MD medical education is not fit for 21st century

[KnuxNole]

I don’t know what your experience has been in med school but I have never actually seen anyone’s life ‘being saved.’ A lot of work is maintenance of really uninspiring things...

What have your rotations been like to never see this?

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[Dantes]

This discussion on SDN always devolves into Banking/Consulting/Tech/Big Law vs. Medicine but this is falling into the same trap that the OP described IMO.

There are school districts where teachers are compensated very well. If you are a motivated, smart, driven individual there is a huge need for excellent teachers and if you play your cards right you can have a well compensated job, with benefits, a large amount of freedom for side projects during the summer, and good quality of life. Are you going to be popping bottles on your G5 @ 30 yo? No but you’ll probably live a comfortable life. It’s also good for ppl who like lifelong learning and as you become more experienced there are opportunities to have a broader impact through research, leadership, policy.

Just curious but what areas pay well for teachers? The ones I know work 50+ hours a week during the year. Then during their two months off they get a part-time job bartending to pay the bills cause their salary isn't enough. Albeit I'm from a state with horrible pay for teachers...

 

[Lucca]

Just curious but what areas pay well for teachers? The ones I know work 50+ hours a week during the year. Then during their two months off they get a part-time job bartending to pay the bills cause their salary isn't enough. Albeit I'm from a state with horrible pay for teachers...

2020 Best Places to Teach in America

Top 100 school districts to teach at based on teacher salary, district ranking, teacher turnover, and more.

www.niche.com

 

[Dantes]

2020 Best Places to Teach in America

Top 100 school districts to teach at based on teacher salary, district ranking, teacher turnover, and more.

www.niche.com

Right but just like any field the top positions are the most coveted and thus the most competitive. I don't think teaching is the way to a good/easy living. In general it's a pretty tough gig. Agree with the rest of your post though.

 

[Med Ed]

It's important to teach med students HOW TO ASK THE RIGHT QUESTIONS --> find answers rather than teaching students facts to memorize. If medical education can somehow eliminate all the non-essential facts and incorporate more critical thinking, I think it is possible to add some interesting/probably more important things like healthcare economics.

Central dogma of 21st century medical education:

Not on Step 1 = DGAF.

 

[907914]

Central dogma of 21st century medical education:

Not on Step 1 = DGAF.

If students do well in preclinical classes, does that directly correlate to performance on step 1?

 

[Kardio]

If students do well in preclinical classes, does that directly correlate to performance on step 1?

Uh oh. I think this is actually a big point of contention between program directors, faculty, and students right now (re: Step 1 going Pass/Fail).

What I got out of reading the "Step 1 Pass/Fail" thread on this issue is:
1. Faculty are irritated that students basically ignore anything they say that isn't Step-applicable. It's the med school version of raising your hand and asking "is this going to be on the test?" I imagine they feel like the coursework and involvement in medical school will make their students better doctors than spending all their time Step prepping.
2. Students generally want a way to distinguish themself in residency applications - and program directors want ways to stratify applicants. The majority of students are upset that, should Step go pass/fail, the prestige of their medical school will determine which/where they do residency.

 

[907914]

the prestige of their medical school will determine which/where they do residency.

This may come off as pretentious of me, but so what...? Isn’t this why we try so hard in undergrad, is to get to the best medical schools to get the best careers?

 

[Kardio]

This may come off as pretentious of me, but so what...? Isn’t this why we try so hard in undergrad, is to get to the best medical schools to get the best careers?

This is all just my opinion:
1. Meritocratic principles shouldn't end at any point in life. It breeds complacenency in people who are already accomplished and hampers ambition in those who aren't.
2. In medical school, GradPLUS loans put all medical students on level economic footing (which isn't the case for undergrad). Everyone's got all the resources they could ever ask for (many for the first time in their life). The differences in performance will boil down closer to work ethic and aptitude than ever before.
3. Students at elite school have a (generally speaking, well-earned) advantage in residency applications already.

 

[993444]

2. In medical school, GradPLUS loans put all medical students on level economic footing.

Completely disagree. The COA allowances of some schools are barely enough to get by. And there is always something to be said about convenience. Sure, you can get through med school using the COA by living 5 miles away and taking the bus. Meanwhile, your classmate's daddy wrote a check to lease him a $2500/mo apartment right by the school along with a BMW3 right off the lot.

 

[AnatomyGrey12]

This may come off as pretentious of me, but so what...? Isn’t this why we try so hard in undergrad, is to get to the best medical schools to get the best careers?

Lol.

Perhaps because my residency prospects should be based on, oh you know, things related to my aptitude with medicine instead of me not knowing I wanted to do medicine as an 18 yo and having a bad gpa for a few semesters?

There are some people at my DO school that are simply gifted at medicine. Crushed class, crushed boards, currently getting absolutely doted on by clinical faculty because they are fantastic on the wards. Should these people be even MORE limited in their career aspirations than they are currently as a DO purely because 12 years ago they got a semester of Fs at a community college where they didn’t quite have their act together?

Yeah I don’t think so either.

 

[VA Hopeful Dr]

Lol.

Perhaps because my residency prospects should be based on, oh you know, things related to my aptitude with medicine instead of me not knowing I wanted to do medicine as an 18 yo and having a bad gpa for a few semesters?

There are some people at my DO school that are simply gifted at medicine. Crushed class, crushed boards, currently getting absolutely doted on by clinical faculty because they are fantastic on the wards. Should these people be even MORE limited in their career aspirations than they are currently as a DO purely because 12 years ago they got a semester of Fs at a community college where they didn’t quite have their act together?

Yeah I don’t think so either.

Devil's advocate, but you could make a similar argument for any part of medical education. There was a woman in my class who kicked ass all 4 years, as you say one of those people just made for medicine. But, her husband left her 2 weeks before Step 1 so her score was not what it likely should have been. Seems even more unfair to her than someone who didn't have their act together in college, no?

Or heck, me. My father died unexpectedly a few weeks before I started medical school so my first year grades sucked. Everything after that went fairly well (and I'm quite happy with where I'm at in life), but had I wanted to do something really competitive I'd have been screwed.

 

[Chibucks15]

Devil's advocate, but you could make a similar argument for any part of medical education. There was a woman in my class who kicked ass all 4 years, as you say one of those people just made for medicine. But, her husband left her 2 weeks before Step 1 so her score was not what it likely should have been. Seems even more unfair to her than someone who didn't have their act together in college, no?

Or heck, me. My father died unexpectedly a few weeks before I started medical school so my first year grades sucked. Everything after that went fairly well (and I'm quite happy with where I'm at in life), but had I wanted to do something really competitive I'd have been screwed.

Not to sound callous and I’m glad everyone ended up okay in the end, but those are the type of things that can happen to anyone in any walk of life. My friends appendix blew up 4 days before step and he did okay

Having extra money from mom and dad in undergrad to pay for tutors and MCAT prep classes, not having to take on a job during undergrad, are advantages that put the upper class kids at a much more advantageous position.

For the people who know what they want at 18 and work hard and get it, more power to them. But there are also tons of rich kids that get perks that help a lot getting into better schools, and having a system even more predicated on medical school prestige than it already is, is not true meritocracy

 

[AnatomyGrey12]

Devil's advocate, but you could make a similar argument for any part of medical education. There was a woman in my class who kicked ass all 4 years, as you say one of those people just made for medicine. But, her husband left her 2 weeks before Step 1 so her score was not what it likely should have been. Seems even more unfair to her than someone who didn't have their act together in college, no?

Or heck, me. My father died unexpectedly a few weeks before I started medical school so my first year grades sucked. Everything after that went fairly well (and I'm quite happy with where I'm at in life), but had I wanted to do something really competitive I'd have been screwed.

But did they get the career they want? Did you? Was your/her career significantly altered forever because of that? You are saying you did and no it wasn't significantly altered so I'm not really seeing the argument here. Also you unwittingly highlight the beauty of a scored Step in your last sentence.... Oh you had a rough first year with grades? Doesn't matter, bust hard second year and get a solid Step score and boom, you're back to being competitive. And as I have pointed out numerous times, Step really isn't the end all be all for residency apps that neurotic med students make it out to be. A lower score doesn't really screw you over the way people on SDN like to act.

 

[VA Hopeful Dr]

Not to sound callous and I’m glad everyone ended up okay in the end, but those are the type of things that can happen to anyone in any walk of life. My friends appendix blew up 4 days before step and he did okay

Having extra money from mom and dad in undergrad to pay for tutors and MCAT prep classes, not having to take on a job during undergrad, are advantages that put the upper class kids at a much more advantageous position.

For the people who know what they want at 18 and work hard and get it, more power to them. But there are also tons of rich kids that get perks that help a lot getting into better schools, and having a system even more predicated on medical school prestige than it already is, is not true meritocracy

Not sure your spouse leaving you is anywhere in the same ballpark as getting your appendix out.

That aside, you're making my point. There's a world of difference between bad things at inopportune times and screwing up in undergrad because you're not taking school seriously.

I'm not sure there is any way to take out the advantages that upper class children.

 

[AnatomyGrey12]

I'm not sure there is any way to take out the advantages that upper class children.

I don't think anyone is arguing that. People who get into top schools already get a lot of perks, and they earned those. I won't say that they didn't. I just think its wrong to push it to the point to where the people at lower tier schools can't rise up the ladder because they succeeded in medical school, while people at top schools can then just ride that prestige train straight into the residency they want without having to do anything but the bare minimum to pass Step 1.

 

[Chibucks15]

Not sure your spouse leaving you is anywhere in the same ballpark as getting your appendix out.

That aside, you're making my point. There's a world of difference between bad things at inopportune times and screwing up in undergrad because you're not taking school seriously.

I'm not sure there is any way to take out the advantages that upper class children.

I was relating it back to being sick not the spouse leaving. I’m not I know there isn’t a way to eliminate advantages. But if S1 goes P/F, any level playing field we have is gone. Just because someone knows they want medicine since age 15 doesn’t mean they should be able to ride that all the way through

 

[AnatomyGrey12]

Just because someone knows they want medicine since age 15 doesn’t mean they should be able to ride that all the way through

Exactly. You effectively are capping someone's potential in medicine based on factors that have nothing to do with anything they've done in medicine. At least now there is an opportunity to level the playing field somewhat and exhibit growth. It's the only standardized thing on any application.

 

[VA Hopeful Dr]

But did they get the career they want? Did you? Was your/her career significantly altered forever because of that? You are saying you did and no it wasn't significantly altered so I'm not really seeing the argument here. Also you unwittingly highlight the beauty of a scored Step in your last sentence.... Oh you had a rough first year with grades? Doesn't matter, bust hard second year and get a solid Step score and boom, you're back to being competitive. And as I have pointed out numerous times, Step really isn't the end all be all for residency apps that neurotic med students make it out to be. A lower score doesn't really screw you over the way people on SDN like to act.

I don't have a strong opinion about P/F Step 1 (I'm leaning towards not changing it, but if they did change it I wouldn't be outraged).

That aside, you clearly didn't read my last part:

but had I wanted to do something really competitive I'd have been screwed.

I came into med school wanting to do FM (which I'm doing), and as a USMD grad from 2010 I'd have had to try pretty hard to NOT achieve that goal. But as I said, had I wanted to do something competitive there's no way that would have happened barring just a crazy Step 1 score.

My point in all of this is that everything in medical education is taken into account for residency matching - what school you attend, grades, Step score, and so on. I personally think this is a good system overall. If you screw up in undergrad and end up at a less than stellar school, you can make up loss ground with grades, Step score, LOR, good interview skills, etc.

That's all I was getting at in responding to your original post the way I did - **** happens to lots of people whether its not taking freshman year biology seriously or getting an RA diagnosis midway through 3rd year (also happened in my class, we were an unlucky bunch). There's nothing special about the former case (ie. the scenario you posted).

 

[AnatomyGrey12]

That aside, you clearly didn't read my last part:

I came into med school wanting to do FM (which I'm doing), and as a USMD grad from 2010 I'd have had to try pretty hard to NOT achieve that goal. But as I said, had I wanted to do something competitive there's no way that would have happened barring just a crazy Step 1 score.

No, clearly you didn’t read mine. That’s what I was addressing. Unless you were in the bottom quartile at your school then some bad grades would most definitely not precluded you from a competitive specialty.... and no you wouldn’t need some insane Step score. Just a solid score (240+), an improvement in grades year 2, and other things needed for a competitive app for those fields like research.

I don’t know how long you’ve been practicing for, and maybe it was like you describe when you were in school I don’t know, but it’s not like that anymore. Pre-clinical grades won’t be the deciding factor in an app to pretty much any field assuming everything else is in order.

My point in all of this is that everything in medical education is taken into account for residency matching - what school you attend, grades, Step score, and so on.

I agree. Removing Step is removing the ONLY standardized element in that list, and would distribute more weight onto the other items.

you screw up in undergrad and end up at a less than stellar school, you can make up loss ground with grades, Step score, LOR, good interview skills, etc.

I agree, and Step is a big part of that. This is why I like the current system. Is it without flaws? No, but it allows for the most opportunity for the most amount of people.

I personally think this is a good system overall.

We are in agreement then.

 

[VA Hopeful Dr]

No, clearly you didn’t read mine. That’s what I was addressing. Unless you were in the bottom quartile at your school then some bad grades would most definitely not precluded you from a competitive specialty.... and no you wouldn’t need some insane Step score. Just a solid score (240+), an improvement in grades year 2, and other things needed for a competitive app for those fields like research.

I don’t know how long you’ve been practicing for, and maybe it was like you describe when you were in school I don’t know, but it’s not like that anymore. Pre-clinical grades won’t be the deciding factor in an app to pretty much any field assuming everything else is in order.


I agree. Removing Step is removing the ONLY standardized element in that list, and would distribute more weight onto the other items.


I agree, and Step is a big part of that. This is why I like the current system. Is it without flaws? No, but it allows for the most opportunity for the most amount of people.


We are in agreement then.

Yes, it was. Average Step 1 scores were 10-15 points lower to match back then. A 230 was the mean for dermatology matching back then (a 240 was a great score, not just a "solid" one. Solid was 230s). You're also making lots of assumptions in that first paragraph beyond the Step part as well.

But if you want to continue showing your impressive ignorance about all of this, don't let me get in your way.

 

[907914]

Yes, it was. Average Step 1 scores were 10-15 points lower to match back then. A 230 was the mean for dermatology matching back then (a 240 was a great score, not just a "solid" one. Solid was 230s). You're also making lots of assumptions in that first paragraph beyond the Step part as well.

But if you want to continue showing your impressive ignorance about all of this, don't let me get in your way.

If PDs have been able to stratify by Step scores/select based off of step scores (obviously there are innumerable factors beyond step as well) why do you think it is just in the last 5-10 years that the climb in average step score has surged?

My best guess as an outside observing premed is that once step 1 specific resources became widely available, students latched on to them, fueled hyper competitiveness, drove up the scores, increased the number of programs students lost on (ERAS?) and it was more or less a self induced problem? Am I missing something?

 

[Chibucks15]

If PDs have been able to stratify by Step scores/select based off of step scores (obviously there are innumerable factors beyond step as well) why do you think it is just in the last 5-10 years that the climb in average step score has surged?

My best guess as an outside observing premed is that once step 1 specific resources became widely available, students latched on to them, fueled hyper competitiveness, drove up the scores, increased the number of programs students lost on (ERAS?) and it was more or less a self induced problem? Am I missing something?

Nope. It was the wonders of the smartphone and sheer number and quality of resources exploding. Not to mention everything is seemingly more hyper competitive now

 

[907914]

Nope. It was the wonders of the smartphone and sheer number and quality of resources exploding. Not to mention everything is seemingly more hyper competitive now

So...it was self induced? Doctors did just fine for 60 years without the resources available to MD students today - it was not until these specific resources became available that ‘we’ started to use them to compete? Am I missing something?

 

[Chibucks15]

So...it was self induced? Doctors did just fine for 60 years without the resources available to MD students today - it was not until these specific resources became available that ‘we’ started to use them to compete? Am I missing something?

Also due to expanding number of applicants for residency slots, relative ease in applying everywhere (compared to the 'old' days), and additional time constraints put on practicing clinicians/PDs. People ain't got the time to go through 50+ applications for 1 slot and not have some sort of shortcut

 

[907914]

Also due to expanding number of applicants for residency slots, relative ease in applying everywhere (compared to the 'old' days), and additional time constraints put on practicing clinicians/PDs. People ain't got the time to go through 50+ applications for 1 slot and not have some sort of shortcut

Right, that is all what I said lol glad I am on the same page. Thought I was making some wild leaps.

 

[AnatomyGrey12]

Yes, it was. Average Step 1 scores were 10-15 points lower to match back then. A 230 was the mean for dermatology matching back then (a 240 was a great score, not just a "solid" one. Solid was 230s). You're also making lots of assumptions in that first paragraph beyond the Step part as well.

But if you want to continue showing your impressive ignorance about all of this, don't let me get in your way.

So.... no actual rebuttal to the point of my post

If PDs have been able to stratify by Step scores/select based off of step scores (obviously there are innumerable factors beyond step as well) why do you think it is just in the last 5-10 years that the climb in average step score has surged?

My best guess as an outside observing premed is that once step 1 specific resources became widely available, students latched on to them, fueled hyper competitiveness, drove up the scores, increased the number of programs students lost on (ERAS?) and it was more or less a self induced problem? Am I missing something?

It's not Step 1 being scored that is the problem. It's in many ways the same phenomena that you see where 10ish years ago the average MCAT at Harvard was a 33.

 

[Goro]

If students do well in preclinical classes, does that directly correlate to performance on step 1?

Yup, sure does.

 

[907914]

Yup, sure does.

So, if one is a student who does very well in classdo they even need this whole "anki is lyfe" mindset?

shouldn't we work on standardizing medical education so that everyone gets the same baseline education and then simply test that baseline education? Then the individual resources available at each school will be what allows students to stand apart.

 

[Goro]

1) So, if one is a student who does very well in class do they even need this whole "anki is lyfe" mindset?

2) shouldn't we work on standardizing medical education so that everyone gets the same baseline education and then simply test that baseline education? Then the individual resources available at each school will be what allows students to stand apart.

1) Totally depends upon the student. Maybe it's Anki that's helping them do so well? The best students use multiple resources

2) There are some 190 medical schools in the US. Do you really think that you're going to get, say, 380+ Anatomy faculty to agree on a single unified curriculum???

I remember a story told to me by a dear friend on faculty in the IU system. The eight centers had eight (eight mind you) Faculty members in a single discipline. They agreed to come up with a statewide discipline exam set for their M1s.

80% of the material was identical, but 20% was left to the discretion of the professors.

So even a mere eight people couldn't agree on what was important or not.

My Pathology colleagues fight each other tooth and nail over what's important.

 

[907914]

1) Totally depends upon the student. Maybe it's Anki that's helping them do so well? The best students use multiple resources

2) There are some 190 medical schools in the US. Do you really think that you're going to get, say, 380+ Anatomy faculty to agree on a single unified curriculum???

I remember a story told to me by a dear friend on faculty in the IU system. The eight centers had eight (eight mind you) Faculty members in a single discipline. They agreed to come up with a statewide discipline exam set for their M1s.

80% of the material was identical, but 20% was left to the discretion of the professors.

So even a mere eight people couldn't agree on what was important or not.

My Pathology colleagues fight each other tooth and nail over what's important.

So then how does USMLE or ACGME or whoever determine what is important for their tests?

 

[AnatomyGrey12]

shouldn't we work on standardizing medical education so that everyone gets the same baseline education

It would be nice if every school used NBME subject exams instead of PhD written tests but medical education already is largely standardized in many ways.

and then simply test that baseline education?

Congratulations, you've effectively described Step 1.

Then the individual resources available at each school will be what allows students to stand apart.

Already happens.

Literally nothing you've discussed is novel, or not currently happening in some way or another.

So, if one is a student who does very well in classdo they even need this whole "anki is lyfe" mindset?

People do very well just going to class and focusing on class materials, and others only do anki and pre-made videos like BnB. Everyone has to find the way they learn best. Anki is a learning tool, and an exceptionally strong one at that for most people, but you don't need it to succeed. I can tell by the way you put that in quotes that you have a pre-formed opinion on Anki and the people who use it. It comes across pretty pretentious and extremely ignorant seeing as it's coming from a pre-med.

 

[Sephirakra]

So.... no actual rebuttal to the point of my post

Other than "I'm right and you're wrong," what was the point of your post?

 

[907914]

pre-formed opinion on Anki and the people who use it

I apologize for how that came across - I am not intending to judge the people, the strategy or the tool. I know I personally will never use it as I am not a cram/memorize type of person (if that is too my detriment then so be it). It does appear to be a very very useful strategy for Step 1 studying. As a more serious inquiry from a confused premed, does being more prepared for step 1 correlate to more prepared for the clerkship years? Like, does this kind of strategy produce a better doctor?

 

[AnatomyGrey12]

I know I personally will never use it as I am not a cram/memorize type of person (if that is too my detriment then so be it).

That's the point of Anki actually.... to avoid cramming. As far as memorization, you will have to memorize. If you "aren't a memorize" type person then medical school will be difficult as a lot of info (perhaps even most honestly) is pure memorization of small details, pathways, receptor type, etc. Ironically I came in skeptical of anki like you, and then converted when I saw how much better I was retaining info when I used it. Whether you use anki or not you will be memorizing things the whole way through training. Even clinically memorization is vital, can't know what the components are of Ranson's Criteria are and what it's utility is when pimped by an attending if you haven't memorized it.

It does appear to be a very very useful strategy for Step 1 studying.

Spaced repetition is something every person who excels in class or Step does whether or not they use anki. It might be in the form of focusing on class and doing 15k practice questions, or it might be anki, but make no mistake you will be doing it if you want to succeed. I will add anki is simply a useful tool in any situation. Many classmates made their own cards from class PPs and did extremely well, so don't think it's just a step 1 thing.

As a more serious inquiry from a confused premed, does being more prepared for step 1 correlate to more prepared for the clerkship years? Like, does this kind of strategy produce a better doctor?

On average people with higher scores are better on the wards. Good students will always be good students. Contrary to common belief, Step 1 is actually full to the brim with clinically relevant information. I've literally been pimped bedside by multiple attendings on concepts that were on my exam. So yes, studying for step 1 does actually make someone more prepared for clerkships.

Other than "I'm right and you're wrong," what was the point of your post?

Serious question, do you have anything valuable to add to the discussion? Or are you just jumping in from the sidelines to make asinine comments?

 

[oil_rig]

Sure, but there is a lot of potential in startups to change how we do basic things. How is AI, machine learning, blockchain etc. all going to affect how medicine is practiced?
How important is health admins vs. doctors in delivery of care today?
Doctor's have no power in where the trajectory of medicine is going because they just keep their heads down.

Boy oh boy if you spent some time in the thick of things of an actual coding/mgmt consulting job, you'll quickly realize how unsexy those careers can become. Most consultants are hired to support management's already-made decisions with "research and data-driven analysis" pulled out of thin air to put up a front that due diligence was done by management. Most programmers are writing very low-impact code in massive code-bases and not revolutionizing anything with 'AI/machine learning/etc.' Btw absolutely not slighting the people who do any of these jobs (they're usually great) as I respect any hustle. Just know that making a widget or spending time in repeated "meetings" where nothing is ever actually accomplished is not as glorious as you may be imagining....

 

[Sephirakra]

Serious question, do you have anything valuable to add to the discussion? Or are you just jumping in from the sidelines to make asinine comments?

I am being serious: what was the point of your post? I read it and the handful preceding it a few times and, other than being dismissive of VA Hopeful Dr for being old or something, I couldn't really find much you were adding to the discussion.

 

[AnatomyGrey12]

I am being serious: what was the point of your post? I read it and the handful preceding it a few times and, other than being dismissive of VA Hopeful Dr for being old or something, I couldn't really find much you were adding to the discussion.

I wasn't dismissive of him being old... I was being serious. Maybe grades meant more when he was in school, I really don't know because I don't know him or how old he is, but nowadays things aren't that way anymore if they were that way when he was in school. I legit said that because I don't know if he's an attending of 1 year or been in practice for 25. Things might have been different for him.

I suggest reading my comments again.. the entire point seems to have been missed.

 

[Goro]

So then how does USMLE or ACGME or whoever determine what is important for their tests?

All I can give insight on is for NBOME. Faculty are requested to write items based upon their blueprints and rules.
Submitted items are then reviewed by a panel of Faculty. The quality of their criticism varies greatly. I had one guy whine about how a particular disease name I used was also known as Xosis.

Except Xosis was an obsolete term and hadn't been seen in Pubmed for 20 years. Reviewer must have been an elderly doc.

NBOME has an entire series of domains based upon complaint, and physician task that students are expect to master, such as "chronic cough".

I know NBME has a massive bank that is fully vetted and items have data to back them up that students perform well on them.

 

[AnatomyGrey12]

All I can give insight on is for NBOME. Faculty are requested to write items based upon their blueprints and rules.
Submitted items are then reviewed by a panel of Faculty. The quality of their criticism varies greatly. I had one guy whine about how a particular disease name I used was also known as Xosis.

Except Xosis was an obsolete term and hadn't been seen in Pubmed for 20 years. Reviewer must have been an elderly doc.

Now I understand why some antiquated terms showed up on a few of the COMSAEs lol.

 

[Med Ed]

My best guess as an outside observing premed is that once step 1 specific resources became widely available, students latched on to them, fueled hyper competitiveness, drove up the scores, increased the number of programs students lost on (ERAS?) and it was more or less a self induced problem? Am I missing something?

Step 1-specific resources predate this mania by many years. UWorld is 16 years old, Kaplan Qbank existed before that. Prior to that there were physical question books. Before Sketchy there was Clinical Microbiology Made Ridiculously Simple. Before Pathoma there was Baby Robbins. The first edition of First Aid came out 29 years ago. Obviously the number of resources, and their relative sophistication, has increased, but I do not think that alone explains this phenomenon.

Rather, this seems to have a number of drivers:
- Fear that residency competition is increasing as the number of AMGs increases
- Over-application due to said fear
- Program directors over-relying on Step 1 filters to narrow excessively large applicant pools due to said over-application
- Students responding to Step 1 filters by focusing ever-increasing amounts of energy on maximizing Step 1 scores
- Widespread adoption of P/F preclinical curricula and diminished practice of ranking students
- Widespread adoption of NBME exams rather than faculty-authored exams
- Amplification of the feedback loop by social media

It's quite the horror show.

 

[Sephirakra]

I wasn't dismissive of him being old... I was being serious. Maybe grades meant more when he was in school, I really don't know because I don't know him or how old he is, but nowadays things aren't that way anymore if they were that way when he was in school. I legit said that because I don't know if he's an attending of 1 year or been in practice for 25. Things might have been different for him.

I suggest reading my comments again.. the entire point seems to have been missed.

Please excuse my confusion then, as you quoted a post of his in which he said he was a 2010 MD grad.

 

[907914]

Step 1-specific resources predate this mania by many years. UWorld is 16 years old, Kaplan Qbank existed before that. Prior to that there were physical question books. Before Sketchy there was Clinical Microbiology Made Ridiculously Simple. Before Pathoma there was Baby Robbins. The first edition of First Aid came out 29 years ago. Obviously the number of resources, and their relative sophistication, has increased, but I do not think that alone explains this phenomenon.

Rather, this seems to have a number of drivers:
- Fear that residency competition is increasing as the number of AMGs increases
- Over-application due to said fear
- Program directors over-relying on Step 1 filters to narrow excessively large applicant pools due to said over-application
- Students responding to Step 1 filters by focusing ever-increasing amounts of energy on Step 1
- Widespread adoption of P/F preclinical curricula and diminished practice of ranking students
- Widespread adoption of NBME exams rather than faculty-authored exams
- Amplification of the feedback loop by social media

It's quite the horror show.

So rather than P/F step exams, could we just cap residency applications? The data show that there are diminishing returns on likelihood of matching into a specialty beyond a certain number...so let’s just cap it?

 

[Med Ed]

So rather than P/F step exams, could we just cap residency applications? The data show that there are diminishing returns on likelihood of matching into a specialty beyond a certain number...so let’s just cap it?

The NRMP would get sued in under 5 seconds.

Dr. Carmody has a nice summary of the options here.

 

[Med Ed]

Please excuse my confusion then, as you quoted a post of his in which he said he was a 2010 MD grad.

It's the usual affliction. If you haven't taken Step 1 then your opinion is irrelevant because you lack firsthand experience. If you took Step 1 in the past then your opinion is irrelevant because times have changed and you're out of touch.

 

[VA Hopeful Dr]

So.... no actual rebuttal to the point of my post

I have no idea which of your points I didn't address. But we do seem to be drifting afield from my original point which boils down to this:

There are many problems that can crop up that can derail a medical career that are at least as valid as your original point of someone screwing around in undergrad and so not getting into a great medical school. I feel reasonably certain that a Step 1 failure or repeating a year are far worse for your residency chances than attending a DO school. Now I could be wrong as things have changed since I went through all this 10 years ago, but back then those things were huge red flags while attending a DO school was not (or at least less of one).

 

[VA Hopeful Dr]

It's the usual affliction. If you haven't taken Step 1 then your opinion is irrelevant because you lack firsthand experience. If you took Step 1 in the past then your opinion is irrelevant because times have changed and you're out of touch.

Every so often we get some of the senior admin folks post in the attending-only section asking us to try and post more here and the general residency forum. And every time they ask the majority bring up stuff like that as to why they don't.

 

[Select All That Apply]

Boy oh boy if you spent some time in the thick of things of an actual coding/mgmt consulting job, you'll quickly realize how unsexy those careers can become. Most consultants are hired to support management's already-made decisions with "research and data-driven analysis" pulled out of thin air to put up a front that due diligence was done by management. Most programmers are writing very low-impact code in massive code-bases and not revolutionizing anything with 'AI/machine learning/etc.' Btw absolutely not slighting the people who do any of these jobs (they're usually great) as I respect any hustle. Just know that making a widget or spending time in repeated "meetings" where nothing is ever actually accomplished is not as glorious as you may be imagining....

As a physician you can practice clinical medicine and you can also practice programming when you're home. Practically all the information has become open source with online resources like Udemy, Coursera, or even videos on YouTube. The same is not true of a programmer, they cannot practice clinical medicine within a practical setting. There are few reasons why someone who codes for a living would look at resources like B&B or Najeeb, however there are many reasons why someone who works as a physician would be interested in setting up a website, be interested in analytics, or enrich themselves by solving a coding challenge.

I feel that there is more of an agnostic attitude with computer programming in terms of input/output when it comes to intrinsic valuation of the work done. When a physician approaches a patient case and attempts to solve it through their personal experience set, there is a deep visceral impact from either achieving or failing to achieve patient outcomes that enable the physician to incorporate that feedback and improve their process. When someone is using Slack and they fail to achieve a ticket, it is still a learning moment if they fail to achieve a ticket, however there is no deep visceral impact on the output. A more senior dev will likely take over the ticket and point out areas that you failed to assess, but this failure will not result in a code blue or for the code to quickly progress into sepsis.

Computer programming camps that teach front-end programming sets e.g. html & CSS markup with javascript still use Wordpress to host their websites. Why? Because it's a convenient resource that works. Even if there is a company working extensively on utilizing Python as a back-end for SEO optimization, the company is still likely using Google Analytics to give them feedback on their current operations. I would like to think that there is less of an agnostic approach to medicine because it is possible that every step matters, especially when it comes to a work up or a rule out of certain conditions.

// In my humble and unqualified opinion.

 

[nimbus]

Is this thread is about making excuses for bad performance? It does not look good. Hopefully people aren't doing this in real life.

Guess what? People die, people break up, and people get sick. It happens to EVERYBODY.

 

[Select All That Apply]

is this thread is about making excuses for bad performance? It does not look good. Hopefully people aren't aren't this in real life. Guess what, people die, people break up, and people get sick. It happens to EVERYBODY.

With respect to what post?