Med School is Broken

[neoevolution]

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I'm not sure what schools you're talking about, but neither of the 6 year programs I know of require the MCAT at all, and have "recommended" ACT/SAT scores and GPAs. I'm talking overall attrition rate. The one I'm more familiar with has a 15% attrition rate in the first 2 years and an 8-9% attrition rate in years 3-6 (more than double the national average). True about the college level thing, but if they decide not to go into health sciences they've essentially wasted 2 years one a hyper-focused UG curriculum that is useless to them.

Even without a hard cutoff, they're not going to take someone from high school who is way below their program median stats. And any premed who changes tracks will have wasted time on prereqs.

Not every program will have MCAT and college GPA requirements, but I know from interviewing at some programs that their students average above the GPA and MCAT minimums if they do have them. Again, no one would run these if everyone entering their med school was a 25 MCAT and 3.0 GPA.

Attrition does vary a lot by program, I think the lower tier ones particularly lose a lot of students.

 

[pookatooth]

1) I would propose doing allof medical school as a 5 year undergraduate degree. Cut all undergrad subjects not deemed useful, which means year 1 would be bio 1 &2, chem 1 &2, stats, physics 1&2, and some humanities (3 semesters, no summer). Year 2 and 3 would be med school years 1 and 2. Years 4 and 5 would be med school years 3 and 4. You would then apply to residency, which becomes a doctoral program, and you don't get the title of doctor until you finish residency.

2) If you did it this way you are right that the admissions process just wouldn't be as selective, and people would fail out. Which would be fine, people fail out of undergrad majors all the time. They wouldn't even have to call it failing, they would just say 'I'm switching out of the med program and changing my major to communications'. It happened all the time in engineering, when people couldn't pass the classes, and it would work jut as well for medicine.

Interesting and pretty damn thought provoking.

I don't think the excess material is necessarily criminal, but rather the timeline that we receive this material in as well as the ever increasing tuition rates due to our government subsidized loan surpluses. We can have the same curriculum required by the pre-requisites done in one and a half years easily with streamlined instruction and catered-to-actual-medicine testing. That being said, doctors should be generalists, even if they aren't in the woods doing everything themselves. The reason being is that knowledge in of itself is what separates the doctor from the general population. It is the integration of mostly useless and sometimes useful information that allow us as humans to perceive an intrinsic difference between ourselves that allow the doctor/patient relationship to exist. Shaving that down to only utilitarian knowledge would degrade that defined relation due to "ignorance as the product of specialization."

What I think is counterproductive today in medical education is the emphasis on separating the high achievers from the highest achievers when it comes to choosing who gets what specialty. The neurosurgeon memorized this much more powerpoint (or STEP material) than the next guy or gal and that is why they are allowed to train as a neurosurgeon. It doesn't matter how more interested or how much relevant research or how much relevant clinical experience you have if you don't have hard number metrics. Which goes back to how ridiculous the minutiae is tested on to determine who gets the sexy specialties. There has to be better competencies derived in the clinical years of medical school to separate candidates rather than basic science regurgitation. (I don't necessarily know what that looks like.)

 

[pookatooth]

But I also advocate government mandated, after high school, two years of military, stateside humanitarian, or some other form of volunteer work before starting university. I've seen it work in Israel personally (although they have a much higher degree of nationalism that plays a part) in turning goofballs into grown men and women. This I believe would be more beneficial to learning "how to think" or "how to learn" or "how to contribute to society" that UG education.

 

[pookatooth]

Golden nugget I found because my brain keeps turning on this...

"Imagine a large corporate machine mobilized to get you to buy something you don't need at a tremendously inflated cost, complete with advertising, marketing, and branding that says you're not hip if you don't have one, but when you get one you discover it's of poor quality and obsolete in ten months. That's a BA." - Joel Salatin

 

[VA Hopeful Dr]

I get where y'all are coming from, but I'm not sure I would describe our system as broken. We still produce excellent physicians.

I see 2 problems that do warrant addressing:

First, tuition. I graduated med school in 2010. Since then, tuition at my alma mater has gone from 20k to 34k. I feel safe in saying the education isn't 14k better now than it was then. This absolutely needs to be fixed. Total loan burden for my graduating class was around 160-180k. That's very reasonable to my mind, and even us primary care types can pay that off fairly easily.

Second, lack of clinical education. I didn't personally mind most of pre-clinical education (biochem seemed a bit much, but I didn't feel that strongly about it at the time). But we need to improve the clinical part.

 

[Perrotfish]

I get where y'all are coming from, but I'm not sure I would describe our system as broken. We still produce excellent physicians.
.

Imagine you bought a car for $500,000, and then found out that its top speed was 15 MPH. Would you consider it a good car, because it eventually got you where you needed to go?

 

[kb1900]

Imagine you bought a car for $500,000, and then found out that its top speed was 15 MPH. Would you consider it a good car, because it eventually got you where you needed to go?

Great analogy

 

[Giovanotto]

Imagine you bought a car for $500,000, and then found out that its top speed was 15 MPH. Would you consider it a good car, because it eventually got you where you needed to go?

Out of curiosity, how do you feel about the current state of residency training? What's your take on resident compensation?

 

[VA Hopeful Dr]

Imagine you bought a car for $500,000, and then found out that its top speed was 15 MPH. Would you consider it a good car, because it eventually got you where you needed to go?

I get kinda tired of pointing this out, but for most specialties our total time in training is very similar if not occasionally shorter than other countries.

 

[kb1900]

I get kinda tired of pointing this out, but for most specialties our total time in training is very similar if not occasionally shorter than other countries.

At the price we pay it should be far shorter than other countries or a quarter of the price

 

[VA Hopeful Dr]

At the price we pay it should be far shorter than other countries or a quarter of the price

I think the pricing when I was a medical student was fair. For state schools people came out with approximately 150k in debt. For private schools it was usually more like 225k. Given how that is the yearly salary range of us low-paid Primary Care types, that does not seem unreasonable to me.

I would also love the 3% interest rate that people had in the early 2000s, but that's probably a pipe dream.

 

[kb1900]

I think the pricing when I was a medical student was fair. For state schools people came out with approximately 150k in debt. For private schools it was usually more like 225k. Given how that is the yearly salary range of us low-paid Primary Care types, that does not seem unreasonable to me.

I would also love the 3% interest rate that people had in the early 2000s, but that's probably a pipe dream.

Do those numbers include undergrad debt?

My tuition after aid is probably closer to what tuition should be but many schools are not as generous

 

[VA Hopeful Dr]

Do those numbers include undergrad debt?

My tuition after aid is probably closer to what tuition should be but many schools are not as generous

No, undergrad is separate as it should be since the vast majority of pre-med students never matriculated medical school.

Also, State undergrad at most places is quite inexpensive.

 

[WingedOx]

No, undergrad is separate as it should be since the vast majority of pre-med students never matriculated medical school.

Also, State undergrad at most places is quite inexpensive.

This is changing though.

 

[Shams al Deen]

How do new PAs compare with fresh MD interns in their ability to practice clinical medicine? If they are comparable, then yeah med school is probably broken.

But I don't think the answer is throwing out classes like biochemistry, rather it should do a better job of extracting the practicality out of subjects like biochemistry. For example, I want my physician to have a basic understanding of metabolism of fats, carbs, and protein. If they do not, then how can I trust their ability to have insight into the efficacy of different diet plans. Med school should focus the biochem classes on nutrition as opposed to obsessing over MSUD and homocystinuria.

 

[vernhart]

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.".

OR....everything I've learned I've basically had to teach myself (well, using outside resources/texts). I'm confident I could accomplish the same knowledge base by being left alone for two years and knowing what resources exist and exactly what is expected of me. Of course it is in your best interest to dismiss these claims...but I do truly think the system is deeply flawed. Still, we have the ability to learn on our own at this point and the system can't be blamed for our lack of knowledge (that is something we can control). However, it can be blamed for being very inefficient with my time and money.

 

[Nucleophile1]

This is changing though.

Yeah, undergrad tuition is going up, but scholarships given by the schools are not changing. I specifically chose my undergrad because scholarships covered my tuition. There was a nicer private undergrad that I wanted to attend, but it would have left me with a lot of debt. However, 10 years from now, the same scholarships that I got at my state undergrad will not cover all of the tuition so students will still have to take out loans.

 

[mehc012]

OR....everything I've learned I've basically had to teach myself (well, using outside resources/texts). I'm confident I could accomplish the same knowledge base by being left alone for two years and knowing what resources exist and exactly what is expected of me. Of course it is in your best interest to dismiss these claims...but I do truly think the system is deeply flawed. Still, we have the ability to learn on our own at this point and the system can't be blamed for our lack of knowledge (that is something we can control). However, it can be blamed for being very inefficient with my time and money.

Isn't this true in all schools, all the time, though? The only real difference I see is that med school teaches straight to a standardized test and therefore has a more universally agreed-upon set of knowledge to be learned and thus more/better organized resources available globally (larger market for prep materials and thus more money to be made making resources for that one exam). If every plant bio course in every college had exactly the same final exam and covered exactly the same material, you'd see a set of widely accepted plant bio sources, too, and everyone would be talking about how they just learned from those instead of their professor's material, so why bother with the professors?

 

[vernhart]

Isn't this true in all schools, all the time, though? The only real difference I see is that med school teaches straight to a standardized test and therefore has a more universally agreed-upon set of knowledge to be learned and thus more/better organized resources available globally (larger market for prep materials and thus more money to be made making resources for that one exam). If every plant bio course in every college had exactly the same final exam and covered exactly the same material, you'd see a set of widely accepted plant bio sources, too, and everyone would be talking about how they just learned from those instead of their professor's material, so why bother with the professors?

Yeah but the difference is professors in my other schooling have been a legitimate source of information (yes, you could still argue they are unnecessary but you couldn't argue that they weren't useful if utilized). I could use ppts and listen to lectures and be confident I was learning the information just as well as if those universal resources were available. I don't see the lectures in medical school this way. They have been so poorly organized and presented that I couldn't survive without the outside resources. [Ok, yeah I could survive...but it would be painful and I would not at all be confident I was learning things at the level I could with these resources]

EDIT: but, yeah, I don't disagree in that I do think most learning could be done independently with modern tech. I very rarely need someone present to answer questions on the spot (which I think is true of most students that have reached graduate level ed.).

 

[neoevolution]

OR....everything I've learned I've basically had to teach myself (well, using outside resources/texts). I'm confident I could accomplish the same knowledge base by being left alone for two years and knowing what resources exist and exactly what is expected of me. Of course it is in your best interest to dismiss these claims...but I do truly think the system is deeply flawed. Still, we have the ability to learn on our own at this point and the system can't be blamed for our lack of knowledge (that is something we can control). However, it can be blamed for being very inefficient with my time and money.

I think part of the issue is that Goro is a preclinical PhD professor, he's going to have limited insight into how our preclinical education translates to Step scores and being on the wards

 

[mehc012]

Yeah but the difference is professors in my other schooling have been a legitimate source of information (yes, you could still argue they are unnecessary but you couldn't argue that they weren't useful if utilized). I could use ppts and listen to lectures and be confident I was learning the information just as well as if those universal resources were available. I don't see the lectures in medical school this way. They have been so poorly organized and presented that I couldn't survive without the outside resources. [Ok, yeah I could survive...but it would be painful and I would not at all be confident I was learning things at the level I could with these resources]

EDIT: but, yeah, I don't disagree in that I do think most learning could be done independently with modern tech. I very rarely need someone present to answer questions on the spot (which I think is true of most students that have reached graduate level ed.).

They were a legitimate source of information because they were the ONLY source of information because they made the tests and the lectures and the homework and graded it all. It's kind of hard not to be an indispensable resource with that setup.

Once you standardize things, you as the professor are no longer the only resource for learning what is needed, you are simply one of many possible ones, and probably making the least money for your efforts out of all the options, to boot. Any wonder that at some point people feel they're better off with publicly available resources?

 

[Goro]

I think part of the issue is that Goro is a preclinical PhD professor, he's going to have limited insight into how our preclinical education translates to Step scores and being on the wards

True for the latter, but not for the former. Unless you're discussing about how the type of curriculum and/or student learning style translates to Boards scores. I don't think anyone has studied this yet. There have been some studies that at their particular school, they find that X class is a predictor of their students' board scores. The trouble is, school #1 say is Physiology, and school #2 says it's Pharmacology!

The take home is that different students learn in different ways. There is no one size fits all medical curriculum, teaching style, or medical student. UCSF learn that the hard way, but at least their students are happier after thier last curriculum change.

 

[Goro]

OR....everything I've learned I've basically had to teach myself (well, using outside resources/texts). I'm confident I could accomplish the same knowledge base by being left alone for two years and knowing what resources exist and exactly what is expected of me. Of course it is in your best interest to dismiss these claims...but I do truly think the system is deeply flawed. Still, we have the ability to learn on our own at this point and the system can't be blamed for our lack of knowledge (that is something we can control). However, it can be blamed for being very inefficient with my time and money.

So we modify the OP to "my school has lousy professors, therefore medical education is broken"?
😉

IF you have professors who are researchers teaching about their research, burn them at the stake! This is something I despise even more than mandatory lecture attendance.

 

[arcus]

IF you have professors who are researchers teaching about their research, burn them at the stake! .

This sounds a bit like the “Rope. Tree. Journalist” meme. Can we substitute “Journalist” with “medical school admin”?

just saying.