Is your biochem being taught to useless levels of detail..

[Nasrudin]

I have nothing against biochemistry. And respect it as a discipline important to medicine.

What I can't fathom is why I am obligated to memorize it's trivial aspects. Like exttremely rare--not the normally rare--but the esoterically--6 reported cases rare defective amino acid pathways.

Why can't I just get a physiological appreciation for certain alarm bells that should cause me to dig deeper as a physician. And when to refer that patient to the one person who might have seen a case or two in their career.

Why am I loading and dumping trivia like a flash drive with feet. I mean. Anatomy I guess we have to.

Just tell me that the USMLE treatment of bichem is more conceptual. Please. This weekend will be lost to this insanity. And I just want to that it's insane and not me.

---

Members don't see this ad.

 

[CBG23]

Just buckle down and learn it - the level of detail is much much worse for anatomy...

 

[auburnO5]

Is your biochem being taught to useless levels of detail..

Yes. Wtf.

I feel like our professors are focusing on such minute details/pathways that the bigger picture/concepts are not even being taught.

 

[MilkmanAl]

As far as your career as a clinician is concerned, there is no such thing as learning biochem and not delving into useless levels of detail.

 

[njbmd]

I too, was a curriculum "expert" when I was an MS-1. I busted my rear end and honored biochem along with all of my other first year coursework. Now that I am a practicing physician, I am glad that I learned the details during my pre-clinical years. My solid knowledge foundation made my clinical rotations and residency/fellowship much easier.

The sheer amount of material to review and learn weekly would be much greater if I had not had a good and thorough biochemistry(and anatomy, pathology, micro etc) course. In addition, I aced all three steps of my USMLE (took Step I three weeks after completing second year) and did well on my in-training exams (you take these every year during residency).

Once you get to clinical practice, even residency, you develop a different perspective about your pre-clinical work. It's a process and not prep for one exam but a lifetime of practice. I am very thankful for my solid grounding.

 

[Zoom-Zoom]

And it's definitely a lot more useful than learning all that worm and mollusk anatomy in college bio. What the heck is a coelomate, anyway? It's a long road from school to practice, and I think the closer we get the more relevant it becomes (to our careers) because what we've already learned (and forgotten most of) can now be tailored in an appropriate way. You never know what superfluous details might enhance your future education. So we forget most of it, but relevant stuff can now be re-learned easily in the future if needed. The thing about med biochem is you learn ALL medical biochem. Everything that's known is somehow relevant or has the potential to be one day, although every individual thing is of relatively small importance. But hey, at least you're not learning the Calvin cycle, or, say, equations to calculate the speed of blocks sliding down ramps at specific angles.

 

[Zoom-Zoom]

Just buckle down and learn it - the level of detail is much much worse for anatomy...

Yes, anatomy is one class where a great deal of stuff can definitively be ruled out from being of any future significance. At least as far as blind recall of anatomical names goes.

 

[Zoom-Zoom]

I have nothing against biochemistry. And respect it as a discipline important to medicine.

What I can't fathom is why I am obligated to memorize it's trivial aspects. Like exttremely rare--not the normally rare--but the esoterically--6 reported cases rare defective amino acid pathways.

Why can't I just get a physiological appreciation for certain alarm bells that should cause me to dig deeper as a physician. And when to refer that patient to the one person who might have seen a case or two in their career.

Why am I loading and dumping trivia like a flash drive with feet. I mean. Anatomy I guess we have to.

Just tell me that the USMLE treatment of bichem is more conceptual. Please. This weekend will be lost to this insanity. And I just want to that it's insane and not me.

I definitely agree that more effort could be put forward to explain important concepts and unify the importance of things. After memorize all the amino acid stuff, for example, I came to conclusions on my own that lead me to alter my daily protein intake 😛 There is definitely no reason to make us memorize stuff and then expect us to put stuff together if they could succinctly do both.

 

[Nasrudin]

Alright then. I guess Rome wasn't built in a day. And I do forget, at this stage I'm just getting the mud to make blocks.

 

[engineeredout]

Would you rather memorize rare enzyme deficiencies or entire biochemical pathways and mechanisms? Med school biochem was not nearly as bad as I was expecting it to be.

 

[DrYoda]

1. Med school is all about the little details, so you guys should just accept that now.

2. Some of the biochem stuff is useful when you get to pharm.

3. I can't believe you guys are complaining about biochem. Sure it's dry, but the light(er) workload makes up for that.

 

[Cruzinman]

I had a patient in lactic acidosis and was asked to recite the Krebs Cycle on the wards. Better learn the stuff.

 

[web2linc]

Biochemistry definitely expanded my horizons and it has helped on the MCAT when it come to enzymes mechanisms and kinetics, hemoglobin dissociation curves, glycolysis etc..

 

[web2linc]

You want to know something interesting. My little brother had some sort of bacterial infection and he had a physical and some blood work done and the Nurse practitioner found that he was iron deficient. Now my brother is a healthy kid who eats all his vegetables and meats (which contain iron). So I had no clue why he was iron deficient. Then I though about biochemistry. When someone is iron deficient they have problems with fatigue because iron is essential for heme, the prosthetic group for hemoglobin and myoglobin. But he was still practicing football and wasn't showing any significant signs of fatigue. So I did some research and I found out that the bodies natural defense mechanism against bacterial infections is to inhibit iron uptake, because iron is essential for bacteria growth and survival. Being a lazy nurse practitioner, she never looked at his file in-depth enough to know he was on antibiotics for his recent medical condition. She suggested that he take multivitamins containing iron.😱 Well, doing that would cause his bacterial infection to flare up and possibly become resistant to the antibiotics. I saved his life thanks to biochemistry lol just kidding.

Moral of the story, biochemistry gives you a deeper understanding of the body and underlying functions.

 

[web2linc]

lol my bad, I thought this was the pre-med forum.

 

[Nanon]

This is something I really appreciate about my school's biochem curriculum. Our labs bring most of the information we learn into a real world scenario, and yes, the level of minutia is mind numbing.

The good news is that you really will use the principles (and the minutia) of what you're learning clinically - all the time. I think they do you a disservice by only showing you what happens in rare cases (my school rides diabetes like a pony, and I appreciate that), but the principles are important.

🙂

 

[URHere]

I'm just waiting for the thread a year and a half from now:

"Did your USMLE form ask biochem questions to useless levels of detail...?"

Because mine sure as heck did, and I'm glad that my school bothered to show that minutiae before I got down to crunch time.

 

[auburnO5]

I too, was a curriculum "expert" when I was an MS-1. I busted my rear end and honored biochem along with all of my other first year coursework. Now that I am a practicing physician, I am glad that I learned the details during my pre-clinical years. My solid knowledge foundation made my clinical rotations and residency/fellowship much easier.

The sheer amount of material to review and learn weekly would be much greater if I had not had a good and thorough biochemistry(and anatomy, pathology, micro etc) course. In addition, I aced all three steps of my USMLE (took Step I three weeks after completing second year) and did well on my in-training exams (you take these every year during residency).

Once you get to clinical practice, even residency, you develop a different perspective about your pre-clinical work. It's a process and not prep for one exam but a lifetime of practice. I am very thankful for my solid grounding.

Would you like a cookie?

 

[ArcGurren]

Would you like a cookie?

Please just ignore her. She's supremely unhelpful 90% of the time and 10% of the time when she is she ends up being condescending.

 

[HPSPpayissues]

Please just ignore her. She's supremely unhelpful 90% of the time and 10% of the time when she is she ends up being condescending.

Dude, she knows what she is talking about, so you better listen to her. I don't see how she was being condescending to y'all. She was just trying to point out that everything that is taught in med school is relevant in some ways clinically- yes, even tidbit details of anatomy and histology. Plus, first two years of med school is not even that hard anyway, as long as you work hard. She didn't call you guys out on it but I will: you guys need to stop complaining and wasting time on SDN; instead, use that energy to learn your school materials and try become a more dedicated student. Oh, and yes, come back and make a point after you take Step 1, 2, or even 3 🙄

 

[KeyzerSoze]

Dude, she knows what she is talking about, so you better listen to her. I don't see how she was being condescending to y'all. She was just trying to point out that everything that is taught in med school may be relevant in some ways clinically to some obscure field of medicine which you will almost certainly not be involved in - yes, even tidbit details of anatomy and histology. Plus, first two years of med school is not even that hard anyway, as long as you work hard. She didn't call you guys out on it but I will: you guys need to stop complaining and wasting time on SDN; instead, use that energy to learn your school materials and try become a more dedicated student. Oh, and yes, come back and make a point after you take Step 1, 2, or even 3 🙄

Fixed that for you.

 

[NTF]

I think learning the pathways is useful, but I do think they harp on a lot of esoteric details rather then the big picture (nutrition, exercise, starvation, relevant clinical conditions). I honestly don't know why they can't just integrate biochem into the other courses rather than have it stand alone. Do I really need to know how many ATP are generated when compound X enters the Kreb cycle at step Y?

 

[Nasrudin]

I think learning the pathways is useful, but I do think they harp on a lot of esoteric details rather then the big picture (nutrition, exercise, starvation, relevant clinical conditions). I honestly don't know why they can't just integrate biochem into the other courses rather than have it stand alone. Do I really need to know how many ATP are generated when compound X enters the Kreb cycle at step Y?

Yeah. That was my basic sentiment. I'm not trying to be disrespectful but I do think the science training continuing in the model of science graduate education is wierd for medical school.

Of course, I can't argue with someone ahead of me who thinks the guy with the mop just just stf up and keep working. I understand that is the socialization at work. I accept it. Even if it doesn't come naturally to me. If it did. I still be cleaning adult diapers right now.

I'm back it without incident and silently working away. With 2 things noted. Don't come to sdn to talk about things that bother you. All of the people above you--pretty much everyone--cares more about you moving the mop than anything else you have to say or think about.

Noted. No problem. No habla ingles.

 

[Knicks]

I think learning the pathways is useful, but I do think they harp on a lot of esoteric details rather then the big picture (nutrition, exercise, starvation, relevant clinical conditions). I honestly don't know why they can't just integrate biochem into the other courses rather than have it stand alone. Do I really need to know how many ATP are generated when compound X enters the Kreb cycle at step Y?

👍

 

[ArcGurren]

Dude, she knows what she is talking about, so you better listen to her. I don't see how she was being condescending to y'all. She was just trying to point out that everything that is taught in med school is relevant in some ways clinically- yes, even tidbit details of anatomy and histology. Plus, first two years of med school is not even that hard anyway, as long as you work hard. She didn't call you guys out on it but I will: you guys need to stop complaining and wasting time on SDN; instead, use that energy to learn your school materials and try become a more dedicated student. Oh, and yes, come back and make a point after you take Step 1, 2, or even 3 🙄

I have never once heard an attending or a resident tell me - even as an M2 - that they ever needed to use the Krebs cycle or the details of FA oxidation in any sort of clinical setting, ever. By and large what is taught in med school biochem is useless. Yes there are some relevant diseases but that doesn't mean you need to know every step of the process. Just know what accumulates in Tay Sachs or whatever and how you treat it. That's it. The minutiae do end up being completely irrelevant.

And seriously go f*&k yourself. The "go and study and spend less time on SDN" card is such utter bull coming from someone else who comments here.

 

[auburnO5]

I have never once heard an attending or a resident tell me - even as an M2 - that they ever needed to use the Krebs cycle or the details of FA oxidation in any sort of clinical setting, ever. By and large what is taught in med school biochem is useless. Yes there are some relevant diseases but that doesn't mean you need to know every step of the process. Just know what accumulates in Tay Sachs or whatever and how you treat it. That's it. The minutiae do end up being completely irrelevant.

And seriously go f*&k yourself. The "go and study and spend less time on SDN" card is such utter bull coming from someone else who comments here.

👍 I like your style.

 

[ANCAdoc]

I agree that the level of detail taught in biochem is overkill. As an internal medicine resident, I do not use most of what I was taught. It never even comes to mind. Medicine is largely practical and unless you are going into academic medicine with a research focus, you won't use that stuff again.

As the push for more clinically oriented material is to be taught in the first two years, I think some of the fluff will be taken out. I hope that includes embryology, which I have never used.

 

[cartoondoc]

In four years of residency, I didn't use one thing from biochemistry. Any of it.

I can understand the whole "this builds on that," but the level of detail is definitely ridiculous. On my metabolism exam, I remember I lost huge amounts of points due to not bothering to memorize coenzymes. Not enzymes but COenzymes. Had I memorized them, my score would have been higher on the exam, but a week after the exam, there would have been absolutely no difference in my knowledge level.

I didn't bother to re-memorize any of it for Step 1 and I still did well. *shrug*

That said, I actually DO use stuff I learned in anatomy.

 

[Knicks]

I agree that the level of detail taught in biochem is overkill. As an internal medicine resident, I do not use most of what I was taught. It never even comes to mind. Medicine is largely practical and unless you are going into academic medicine with a research focus, you won't use that stuff again.

As the push for more clinically oriented material is to be taught in the first two years, I think some of the fluff will be taken out. I hope that includes embryology, which I have never used.

In four years of residency, I didn't use one thing from biochemistry. Any of it.

I can understand the whole "this builds on that," but the level of detail is definitely ridiculous. On my metabolism exam, I remember I lost huge amounts of points due to not bothering to memorize coenzymes. Not enzymes but COenzymes. Had I memorized them, my score would have been higher on the exam, but a week after the exam, there would have been absolutely no difference in my knowledge level.

I didn't bother to re-memorize any of it for Step 1 and I still did well. *shrug*

That said, I actually DO use stuff I learned in anatomy.

I absolutely LOVE how these 2 posts completely SHUT-DOWN any and all "ZOMG! yOU G0tTA LErN ALL DA DEtAILZ!" apologists.

Good job, fellaz. 👍

 

[justaregularmed]

I don't really agree. If you don't know the details do you really know what your doing?

 

[MilkmanAl]

Do you fully understand the particle physics behind how drugs bind receptors? Didn't think so.

 

[justaregularmed]

Do you fully understand the particle physics behind how drugs bind receptors? Didn't think so.

While I enjoy your jib, you did learn about diffusion (hopefully you understand it). Somebody simplified the particle physics for you (in the form of fun constants and equations), so if you really want to understand those equations you look into it, but I don't think its a fair comparison to biochemistry. You learn the Krebs cycle so you know why people are alive, because in general you want to keep them that way.

But we are arguing about the bare minimum here. While sure some of the detail is silly but the grand majority of it comes up again sometime whether you like it or not was all I was saying.

 

[MilkmanAl]

The "grand majority" of biochem comes up again? I guess we didn't take the same biochem class or something. As if it wasn't obvious enough already that your time spent in biochem is largely time wasted where medical education is concerned, reading a path book will set you straight pretty quickly. Goljan has a chapter on fluids (essentially all about diffusion) and a little chapterlet on nutrition. There are a few storage diseases and hemoglobinopathies here and there. In all cases, the mechanisms of these diseases are glossed over, at most. You really don't need to know an entire enzyme cycle to know what a disorder does and how to fix it.

 

[justaregularmed]

The "grand majority" of biochem comes up again? I guess we didn't take the same biochem class or something. As if it wasn't obvious enough already that your time spent in biochem is largely time wasted where medical education is concerned, reading a path book will set you straight pretty quickly. Goljan has a chapter on fluids (essentially all about diffusion) and a little chapterlet on nutrition. There are a few storage diseases and hemoglobinopathies here and there. In all cases, the mechanisms of these diseases are glossed over, at most. You really don't need to know an entire enzyme cycle to know what a disorder does and how to fix it.

I guess my course was different they did teach everything but they only expected you to know the important things like regulatory enzymes and the like. Most of it was focused on mechanisms and pathways that come up again in 2nd year.

I dunno i'm not comfortable with the bare minimum, i think its a bad attitude and its mainly what separates us from the other allied health professionals.

 

[justaregularmed]

A new post for a new rant.

You can make this argument about all the required rotations you have as well, if I want to be a psychiatrist why do I have to do a OB rotation?

You can see this same argument for integrated thoracic surgery, vascular surgery and integrated plastics.

You can see intern/prelim year being eliminated from some specialties, still others hang onto it.

I for one am not all that psyched about the race to the bottom, and I don't exactly understand the rational for it.

How on earth is being less well rounded better for anyone?

 

[Doctor Bob]

Do you need to memorize all of this biochem? No, not really.
Do you need to be taught all of this biochem? Yea.

All the little things you get taught during medschool come in handy now and then... you'll see some patient with some obscure problem and there'll be a little voice in the back of your head trying to remind you about the thing you were taught... it'll be too old of a voice to clearly hear, but it'll be enough to get you to go and look it up.

Without having the endless detail taught and without the requirement to memorize it for the test the little particles of knowledge won't lodge in your brain to be dredged up years and years later as a prompt to go read something.

In clinical practice, once in a while someone comes in with some presentation or some reaction and I won't know what's going on, but I get this nagging sensation that I've heard this before and it has something to do with an inborn error of metabolism (for example) and that's enough to set me on the correct path. Did I need to be able to stand at the bedside and recite the enzymatic deficiency? No, not really (although that would be kind of cool). But without sitting through biochem and having to memorize it for the exam I wouldn't have gotten enough of it stuck in the deep recesses of my brain for use down the line.

 

[xanthomondo]

My argument for learning the ridiculous detail is this:

You're never going to retain 100% of what you learn. Hell I'm lucky if I retain 50% of what I learn. The more in depth that I learn a subject the more I retain on a basic level.

So you are forced to learn the tiny tiny details of biochem, and while true you will probably never need to recall what enzyme catalyzes the X reaction in glycolysis but at least you'll be able to appreciate the pathways and how they intertwine together in the future.

 

[cartoondoc]

I find it interesting how people cling to things that are pointless and antiquated just because "they were always that way so there must be a reason."

There's no reason to learn biochemistry in the detail that it is currently taught. Back in the olden days (when lions had riches), there was a lot less medicine to learn so it was fine to dedicate excessive amounts of time to learning all the coenzymes. These days, the time would be better spent learning other things or even gaining more clinical experience in the pre-clinical years, but it's really hard to make a change from the way things have always been.

It's a shame, really.

 

[justaregularmed]

I find it interesting how people cling to things that are pointless and antiquated just because "they were always that way so there must be a reason."

There's no reason to learn biochemistry in the detail that it is currently taught. Back in the olden days (when lions had riches), there was a lot less medicine to learn so it was fine to dedicate excessive amounts of time to learning all the coenzymes. These days, the time would be better spent learning other things or even gaining more clinical experience in the pre-clinical years, but it's really hard to make a change from the way things have always been.

It's a shame, really.

Pointless? Basic Science is the only thing that separates a PA and NP from a MD. This post makes me sad.

 

[MossPoh]

I find it interesting how people cling to things that are pointless and antiquated just because "they were always that way so there must be a reason."

There's no reason to learn biochemistry in the detail that it is currently taught. Back in the olden days (when lions had riches), there was a lot less medicine to learn so it was fine to dedicate excessive amounts of time to learning all the coenzymes. These days, the time would be better spent learning other things or even gaining more clinical experience in the pre-clinical years, but it's really hard to make a change from the way things have always been.

It's a shame, really.

Back in the old days there wasn't that much biochemistry either. They refined things like clinical skills.

Biochemistry seriously wasn't that bad. Yes, it was a lot of junk to remember but I've yet to take a class yet that hasn't had information I thought would be pointless.

I think people aren't really looking far enough down the line. They view everything as a learning X, so I can do Y type scenario. Medicine is constantly evolving. What distinguishes us from most midlevels IS that depth we go into. It allows us to understand and apply things with a better understanding than a simple algorithm. It also allows us to learn new things faster and more efficiently in the future.

Do you REALLY need to know every coenzyme for every reaction? Probably not. But you can use that philosophy for a lot of what we go through. If one continually pares things down we become nothing more than technicians following a flow chart on a piece of paper. Sound clinical reasoning isn't derived from learning the bare minimum. It comes from years of grinding through ungodly amounts of data and figuring out how to parse it out and apply it to new situations with some degree of efficiency.

 

[Knicks]

^^ The person you quoted is a resident, so I'm sure his/her opinions on the matter outweigh yours.

Both "sides" provide good arguments, but for me, the scale is tipped toward the residents' sides.

 

[DrYoda]

Pointless? Basic Science is the only thing that separates a PA and NP from a MD. This post makes me sad.

I wouldn't make the jump from detailed biochem is pointless to the basic sciences are pointless based on that post.

 

[Encephalectomy]

My take on biochem was that 60-70% of the course is taught with the goal of giving anybody who is interested in going into academics/research a solid foundation. I don't think that is such an unreasonable thing for a school to do, especially when the deans have wet dreams about their first years going on to be important cheifs of medicine and surgery.

 

[Doctor Bob]

^^ The person you quoted is a resident, so I'm sure his/her opinions on the matter outweigh yours.

Both "sides" provide good arguments, but for me, the scale is tipped toward the residents' sides.

Errr... well, we're frequently wrong also, and can be just as irrational as anyone else.

I try to make a habit of being completely wrong at least once an hour. It keeps me on my toes. The important thing is to not be completely wrong on something of vital importance.

 

[cartoondoc]

Pointless? Basic Science is the only thing that separates a PA and NP from a MD. This post makes me sad.

Oh my god, you really think so? So the ONLY thing that separates, say, an orthopedic surgeon from the ortho PA is BASIC SCIENCE??? Not the seven or so years of extra training, 90% of which is clinical?

Look, there are plenty of things in med school that seemed useless at the time (e.g. acid-base stuff) that actually ended up being important. And some things, like much of biochem, were never important. I'm not saying all of basic science should be abandoned. I'm not saying we shouldn't learn the Kreb's cycle at all.... but do we really gain anything from memorizing every single detail of every pathway, which will undoubtedly be forgotten a day later? The field of medicine is huge and med school barely has time to brush the surface. Don't you think it would be more useful to spend that time doing more clinically relevant cases?

But like I said, people will always cling to the way things have always been done historically. It's the same way even exhausted residents used to cling to and vehemently support the ridiculous work hours, because of the belief that things were always done this way, so there must be a reason.

 

[Knicks]

Errr... well, we're frequently wrong also, and can be just as irrational as anyone else.

I try to make a habit of being completely wrong at least once an hour. It keeps me on my toes. The important thing is to not be completely wrong on something of vital importance.

👍

Oh my god, you really think so? So the ONLY thing that separates, say, an orthopedic surgeon from the ortho PA is BASIC SCIENCE??? Not the seven or so years of extra training, 90% of which is clinical?

Look, there are plenty of things in med school that seemed useless at the time (e.g. acid-base stuff) that actually ended up being important. And some things, like much of biochem, were never important. I'm not saying all of basic science should be abandoned. I'm not saying we shouldn't learn the Kreb's cycle at all.... but do we really gain anything from memorizing every single detail of every pathway, which will undoubtedly be forgotten a day later? The field of medicine is huge and med school barely has time to brush the surface. Don't you think it would be more useful to spend that time doing more clinically relevant cases?

But like I said, people will always cling to the way things have always been done historically. It's the same way even exhausted residents used to cling to and vehemently support the ridiculous work hours, because of the belief that things were always done this way, so there must be a reason.

Perfect.

 

[justaregularmed]

Last comment to whom I would guess is a 2nd year surgical resident. 23ish? states have already allowed PA/NP autonomy regardless of the huge difference in training hours. While I think the surgical specialties are safer, thats a dangerous thing to cling to. Besides the nurses are already as some have said moving to improve their product, I would watch out.

 

[womp]

I can't even remember certain details I learned two weeks ago.

What doesn't get utilized repeatedly, doesn't get retained. You've got to be pretty full of yourself to think that your studying prowess or sheer willpower will make you retain all the things you learned in your basic sciences years by the time you're a resident.

AFP: Chinese and Japanese people forget how to write Chinese characters because of computers and cellphones

Like every Chinese child, Li Hanwei spent her schooldays memorising thousands of the intricate characters that make up the Chinese writing system. Yet aged just 21 and now a university student in Hong Kong, Li already finds that when she picks up a pen to write, the characters for words as simple as "embarrassed" have slipped from her mind.

Surveys indicate the phenomenon, dubbed "character amnesia", is widespread across China, causing young Chinese to fear for the future of their ancient writing system.

Young Japanese people also report the problem, which is caused by the constant use of computers and mobile phones with alphabet-based input systems.