MD medical education is not fit for 21st century

[libertyyne]

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...

Have you never seen a hypotensive, febrile , tachycardic man who gets iv abx and fluids and gets dc-ed 5 days after admission ? What do you think is going on there if not saving a life. Are you rotating with chiropractors ?

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[AnatomyGrey12]

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.

We weren't really talking about Step 1 being P/F because we agree on that. Apparently we were talking past each other. But yes, people who have yet to start medical school or are in their first week don't really have a relevant opinion.

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).

But it's not. One person performed exceptionally well in medical school but as a dumb teenager made some dumb academic decisions. 10+ years later when that person has a 250/10+ pubs/4.0 GPA I don't think they should be punished further than the current headaches they have to deal with as a DO. One person had unforeseeable life events. I don't really see it the same. I definitely agree with your point in the second paragraph, in many ways we are saying the same thing. Being a DO is not a death sentence for anything, however being a DO in a world where Step 1 is P/F then yeah you are effectively screwed for not only different fields, but the quality of programs open to you in even some of the less competitive ones. This is my point, and honestly we are more in agreement than disagreement.

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.

I legit didn't see you say you were a 2010 grad. I wasn't just being a dick.

 

[VincentAdultman]

I guess the OP is long gone

 

[MedicineZ0Z]

My mistake. I think my point still holds because anyone who went to a decent undergrad probably has friends who have done comp sci and are doing well.
If medical education is doing a good job, why is it that 30% (I will find the paper in a sec) of MS4 would have never done med school now v 7% or so back in 2006?

Well doctors make a lot more now than in 2006 Ironic huh...

 

[gyngyn]

Let's remember to remain civil even as we disagree.

 

[efle]

Re: what's driving the changes in preclinical studying

I think the rise of the semi-standardized "UFAPS" as an alternative curriculum deserves a lot more credit. You now have a clearly delineated body of stuff to master, and you know everyone else is studying this same exact set of resources. Add into this anki, the perfect spaced repetition tool for converting more study hours directly into more high-yield facts memorized, and you've got the perfect storm.

It really feels like an arms race. It's one big competition to see who can grind the hardest to know he closest to 100% of UFAPS. That, I think, is what's driving the whole "step vs wellness" component of the debate. People can be passing their classes fine and be 6+ months away from dedicated, and yet still be plagued every day by a constant sense of study-guilt because they're behind on their anki reviews. There's a pervading sense that if you aren't studying UFAPS on a daily basis, you're falling behind, and I don't think that was the case 5-10 years ago, even with Uworld and First Aid already popular.

 

[premed9901]

Re: what's driving the changes in preclinical studying

I think the rise of the semi-standardized "UFAPS" as an alternative curriculum deserves a lot more credit. You now have a clearly delineated body of stuff to master, and you know everyone else is studying this same exact set of resources. Add into this anki, the perfect spaced repetition tool for converting more study hours directly into more high-yield facts memorized, and you've got the perfect storm.

It really feels like an arms race. It's one big competition to see who can grind the hardest to know he closest to 100% of UFAPS. That, I think, is what's driving the whole "step vs wellness" component of the debate. People can be passing their classes fine and be 6+ months away from dedicated, and yet still be plagued every day by a constant sense of study-guilt because they're behind on their anki reviews. There's a pervading sense that if you aren't studying UFAPS on a daily basis, you're falling behind, and I don't think that was the case 5-10 years ago, even with Uworld and First Aid already popular.

I vastly prefer the grind to taking a research year, because that is what pass/fail step will cause for students at lower-tier schools that want to match a competitive specialty. That would completely obliterate the 200k advantage I got choosing a cheaper, yet less prestigious, school.

 

[Thesimplelifeofamyloid]

Re: what's driving the changes in preclinical studying

I think the rise of the semi-standardized "UFAPS" as an alternative curriculum deserves a lot more credit. You now have a clearly delineated body of stuff to master, and you know everyone else is studying this same exact set of resources. Add into this anki, the perfect spaced repetition tool for converting more study hours directly into more high-yield facts memorized, and you've got the perfect storm.

It really feels like an arms race. It's one big competition to see who can grind the hardest to know he closest to 100% of UFAPS. That, I think, is what's driving the whole "step vs wellness" component of the debate. People can be passing their classes fine and be 6+ months away from dedicated, and yet still be plagued every day by a constant sense of study-guilt because they're behind on their anki reviews. There's a pervading sense that if you aren't studying UFAPS on a daily basis, you're falling behind, and I don't think that was the case 5-10 years ago, even with Uworld and First Aid already popular.

One thing you fail to mention the fact that things like BnB and pathoma on average are higher quality resources then most lectures. UFAPs/ANKI doesn't make the average student's life harder. What makes our lives harder is constantly sifting through poor PowerPoint materials from 2006, figuring what's relevant to me in the current moment. I also hate the argument that lectures teach clinically relevant information. Just because something is CLINICAL doesn't mean it's RELEVANT to the current moment. Ultimately, the explosion of medical knowledge has made the traditional lecture system seen in medical schools ineffective/outdated. Simply put, it's the school's failure to adapt that makes our lives harder.

 

[efle]

One thing you fail to mention the fact that things like BnB and pathoma on average are higher quality resources then most lectures. UFAPs/ANKI doesn't make the average student's life harder. What makes our lives harder is constantly sifting through poor PowerPoint materials from 2006, figuring what's relevant to me in the current moment. I also hate the argument that lectures teach clinically relevant information. Just because something is CLINICAL doesn't mean it's RELEVANT to the current moment. Ultimately, the explosion of medical knowledge has made the traditional lecture system seen in medical schools ineffective/outdated. Simply put, it's the school's failure to adapt that makes our lives harder.

I feel like the body of information has remained similar in the last 5-10 years though, I mean Uworld adds occasional small batches of questions but overall has been mostly the same.

It's just that the modern students are doing a better job of knowing it all cold.

Using the NBME18 practice exam as an example, since that's long been considered the best practice test:

In 2016, 90% correct was scaled to a 260
In 2019, 90% correct was scaled to a 248

So for people mastering 90% of the material, there's literally been a 10+ point drift in the last 3 years.

The contents of that practice test didn't change. It's just that we're throwing far, far more hours into UFAPS/anki across a year or more before even reaching dedicated and getting a much higher percentage of questions correct.

 

[Thesimplelifeofamyloid]

I feel like the body of information has remained similar in the last 5-10 years though, I mean Uworld adds occasional small batches of questions but overall has been mostly the same.

It's just that the modern students are doing a better job of knowing it all cold.

Using the NBME18 practice exam as an example, since that's long been considered the best practice test:

In 2016, 90% correct was scaled to a 260
In 2019, 90% correct was scaled to a 248

So for people mastering 90% of the material, there's literally been a 10+ point drift in the last 3 years.

The contents of that practice test didn't change. It's just that we're throwing far, far more hours into UFAPS/anki across a year or more before even reaching dedicated and getting a much higher percentage of questions correct.

5 years, yes. 15-20 years, no. Compare the 1998 size of first aid to the 2019 version. And I think that difference is inflated because a lot of the Anki decks take concepts right from the NBME's and throw them in there. When you consider that, I think the difference is less stark. You also see that with some of the MCAT prep sources too. I remember within a few years on one of the AAMC practice tests. my score actually went down. As resources improve, scores go up, and that's not unique to step 1.

 

[Aree]

MS4 here reflecting on coming to medical school. The following are just my personal views, so don't attack me if you disagree!
I think that we live in a really exciting time in history where globalization is rapid and there are so many high impact and rewarding careers. But I don't think I've really realized that until fairly recently. I have always had this shadow over me, telling me that medicine is the only way that I can have a rewarding and respected career. Medicine was never a calling for me. Because of how miserable I have been the past 2-3 years in med school, I've taken a lot of time to reflect on why I'm still pursuing this career. At the end of the day, i think the pull for me has always been a socially constructed idea of what it means to have a "good job." Then I realized that these ideas were shaped by assumptions formed so long ago that they're essentially meaningless today.
Anyway, I have friends who studied comp sci, now working at google/microsoft/startups that are doing amazing work that seem not only rewarding on a professional level but actually making a difference in the world. There are also people who have gone into mgmt consulting doing a lot of diverse work/traveling and making career advancements that I feel like would be nearly impossible to achieve from a medical education.
In a way, I guess I feel like medical school/medical degree is good for nothing except for practicing medicine. It's like a certificate of completion, but then you're trapped into committing in additional 4 years to residency and not a lot of room for creativity/career advancement or real impact in the long run.
What do you guys think?

OP idk if you're still around, but I thought this might be helpful: 10 Reasons Why Doctors Make Great Entrepreneurs | The MIT Entrepreneurship Review

As some of the others have pointed out, it is (obviously) true that an MD primarily prepares you for practicing medicine. However, as the piece above points out, many of the skills that are fundamental to being a successful physician are also desirable and hence transferable ones in many other industries. That is why, again as others have pointed out, you can see doctors pretty much everywhere doing all kinds of things. At the end of the day, in today's world it all really boils down to how you market/sell yourself, and imo an MD is a damn marketable degree.

Also, if you still have time, and your school has a top 20-25 MBA program, try to do a combined degree. That can open doors for you. Best of luck.