Also the hope is that when you go practice and see something 'different', at least some vague memory will be triggered from your basic science days.

It is challenging to guzzle down all that you're learning the first two years of medical school, without the full context. But that will come eventually later.

It comes in handy when you least expect it, and allows you to understand research much more easily. If you want to stay on the cutting edge of medicine, those details really do matter.

The basics help you read the science of your future specialty. After about wrapping up first year, I looked at a pretty complex immuno paper in the field and understood the principles of what they hell they were talking about. All this basic science minutia that you and some of my classmates gripe about is giving you a basis to understand the work of scientists, which you should be able to understand. Doctors are scientists first and foremost (unlike other practitioners), so we should be able to hold a conversation with scientists and know what they are talking about.

Besides, don't you like the feeling of being completely and un-apologetically superior in the realm of science? We match many PhDs in a basic understanding of bioscience topics by the time we graduate. Sure, they do a dissertation later on an extremely specific subject, but we master the basics in a condensed 1 year gig while we party and gloat about being future doctors.

Edit: TL;DR - the minutia you gripe about let's us talk to scientists - no one else understands them or what the hell they are saying. We are needed for translational research and for decoding science language for patients.

Also - If we aren't the ones keeping the basic science of the human body in medicine, who is? Pharmacists?

Seriously, stop whining. Remove basic human science from medical school and then we are just glorified nurses with longer training. Be proud that doctors are rooted in science.

Medicine and science are human endeavors. therefore, they are both flawed. The beauty of the two is that they are self-correcting. Part of the training you are getting is to be able to say "hmmm...that doesn't work like it's supposed to."

As an example, it took over sixty years for surgeons to realize that a lumpectomy is just as good as a radical mastectomy for the treatment of breast Ca.

So there's a reason you engage in continuing medical education, and that there is a huge emphasis into turning you into life long learners.

The whole point of American medical curricula for the past 110+ years has been to train doctors AS scientists!

The first people who figured out that there was an AIDS epidemic were doctors (not PhDs) who wondered why previously healthy gay young men were all of sudden having these weird opportunistic infections seen only in the heavily immunosuppressed. That and clinicians at the CDC who wondered "why all these requests for aerosol pentamidine (the treatment for Pneumocystis)?" I remember this vividly because I lived through that time. It strongly influenced my career choice.

OP was wondering "what's the point of med school?" The point is to get you to think clinically.

Every school has people who teach minutiae. But all faculty still struggle with "what does an MS1/2/OMSI/II need to know????" Then again, just because it seems like minutiae, that doesn't mean it is minutiae.

I do get appalled at my colleagues who teach their research, instead of what you need to know. The only solution to that is to continually bend the ear of the curriculum deans and don't let up.

It could be worse...there was a time where med schools had wet micro, path, and physiology labs. You had to learn how to culture bugs, H&E stain tissue samples and do experiments on, say dogs and rabbits!

Great thread, kids!

What are your thoughts on the recent trend of medical schools adopting a much more condensed preclinical curriculum (1.5 yr and 1 yr)? Good idea? Bad idea? Is a 2 + 2 systems-based curriculum optimal given the crucial importance of basic science?

 

[Goro]

What are your thoughts on the recent trend of medical schools adopting a much more condensed preclinical curriculum (1.5 yr and 1 yr)? Good idea? Bad idea? Is a 2 + 2 systems-based curriculum optimal given the crucial importance of basic science?

I honestly don't know. What gets cut out in the 1.5+ 2.5 or 1+3 model???? I can just imagine the turf wars that would occur: "They need to know my stuff!" "No, they need to know MY stuff!!!"

 

[Lawpy]

I honestly don't know. What gets cut out in the 1.5+ 2.5 or 1+3 model???? I can just imagine the turf wars that would occur: "They need to know my stuff!" "No, they need to know MY stuff!!!"

Maybe nothing at all and everything is covered in a compressed time frame

 

[Moose A Moose]

If you grill in minutiae, your subject foundation will always remain. Brushing up on the broad strokes will be cake for boards and beyond.

 

[Domperidone]

What are your thoughts on the recent trend of medical schools adopting a much more condensed preclinical curriculum (1.5 yr and 1 yr)? Good idea? Bad idea? Is a 2 + 2 systems-based curriculum optimal given the crucial importance of basic science?

Good question.
Like Goro said, it depends on what's removed.

If you ask me, medicine is already super condensed (it is a wall of information coming at you, that you're expected to meaningfully absorb in a very short time frame as it is. People in undergrad can spend a whole semester on cardiac physiology that we spend a few weeks on, as we have to move onto something else quickly after). The grey area is determining what's most relevant to clinical practice. That's what justifies the condensation process (I think). It usually means something is removed. i.e. if you're going to trim the fat, what's 'the fat' and where do you begin?

If not done well, it can mean that you end having to compensate for that loss in some way. As in, it results in more self directed studying in either the pre-clinical or clinical years. Imagine having to re-teach yourself the basic science while on rotation. It sucks. but sooner or later, things catch up with you.

It's harder to live with regret like that by the way. I.e. the feeling of having not studied more in a particular area, when you had more time to as a student, while it was being actively taught (no matter the quality).

It really shows during clinical rotations what basic science knowledge you're lacking in for whatever the reason. Perhaps it wasn't taught as thoroughly (not all lecturers being perfect at teaching), or you were just plain weak on that area or not interested so none of it really stuck. Or it was just lower yield v.s. something higher yield, etc etc. Back in first or second year for me, there were moments I went yay, I still passed my exams anyway. or yay, that section wasn't covered in the exam after all, how lucky is that? that feeling was short lived. It all came back to bite me in the ass years later on rotations, because then I had to study harder for a particular rotation that was rooted in that area of basic science I wasn't as strong in. Or I got pimped way harder.

(Don't get me started on terrifying it was an intern if I didn't know something, and suddenly had genuine responsibility over multiple different patients. I still get an element of fear, whenever i approach a new patient or someone becomes unwell, unexpectedly. what gets me through is breaking things down, taking it a step at a time. Remembering the basics, like the disease process, guides what investigations i need to do next or medications are appropriate to adjust. When you're fatigued, you're juggling multiple things, it's very easy to forget what could be obvious. it's very easy to get overwhelmed. If you don't have a strong foundation - whether through self-discipline or a strong curriculum at school, it makes life harder later. It's possible to look things up, but in truth, there isn't always time. After work, you're not going to have the same energy to study either)

Incidentally, where I was, they trialled condensing anatomy. They went from 3 years worth (right into clinical rotations too) of gross anatomy dissection courses. frequent spotter exams. It was thought to be too much. Particularly the family doctors that came out of that era, felt it was over kill looking back as grads. So, it was decided that it was time to scale that back a lot, and also to make it more 'self-directed'. Things on that front were condensed into 1.5ish or 2 years. It was still mandatory to show up to lab, but you could spend as much time or as little as you wanted during the session. You self determined the time spent and the 'amount learned' to a degree. It was a bit dangerous, because many students ended up spending more time on other subjects. The end result is that on surgical rotations, consistently all the surgeons felt we were on a whole, terrible at anatomy. they had to grill us harder. We or I had to put more hours into studying during my surgical rotation. Now the school's going the other direction and teaching more anatomy in the first two years, trying to find a balance.

Possibly, a condensed curriculum could be applicable for certain situations or purposes. If you knew early on what sort of doctor you wished to be, you can actively seek the programs more tailored to your needs. Depending on what's condensed, maybe it wouldn't matter as much to whatever field you go into later. Hypothetically speaking anyway. For instance, if you want to be a surgeon, you probably wouldn't want to be in a school that condenses your exposure to anatomy. However, not everyone has a clear idea about what they want to do after medical school as a premed.

Regardless, on the whole, I imagine condensing med school further it would still come at some cost, for which everyone would have to find a way to adapt to or just find a way to live with. The hope would be that it wouldn't compromise patient care later on.

If it's a matter of condensing the same material into a shorter time frame, that would be one hellish year or year & a half to live through. Trying to learn things that used to be spread out over two years, into one? you'd have to learn to be very clever and creative in finding ways to not burn out and still grasp the material.