Med School is Broken

[HumbledHuman]

Sorry.

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[Kkshake]

This post is so enlightening

 

[HumbledHuman]

This post is so enlightening

haha I had to edit and tone down my 2am SDN original post... it was "too" real

 

[Goro]

Whenever I see titles like the one of this thread, I think "Hmmmmm.....you're having trouble in med school, and thus all of American medical education is at fault.".

 

[mehc012]

Whenever I see titles like the one of this thread, I think "Hmmmmm.....you're having trouble in med school, and thus all of American medical education is at fault.".

I didn't see the OP, but I agree with the sentiment expressed in the title. I've never before felt so much that I am just spinning my wheels wasting time and large amounts of money the way I do in medical school. I learned more about the human body and got better clinical experience during my postbacc, when I was in control of what I learned and what I got to see. I've learned almost nothing new in med school, and there's only one block left (for which I've already taken courses covering the better part of the material). I had better, more quality time in the hospital and I go to a school that does, relatively speaking, a great job at that. I was excited for the challenge and how much I would learn and grow during medical school, but it just feels stagnant, like a massive step backwards that's wasting time and money and is just funneling me endlessly into the application game that I would love to not be playing anymore.
So yeah, maybe I'm fooling myself, but I see the title and it resonates pretty strongly with me, and I'm decidedly not having trouble in medical school.

 

[VincentAdultman]

I don't think med school is broken but I do think I'd like to know what ultimately leads to someone getting banned. This dude seemed pretty innocuous.

 

[Mad Jack]

I didn't see the OP, but I agree with the sentiment expressed in the title. I've never before felt so much that I am just spinning my wheels wasting time and large amounts of money the way I do in medical school. I learned more about the human body and got better clinical experience during my postbacc, when I was in control of what I learned and what I got to see. I've learned almost nothing new in med school, and there's only one block left (for which I've already taken courses covering the better part of the material). I had better, more quality time in the hospital and I go to a school that does, relatively speaking, a great job at that. I was excited for the challenge and how much I would learn and grow during medical school, but it just feels stagnant, like a massive step backwards that's wasting time and money and is just funneling me endlessly into the application game that I would love to not be playing anymore.
So yeah, maybe I'm fooling myself, but I see the title and it resonates pretty strongly with me, and I'm decidedly not having trouble in medical school.

I thought school was fine up to this point, wouldn't change a thing.

 

[Mad Jack]

I don't think med school is broken but I do think I'd like to know what ultimately leads to someone getting banned. This dude seemed pretty innocuous.

Probably a previously banned person under a new account or something

 

[libertyyne]

I feel like I am learning minutiae that will be lost in neurons culled in a few years. I dont feel challenged, just annoyed that they are making me memorize stuff that is easily accessible over a phone. The only part of my brain that is being challenged is the regurgitation part, and the ability to sit for x amount of hours part.

 

[guytakingboards]

I feel like I am learning minutiae that will be lost in neurons culled in a few years. I dont feel challenged, just annoyed that they are making me memorize stuff that is easily accessible over a phone. The only part of my brain that is being challenged is the regurgitation part, and the ability to sit for x amount of hours part.

I think we've all felt that way. It's really really tough when there is so much information at our fingertips but actually studying it/memorizing it/integrating it is what separates us from mid-levels much less the layman with an iPhone.

 

[libertyyne]

I think we've all felt that way. It's really really tough when there is so much information at our fingertips but actually studying it/memorizing it/integrating it is what separates us from mid-levels much less the layman with an iPhone.

I guess I am cynical. If you dont use it , you loose it . I have never asked any physicians I met what the histological appearance of the collecting duct of kidneys are, but I am willing to bet 2 out of 50 would know, and one of them would be a nephrologist and the other would be a pathologist. I just wish i was getting more clinical reasoning skills right now. I know for a fact I will not remember the nuances of histological differentiation of the male reproductive tract after my histo final.

 

[Nucleophile1]

I came straight from undergrad a with a bachelors degree in a non-science field so I feel like I have learned a lot in the past couple months (including stuff that I will remember). There is no doubt minutiae that I will forget, but as a whole, I have definitely increased my knowledge base. However, I think I come from a much different perspective than someone who has done a post-bacc, masters program, etc.

At my school, it seems like a majority of my classmates have done some sort of program between undergrad and medical school or worked in a medically related job (ENT, Technician, etc.) so plenty of my classmates walked in knowing lots of things that I did not know.

 

[guytakingboards]

I guess I am cynical. If you dont use it , you loose it . I have never asked any physicians I met what the histological appearance of the collecting duct of kidneys are, but I am willing to bet 2 out of 50 would know, and one of them would be a nephrologist and the other would be a pathologist. I just wish i was getting more clinical reasoning skills right now. I know for a fact I will not remember the nuances of histological differentiation of the male reproductive tract after my histo final.

Honestly that's just losing perspective of how education works. At each level a foundation is laid. At each successive level you use maybe a small amount of what your previously learned to build on a new level of knowledge. You forget the other 95%+ information from the previous step. Hopefully you recall some that possibly may become useful or at least give you a starting place to look stuff up.

I don't see your attitude as cynical. Just fatigued from the grind that is the never-ending process of medical education/adult learning. We all have been there (and may well be again).

 

[Goro]

Honestly that's just losing perspective of how education works. At each level a foundation is laid. At each successive level you use maybe a small amount of what your previously learned to build on a new level of knowledge. You forget the other 95%+ information from the previous step. Hopefully you recall some that possibly may become useful or at least give you a starting place to look stuff up.

I don't see your attitude as cynical. Just fatigued from the grind that is the never-ending process of medical education/adult learning. We all have been there (and may well be again).

Yup! They're all Legos, building upon each other.

 

[VincentAdultman]

I didn't see the OP, but I agree with the sentiment expressed in the title. I've never before felt so much that I am just spinning my wheels wasting time and large amounts of money the way I do in medical school. I learned more about the human body and got better clinical experience during my postbacc, when I was in control of what I learned and what I got to see. I've learned almost nothing new in med school, and there's only one block left (for which I've already taken courses covering the better part of the material). I had better, more quality time in the hospital and I go to a school that does, relatively speaking, a great job at that. I was excited for the challenge and how much I would learn and grow during medical school, but it just feels stagnant, like a massive step backwards that's wasting time and money and is just funneling me endlessly into the application game that I would love to not be playing anymore.
So yeah, maybe I'm fooling myself, but I see the title and it resonates pretty strongly with me, and I'm decidedly not having trouble in medical school.

Not everyone who goes into med school did a postbacc.

 

[mehc012]

I think we've all felt that way. It's really really tough when there is so much information at our fingertips but actually studying it/memorizing it/integrating it is what separates us from mid-levels much less the layman with an iPhone.

No. I feel as if I have learned almost nothing. I expected more from med school.

Honestly that's just losing perspective of how education works. At each level a foundation is laid. At each successive level you use maybe a small amount of what your previously learned to build on a new level of knowledge. You forget the other 95%+ information from the previous step. Hopefully you recall some that possibly may become useful or at least give you a starting place to look stuff up.

I don't see your attitude as cynical. Just fatigued from the grind that is the never-ending process of medical education/adult learning. We all have been there (and may well be again).

I am learning less in medical school than I did before med school, so I am not building on my foundation, but just repainting it and altering the tiny details to fit the new professors. It is 100% a waste of time.

 

[mehc012]

Not everyone who goes into med school did a postbacc.

True, but everyone always pretends that medical school covers soooo much more than undergrad classes and is sooo much harder and...that's not true in my experience. Thus far I've learned less in these 2yrs than in the 2yrs I took doing my postbacc.

 

[guytakingboards]

True, but everyone always pretends that medical school covers soooo much more than undergrad classes and is sooo much harder and...that's not true in my experience. Thus far I've learned less in these 2yrs than in the 2yrs I took doing my postbacc.

Mark me down as one of the confused people. Medical school isn't as hard as you thought and your first instinct is to whine about that? a) you better crushing everything (e.g. junior AOA) and b) why don't you focus on other stuff like literally anything else if material isn't hard for you?

 

[VincentAdultman]

True, but everyone always pretends that medical school covers soooo much more than undergrad classes and is sooo much harder and...that's not true in my experience. Thus far I've learned less in these 2yrs than in the 2yrs I took doing my postbacc.

A postbacc is not undergrad like by definition (post baccalaureate). And admittedly while I don't know much about them I thought that people did postbaccs and SMPs to show that they can handle a med school curriculum.

 

[libertyyne]

A postbacc is not undergrad like by definition (post baccalaureate). And admittedly while I don't know much about them I thought that people did postbaccs and SMPs to show that they can handle a med school curriculum.

Postbacs are usually atonement for sins of UG or career changers who have no science pre-reqs.

 

[operaman]

I’d have to disagree and say that it isn’t really broken per se, but could always be improved. Personally, I find it ironic that many schools are trimming back basic sciences at a time when basic science is expanding faster than ever before.

While I personally use very little of my basic science understanding each day, I think it’s hard to separate direct use from how those concepts are woven into my thinking. Sure, much of clinical medicine is algorithmic, but frequently something doesn’t quite follow the book and I have to think through it from a basic physiological level.

I think you do get taught a decent amount of clinical reasoning basics in Med school, but there’s a limit to what you can learn before you’re the one making some decisions. You need those solo night calls where you make a decision then lie awake in the dark wondering whether you’ve missed something. You need the every day practice of seeing sick people alongside your seniors and attendings and learning how to make good clinical decisions. My sense is that even residency will have its limits and there will be a new kind of clinical thinking that will develop after I’m an attending seeing my own patients over the long haul.

So yes, I think Med ed can improve, but I think we must keep in mind its foundational role in the bigger picture.

 

[mehc012]

A postbacc is not undergrad like by definition (post baccalaureate). And admittedly while I don't know much about them I thought that people did postbaccs and SMPs to show that they can handle a med school curriculum.

By definition it's just undergrad courses taken after completion of a degree. I took no graduate credits. I think you're thinking of SMP.

 

[Perrotfish]

Honestly that's just losing perspective of how education works. At each level a foundation is laid. At each successive level you use maybe a small amount of what your previously learned to build on a new level of knowledge. You forget the other 95%+ information from the previous step. Hopefully you recall some that possibly may become useful or at least give you a starting place to look stuff up.

Nonsense. You are learning a huge amount of information that you won't use and, in 5 years, won't remember. It's not a foundation, there is nothing that learning biochem helps you learn later, it's just wasted time and money.

The issue with medical school is that it was very specifically designed to make you a late 19th century general practitioner who runs his own lab and compunds his own meds. You learn histology because when they designed the curriculum they expected you to be out in the country with a microscope. You do chem because they expected you to have two dozen jars of powder on your shelf to compound meds from. Everyone gets a surgery and an OB rotation because back then everyone did amputations and delivered babies. No one has a mandatory rotation in heme/once, radiology, or anesthesia because we invented those specialties after we invented medical school.

A huge chunk of your training exists, despite being obsolete for more than a century, solely because the people who write the regulations make money off of it. It's no better or worse than if the government forced you to buy a horse and buggy before you were allowed to buy a car, because buggy operation is a 'foundation' for driving. You will pay nearly a tenth of your total lifetime earnings to your deans and administrators in exchange for a few thousand dollars worth of information which you will learn either from outside resources that you pay for separately , or by following around attendings who get none of your tuition. That is a broken system.

 

[libertyyne]

I guess this is my personal observation and perhaps very school dependent. I am not being challenged to apply information being thrown at me. My exams are not conceptual in nature, rather they require regurgitation of facts to rule out wrong answers and select the correct ones. I am not being taught to apply the scientific method to problems, or clinical reasoning , or even methodological thinking . I have a graduate degree in an unrelated feild and I can safely say that even though the coursework was not as rigorous, its impact on changing the way I think was substantial. It lead to me trying to solve problems in a more systematic fashion. I do not believe I am getting that currently at my school, maybe I will look back and think differently but currently in the midst of it I just feel like a glorified stick of RAM , where my memory is temporary and it will be completely dumped once I move on to the next subject.

 

[VincentAdultman]

By definition it's just undergrad courses taken after completion of a degree. I took no graduate credits. I think you're thinking of SMP.

I guess I'll take your word for it.

Hopefully you're crushing your classes. TBH I didn't think my first two years were that hard either and I was able to pass everything (not honor) by just shutting it down for a week before exams. I spent most of my free time going to bars, bowling, or playing Vice City. I don't really recommend that.

 

[mehc012]

My point is more that, from what I can tell so far, all of preclinical years is more than sufficiently replaced by a few years of part-time undergrad courses at far lower cost, plus clinical experience that actually pays money. I learned more while MAKING money than I have while in school spending it; how is that not broken?

 

[guytakingboards]

My point is more that, from what I can tell so far, all of preclinical years is more than sufficiently replaced by a few years of part-time undergrad courses at far lower cost, plus clinical experience that actually pays money. I learned more while MAKING money than I have while in school spending it; how is that not broken?

It doesn't work for you and thus the entire system is broken...

You think that'll work for the tens of thousands of new medical students per year?

 

[neoevolution]

My point is more that, from what I can tell so far, all of preclinical years is more than sufficiently replaced by a few years of part-time undergrad courses at far lower cost, plus clinical experience that actually pays money. I learned more while MAKING money than I have while in school spending it; how is that not broken?

If your undergrad level courses can cover preclinical med school content fully, they must have been much more rigorous than average. Everyone takes the same pre-reqs, and they're just a foundation for what preclinical covers.

But since your courses were post-bacc, I'd argue that the system isn't really efficient for a high performer if you finish undergrad, do extra courses, and then finally go to med school. Students who perform well enough in undergrad should go straight to med school, as that's the prior knowledge level that med school is designed for. Extra courses are for students who didn't show mastery of undergrad material and need to prove themselves to med school admissions that they can cut it.

 

[guytakingboards]

Nonsense. You are learning a huge amount of information that you won't use and, in 5 years, won't remember. It's not a foundation, there is nothing that learning biochem helps you learn later, it's just wasted time and money.

The issue with medical school is that it was very specifically designed to make you a late 19th century general practitioner who runs his own lab and compunds his own meds. You learn histology because when they designed the curriculum they expected you to be out in the country with a microscope. You do chem because they expected you to have two dozen jars of powder on your shelf to compound meds from. Everyone gets a surgery and an OB rotation because back then everyone did amputations and delivered babies. No one has a mandatory rotation in heme/once, radiology, or anesthesia because we invented those specialties after we invented medical school.

A huge chunk of your training exists, despite being obsolete for more than a century, solely because the people who write the regulations make money off of it. It's no better or worse than if the government forced you to buy a horse and buggy before you were allowed to buy a car, because buggy operation is a 'foundation' for driving. You will pay nearly a tenth of your total lifetime earnings to your deans and administrators in exchange for a few thousand dollars worth of information which you will learn either from outside resources that you pay for separately , or by following around attendings who get none of your tuition. That is a broken system.

How is it different that any other education? By your logic nearly all education is stupid. Why learn about sedimentary rocks or literature? Why not start studying medicine in Kindergarten?

I think some people have wildly unreasonable expectations about medical school. If you think that medical school or anything else in higher education/adult learning is going to be high yield you're way off base.

Even in practice you may spend half an hour reading a journal article that gives you 1-2 useful points to integrate into practice.

I feel ridiculous saying this, because I am a millennial too, but medicine and medical education are not supposed to be fun or easy. There's a lot of drudgery and tedium in it.

 

[mehc012]

If your undergrad level courses can cover preclinical med school content fully, they must have been much more rigorous than average. Everyone takes the same pre-reqs, and they're just a foundation for what preclinical covers.

But since your courses were post-bacc, I'd argue that the system isn't really efficient for a high performer if you finish undergrad, do extra courses, and then finally go to med school. Students who perform well enough in undergrad should go straight to med school, as that's the prior knowledge level that med school is designed for. Extra courses are for students who didn't show mastery of undergrad material and need to prove themselves to med school admissions that they can cut it.

My courses were postbacc because I wasn't interested in medicine in undergrad. You could have taken them during undergrad, no issue. And they weren't particularly rigorous; far less so than the standard class at my actual undergrad was. Med school just...isn't that complicated, and it really doesn't cover that much.

More to the point, all together they cost me less than one semester of med school. My point isn't that everyone should take those classes before going to med school, but that medical school preclinicals are unnecessarily expensive and redundant. You could learn all of the content during normal undergraduate classes. Just saying that I agree that medical school is broken.

 

[operaman]

Nonsense. You are learning a huge amount of information that you won't use and, in 5 years, won't remember. It's not a foundation, there is nothing that learning biochem helps you learn later, it's just wasted time and money.

The issue with medical school is that it was very specifically designed to make you a late 19th century general practitioner who runs his own lab and compunds his own meds. You learn histology because when they designed the curriculum they expected you to be out in the country with a microscope. You do chem because they expected you to have two dozen jars of powder on your shelf to compound meds from. Everyone gets a surgery and an OB rotation because back then everyone did amputations and delivered babies. No one has a mandatory rotation in heme/once, radiology, or anesthesia because we invented those specialties after we invented medical school.

A huge chunk of your training exists, despite being obsolete for more than a century, solely because the people who write the regulations make money off of it. It's no better or worse than if the government forced you to buy a horse and buggy before you were allowed to buy a car, because buggy operation is a 'foundation' for driving. You will pay nearly a tenth of your total lifetime earnings to your deans and administrators in exchange for a few thousand dollars worth of information which you will learn either from outside resources that you pay for separately , or by following around attendings who get none of your tuition. That is a broken system.

You make some really good points here. I guess the challenge comes in deciding exactly which things can be cut back and what best to replace them with - obviously no easy answers there. Perhaps the ultimate answer will be down the path of earlier clinical immersion and specialization with the basic sciences more tailored to what you will actually use.

The system is definitely geared toward training generalists. That said, for those of us in specialties, I find great value in having just enough background to communicate well with people in other fields. Lord knows we all get consults from people who clearly never paid attention in Med school and have no clue what they’re asking or what they want us to do. We could probably get that baseline knowledge much more efficiently, though.

 

[jhamaican]

18 posts. He had a good run.

 

[SunsFun]

My courses were postbacc because I wasn't interested in medicine in undergrad. You could have taken them during undergrad, no issue. And they weren't particularly rigorous; far less so than the standard class at my actual undergrad was. Med school just...isn't that complicated, and it really doesn't cover that much.

More to the point, all together they cost me less than one semester of med school. My point isn't that everyone should take those classes before going to med school, but that medical school preclinicals are unnecessarily expensive and redundant. You could learn all of the content during normal undergraduate classes. Just saying that I agree that medical school is broken.

Maybe it’s just your curriculum because I didn’t study science in UG although did take pre-Recs and found my knowledge base to expand exponentially during the first 2 years of Med school.

 

[Perrotfish]

How is it different that any other education? By your logic nearly all education is stupid. Why learn about sedimentary rocks or literature? Why not start studying medicine in Kindergarten?

There are two basic kinds of education: education that teaches you to do a specific useful task, and education that teaches you to make ethical decisions.

A huge amount of our education through the end of college is geared towards making ethical decisions. History, government, literature, climate science, etc: the goal of these courses is to promote ethical in spiritual growth so that you can be a better citizen and person. The effectiveness and utility of this subset of education is difficult to measure, if for no other reason that that reasonable, intelligent people can disagree about what ethical and useful behavior actually is.

The rest of our education, though, is geared towards performing specific, useful tasks. These can be general life skills: algebra so you can calculate a mortgage, health class so that you know how to use birth control, etc. In college and graduate school many of those classes, though, begin to focus on more complicated tasks which make up a career: law, medicine, engineering, etc. The quality of that education is very easy to evaluate, because we can measure how well the training prepares you to perform the tasks.

When education fails to meet either missions, for example when we drag every medical student through calculus or biochem, the professors of those subjects often fall back on the excuse that they are teaching you to think, or teaching you to learn. They argue that we are spending years running in the wrong direction so that you won't feel winded when they finally let us run in the right direction. The obvious fallacy here is that we could easily teach you to think and learn just as well by teaching you things you actually need to know.

Its not like we don't know what effective medical education looks like. We do it! We just call it residency. For that matter medical school itself WAS a perfectly good education, when it was originally designed it only became about 'teaching you to think' when it became obsolete. They are stapling effective training onto the end of years of ineffective training, rather than redesigning the entire thing, because they aren't incentivized to cut costs or streamline anything. They earn more for every day that you are a student, rather than a doctor.

There is nothing wrong with learning for learning's sake... for free. Lots of us have educational hobbies and feel that there is a kind of spiritual growth associated with completing challenging, though useless, assignments.. However when someone stands at the door of your profession and declares that none shall pass without giving them 500K and passing a biochem course, you need to question that. They aren't teaching you, they're robbing you. Don't let them tell you otherwise.

 

[Perrotfish]

You make some really good points here. I guess the challenge comes in deciding exactly which things can be cut back and what best to replace them with - obviously no easy answers there. Perhaps the ultimate answer will be down the path of earlier clinical immersion and specialization with the basic sciences more tailored to what you will actually use. .

There are some easy answers. They key is that you just need to cut back, nothing needs replacing because the useful training is already there, stapled onto the end of all the nonsense. Eliminate undergrad degrees and premedicine and make medical school a 5 year undergraduate degree with three preclinical years rather than two to fit in the basic bio/chem/English classes. Eliminate the requirements for organic chemistry, biochemistry, calculus, and histology. Make residency a graduate program and award doctoral degrees upon the completion of residency rather than upon completion of medical school. Get people out into practice by the age of 26.

 

[jcorpsmanMD]

Sure, medical school is broken, so is the world.. so is our political system.. etc. etc. whine less, do more. My humble opinion.

 

[libertyyne]

Sure, medical school is broken, so is the world.. so is our political system.. etc. etc. whine less, do more. My humble opinion.

Acknowledging a problem exists is the first step in fixing it.

 

[jcorpsmanMD]

Acknowledging a problem exists is the first step in fixing it.

hence the "do more"

 

[ERDOC555]

I agree that medical education in 2017 is broken beyond repair. The first 2 years are so poorly managed, to the point where a massive proportion of students simply pay for high quality online resources and teach themselves what they need to know for 2 years, while paying $50k in tuition to have the school hinder and slow your progress.

I've excelled despite, not because of, my school. They set us up for failure pretty much from day 1, but by ignoring their curriculum I'm able to focus on what actually matters.

We live in the 21st century, Ms1/2 needs to be revamped, standardized, and entirely online for a fraction of the cost so that all students are getting the best education possible and it's covering material that will actually be useful going forward.

Nonsense. You are learning a huge amount of information that you won't use and, in 5 years, won't remember. It's not a foundation, there is nothing that learning biochem helps you learn later, it's just wasted time and money.

The issue with medical school is that it was very specifically designed to make you a late 19th century general practitioner who runs his own lab and compunds his own meds. You learn histology because when they designed the curriculum they expected you to be out in the country with a microscope. You do chem because they expected you to have two dozen jars of powder on your shelf to compound meds from. Everyone gets a surgery and an OB rotation because back then everyone did amputations and delivered babies. No one has a mandatory rotation in heme/once, radiology, or anesthesia because we invented those specialties after we invented medical school.

A huge chunk of your training exists, despite being obsolete for more than a century, solely because the people who write the regulations make money off of it. It's no better or worse than if the government forced you to buy a horse and buggy before you were allowed to buy a car, because buggy operation is a 'foundation' for driving. You will pay nearly a tenth of your total lifetime earnings to your deans and administrators in exchange for a few thousand dollars worth of information which you will learn either from outside resources that you pay for separately , or by following around attendings who get none of your tuition. That is a broken system.

This is one of the best/most informative posts I've seen in my life.

There are two basic kinds of education: education that teaches you to do a specific useful task, and education that teaches you to make ethical decisions.

A huge amount of our education through the end of college is geared towards making ethical decisions. History, government, literature, climate science, etc: the goal of these courses is to promote ethical in spiritual growth so that you can be a better citizen and person. The effectiveness and utility of this subset of education is difficult to measure, if for no other reason that that reasonable, intelligent people can disagree about what ethical and useful behavior actually is.

The rest of our education, though, is geared towards performing specific, useful tasks. These can be general life skills: algebra so you can calculate a mortgage, health class so that you know how to use birth control, etc. In college and graduate school many of those classes, though, begin to focus on more complicated tasks which make up a career: law, medicine, engineering, etc. The quality of that education is very easy to evaluate, because we can measure how well the training prepares you to perform the tasks.

When education fails to meet either missions, for example when we drag every medical student through calculus or biochem, the professors of those subjects often fall back on the excuse that they are teaching you to think, or teaching you to learn. They argue that we are spending years running in the wrong direction so that you won't feel winded when they finally let us run in the right direction. The obvious fallacy here is that we could easily teach you to think and learn just as well by teaching you things you actually need to know.

Its not like we don't know what effective medical education looks like. We do it! We just call it residency. For that matter medical school itself WAS a perfectly good education, when it was originally designed it only became about 'teaching you to think' when it became obsolete. They are stapling effective training onto the end of years of ineffective training, rather than redesigning the entire thing, because they aren't incentivized to cut costs or streamline anything. They earn more for every day that you are a student, rather than a doctor.

There is nothing wrong with learning for learning's sake... for free. Lots of us have educational hobbies and feel that there is a kind of spiritual growth associated with completing challenging, though useless, assignments.. However when someone stands at the door of your profession and declares that none shall pass without giving them 500K and passing a biochem course, you need to question that. They aren't teaching you, they're robbing you. Don't let them tell you otherwise.

Agree 100%. Also we could easily condense medical school to 2 years (similar to PA) and keep residencies the same and I don't think we'd lose quality whatsoever. Year 4 is a complete waste, and years 1 and 2 can easily be combined without sacrificing quality down the road. Medical school doesn't make you a good doctor, residency does.

 

[neoevolution]

I've seen a lot of faculty argue that Step 1 prep resources aren't enough to excel, and therefore traditional courses are needed. But really, the current Step 1 resources are so efficient and well organized, that if we wasted less time watching lecture to learn material for our school specific exams, those companies could double or triple the content they cover (since students would actually have time to go through all of it thoroughly) and we would all be learning more material and more easily. I think it's possible for med schools to reach the level of quality or at least approximate the level of quality that these resources achieve, but they don't seem to care to do so since students will just bust their ass to do as well as they can and thus the vast majority are still doing well even if they could be doing better.

 

[njtrimed]

How is it different that any other education? By your logic nearly all education is stupid. Why learn about sedimentary rocks or literature? Why not start studying medicine in Kindergarten?

I think some people have wildly unreasonable expectations about medical school. If you think that medical school or anything else in higher education/adult learning is going to be high yield you're way off base.

Even in practice you may spend half an hour reading a journal article that gives you 1-2 useful points to integrate into practice.

I feel ridiculous saying this, because I am a millennial too, but medicine and medical education are not supposed to be fun or easy. There's a lot of drudgery and tedium in it.

Agreed. Maybe it depends on the school, but I definitely don’t think medical education is broken. I have a strong background in the sciences, as well as a prior career in the medical field, so several aspects of the preclinical years are basically just repackaging material I’ve already learned. And sometimes it does feel like med schools are great at finding ways to waste your time. But just when I’m feeling frustrated about another seemingly unnecessary mandatory session, I learn something that pulls things together and makes new connections for me, or I have an interaction with a real or standardized patient that surprises me in that I realize I suddenly have some degree of clinical competency I absolutely did NOT have before. If it’s repetitive at times, it’s often by design.

 

[username456789]

Oh look, another "we would rather be PAs!" thread.

 

[Goro]

I disagree with the first and last paras as it all of your basics goes into being Legos. You need a foundation if you want to build anything.

But the bolded is so spot on I want to scream! I get annoyed to no end that my students have to learn about bacterial lab tests when none of them will ever set foot in a clinical lab, and all they have to do in the future is take a specimen, submit it, and wait for the lab to make an ID.

Nonsense. You are learning a huge amount of information that you won't use and, in 5 years, won't remember. It's not a foundation, there is nothing that learning biochem helps you learn later, it's just wasted time and money.

The issue with medical school is that it was very specifically designed to make you a late 19th century general practitioner who runs his own lab and compunds his own meds. You learn histology because when they designed the curriculum they expected you to be out in the country with a microscope. You do chem because they expected you to have two dozen jars of powder on your shelf to compound meds from. Everyone gets a surgery and an OB rotation because back then everyone did amputations and delivered babies. No one has a mandatory rotation in heme/once, radiology, or anesthesia because we invented those specialties after we invented medical school.

A huge chunk of your training exists, despite being obsolete for more than a century, solely because the people who write the regulations make money off of it. It's no better or worse than if the government forced you to buy a horse and buggy before you were allowed to buy a car, because buggy operation is a 'foundation' for driving. You will pay nearly a tenth of your total lifetime earnings to your deans and administrators in exchange for a few thousand dollars worth of information which you will learn either from outside resources that you pay for separately , or by following around attendings who get none of your tuition. That is a broken system.

 

[Localnative]

Yup! They're all Legos, building upon each other.

Lego (not Legos...)
Now there's something I can relate to Goro.
Just bought the Saturn V, Simpson's Kwik - E - Mart and Palace Cinema.
Sweeeeeeeeeeeeeeeeeeeeeeeeeeeeet.

 

[Perrotfish]

I disagree with the first and last paras as it all of your basics goes into being Legos. You need a foundation if you want to build anything.

Its not that I don't get the concept, but most of the 'foundation' courses we take aren't actually a foundation for anything. What exactly does taking literally any college major prepare you for? What course are we getting ready for when we take organic chemistry and biochem?

There are a handful of courses in the progression towards pathology in MS2 that are a legitimate foundation. Bio1 and Bio2 are foundations for anatomy and pathology. Anatomy and pathology are foundations for path and pharm. Path and pharm are 100% necessary foundations for clinical medicine. Pretty much everything else in the 5 YEARS leading up to MS3 is just useless.

 

[mehc012]

Its not that I don't get the concept, but most of the 'foundation' courses we take aren't actually a foundation for anything. What exactly does taking literally any college major prepare you for? What course are we getting ready for when we take organic chemistry and biochem?

There are a handful of courses in the progression towards pathology in MS2 that are a legitimate foundation. Bio1 and Bio2 are foundations for anatomy and pathology. Anatomy and pathology are foundations for path and pharm. Path and pharm are 100% necessary foundations for clinical medicine. Pretty much everything else in the 5 YEARS leading up to MS3 is just useless.

This I don't fully agree with...organic chem and biochem directly underly everything in pharm and med school biochem.

But then, I suppose we're arguing opposites anyway. You're arguing they should teach us less, I'm frustrated that they're not giving us enough.

 

[Goro]

Its not that I don't get the concept, but most of the 'foundation' courses we take aren't actually a foundation for anything. What exactly does taking literally any college major prepare you for? What course are we getting ready for when we take organic chemistry and biochem?

There are a handful of courses in the progression towards pathology in MS2 that are a legitimate foundation. Bio1 and Bio2 are foundations for anatomy and pathology. Anatomy and pathology are foundations for path and pharm. Path and pharm are 100% necessary foundations for clinical medicine. Pretty much everything else in the 5 YEARS leading up to MS3 is just useless.

Oh that's easy... UG gets you to be able to think. Obviously, it's not a perfect process, given the number of anti-vax people and devotees' of herbalism out there.


There's a reason why college grads make ~$1 million more over their lifetime than those without a degree.

 

[mistafab]

I think if you thought about it, you could make quite a bit more concessions than that. Off the top of my head 1) stats 2)psych/brain and behavior 3) And honestly even inorganic (basic) chemistry is prety much essential for everything pharm related. Titration? Acid base? Covalent / hydrostatic forces? DIFFUSION? These were all concepts in inorganic chem that seems so completely basic now where you are at but these were learned in basic chemistry.

I can understand the argument for requiring a degree before med school, since you are correct that just the minimum requirements do provide some foundation for med school. However, I think that once you are at one end of the spectrum (I'm a lowly M2), you sometimes forget how some basic concepts that are part of how you think were NOT things that you knew before.

Its not that I don't get the concept, but most of the 'foundation' courses we take aren't actually a foundation for anything. What exactly does taking literally any college major prepare you for? What course are we getting ready for when we take organic chemistry and biochem?

There are a handful of courses in the progression towards pathology in MS2 that are a legitimate foundation. Bio1 and Bio2 are foundations for anatomy and pathology. Anatomy and pathology are foundations for path and pharm. Path and pharm are 100% necessary foundations for clinical medicine. Pretty much everything else in the 5 YEARS leading up to MS3 is just useless.

 

[mistafab]

I also want to go a little farther and say that undergraduate is probably one of the best opportunities people have to become better people. Since the requirements/foundation for med school is sort of a step by step building of classes, you have to take them in sequence anyway (can't really be done in less than two years). So, it is honestly a blessing that people are allowed to take undergrad to pursue learning in something they care about while taking the med school foundation classes.

In school now, there were many times in m1 where classmates groaned and moaned about all these things that they "didn't need to know." Low and behold - in robbins I am reading and understanding the pathology while classmates are forced to just "memorize" because they never let things build onto eachother. "I'm not going into this field so it doesn't matter" was on an email I got the other day... It feels like echoes of my sentiments about undergrad. Sad.

Med school is another chance to learn a bunch of stuff largely at your own pace. Meanwhile, you will pretty much get the legos of medicine fed to you through a tube whether you like it or not. Thus is the system.

It is REALLY tough to think about how useful past knowledge is to what you do today because it all builds on eachother. For an extreme example, in first grade I learned 1 + x = 2 and what not. USELESS I could say, that is so EASY. But c'mon - we can all see in this example that me being able to pick up a research paper and grade it COLD for their methods section is due to the building of learning that occured in the past.

 

[SunsFun]

I also want to go a little farther and say that undergraduate is probably one of the best opportunities people have to become better people. Since the requirements/foundation for med school is sort of a step by step building of classes, you have to take them in sequence anyway (can't really be done in less than two years). So, it is honestly a blessing that people are allowed to take undergrad to pursue learning in something they care about while taking the med school foundation classes.

In school now, there were many times in m1 where classmates groaned and moaned about all these things that they "didn't need to know." Low and behold - in robbins I am reading and understanding the pathology while classmates are forced to just "memorize" because they never let things build onto eachother. "I'm not going into this field so it doesn't matter" was on an email I got the other day... It feels like echoes of my sentiments about undergrad. Sad.

Med school is another chance to learn a bunch of stuff largely at your own pace. Meanwhile, you will pretty much get the legos of medicine fed to you through a tube whether you like it or not. Thus is the system.

It is REALLY tough to think about how useful past knowledge is to what you do today because it all builds on eachother. For an extreme example, in first grade I learned 1 + x = 2 and what not. USELESS I could say, that is so EASY. But c'mon - we can all see in this example that me being able to pick up a research paper and grade it COLD for their methods section is due to the building of learning that occured in the past.

I think you hit the nail on the head here. Sure, the curriculum can always be improved, but discarding everything in favor of only learning things that you will certinaly need to do your job takes the joy out of learning.

Approaching UG and then pre-clinical it as another checkmark to fill in makes me sad. In my view, essential role education play is to broaden our horizons, to force us to think about and do things we normally wouldn’t be doing. In the process, a person should grow both in terms of knowledge as well as perspective.