MS1-2 as a career

[Apoplexy__]

If offered the chance to do MS1-2 as a paid vocation perpetually for the rest of your life, would you take it? You would be paid accordingly:
A's/Honors: $175k/yr
B's/High Pass: $125k/yr
C's/Pass: $100k/yr
Failure: $20k/yr

In this hypothetical thought experiment, the material would change significantly enough that only every 8 years would you repeat information (I know, doesn't make sense). In this way, it would "feel" similar to actually going through MS1-2 repeatedly, with the fire-hydrant style of info feed and lack of familiarity with material.

Going through the pre-clinical years was sucky. But after thinking about it a bit, I realized that the primary sources of my stress at the time were related to pressure to perform for a residency spot. But if we take that pressure away, what's left?

While not contributing to society significantly, you might feel some fulfillment from the intellectual satisfaction. You could publish, volunteer, and teach on the side.

Thoughts?

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[Psai]

wtf...

 

[Apoplexy__]

wtf...

I was bored by all the threads in Allo, so I made an even more boring one.

 

[Jabbed]

I'd do it for double the figures you posted.

 

[repititionition]

If offered the chance to do MS1-2 as a paid vocation perpetually for the rest of your life, would you take it? You would be paid accordingly:
...
Failure: $20k/yr

Thoughts?

"At either end of the income spectrum lies a leisure class..."

 

[Awared]

Probably not. The excitement I get from pre-clinical information is that some day I'll be able to actually use some of it for patient care. I love the clinical correlates we get.

 

[JP2740]

Absolutely. I'd just not show up until exam day, fail it, and collect 20,000 a year. At the same time, I'd be doing another field.

 

[circulus vitios]

If offered the chance to do MS1-2 as a paid vocation perpetually for the rest of your life, would you take it? You would be paid accordingly:
A's/Honors: $175k/yr
B's/High Pass: $125k/yr
C's/Pass: $100k/yr
Failure: $20k/yr

In this hypothetical thought experiment, the material would change significantly enough that only every 8 years would you repeat information (I know, doesn't make sense). In this way, it would "feel" similar to actually going through MS1-2 repeatedly, with the fire-hydrant style of info feed and lack of familiarity with material.

Going through the pre-clinical years was sucky. But after thinking about it a bit, I realized that the primary sources of my stress at the time were related to pressure to perform for a residency spot. But if we take that pressure away, what's left?

While not contributing to society significantly, you might feel some fulfillment from the intellectual satisfaction. You could publish, volunteer, and teach on the side.

Thoughts?

**** no. I'd rather go back to doing manual labor.

 

[Jabbed]

Absolutely. I'd just not show up until exam day, fail it, and collect 20,000 a year. At the same time, I'd be doing another field.

Having done it once, I'd wager that you could get at least a C in med school without studying.

 

[Freddie Mercury]

Definitely. I didn't mind M1-M2 so much (maybe its just the sleep deprived M3 me talking here). Dedicated like 40-50 hours a week to school, had lots of free time. No mandatory class attendance etc, so most of my studying was done in my underwear at home, where I could take breaks whenever I want. I'd be more than happy with 125-175k / year for that kind of lifestyle.

But I wouldn't accept the salaries listed for a perpetual M3 life.

 

[Apoplexy__]

Probably not. The excitement I get from pre-clinical information is that some day I'll be able to actually use some of it for patient care. I love the clinical correlates we get.

I've discussed this idea over drinks with some buddies, and that's what they said too. Ironically, I personally find the intrinsic value of the material more appealing than the clinical application.

But I wouldn't accept the salaries listed for a perpetual M3 life.

Seriously...Personally, my lifestyle as an MS3 is significantly improved, but everything is just so much more annoying and monotonous. Yesterday, I scrubbed into a surgery I did literally nothing but observe for, then had my attending waste my time waiting in a room alone for her for about 30 minutes. She ended my day by having me help her type up e-mails.

 

[Awared]

I've discussed this idea over drinks with some buddies, and that's what they said too. Ironically, I personally find the intrinsic value of the material more appealing than the clinical application.

I think in the end it is just a personal preference and will probably dictate what kind of field you go into, whether it be more research focused or patient based

 

[Psai]

I've discussed this idea over drinks with some buddies, and that's what they said too. Ironically, I personally find the intrinsic value of the material more appealing than the clinical application.



Seriously...Personally, my lifestyle as an MS3 is significantly improved, but everything is just so much more annoying and monotonous. Yesterday, I scrubbed into a surgery I did literally nothing but observe for, then had my attending waste my time waiting in a room alone for her for about 30 minutes. She ended my day by having me help her type up e-mails.

hey if you're lucky you might get to put in a suture or two but only if they have time and if they like you

 

[circulus vitios]

I've discussed this idea over drinks with some buddies, and that's what they said too. Ironically, I personally find the intrinsic value of the material more appealing than the clinical application.



Seriously...Personally, my lifestyle as an MS3 is significantly improved, but everything is just so much more annoying and monotonous. Yesterday, I scrubbed into a surgery I did literally nothing but observe for, then had my attending waste my time waiting in a room alone for her for about 30 minutes. She ended my day by having me help her type up e-mails.

Does that really bother you? I'm only an MS1 but I've had residents and attendings give me busy work while shadowing. I don't care, at least I'm doing something. Better than memorizing for hours on end, even if it is meaningless busy work.

 

[ohioguy]

Does that really bother you? I'm only an MS1 but I've had residents and attendings give me busy work while shadowing. I don't care, at least I'm doing something. Better than memorizing for hours on end, even if it is meaningless busy work.

Paying 40 or so grand in tuition to be someone's bitch and not learn anything...yeah that would bother me.

 

[circulus vitios]

Paying 40 or so grand in tuition to be someone's bitch and not learn anything...yeah that would bother me.

But memorizing minutiae or your professor's research is a good use of your tuition dollars?

 

[Apoplexy__]

Does that really bother you? I'm only an MS1 but I've had residents and attendings give me busy work while shadowing. I don't care, at least I'm doing something. Better than memorizing for hours on end, even if it is meaningless busy work.

Definitely rather memorize for hours on end. At least it's productive for something. Indirectly, even minutely, it ultimately betters you as a residency applicant and future physician.

I think it's the concept that every hour I waste on a rotation is an hour I can spend on studying, working, research...anything else. And I can't control it.

 

[touchpause13]

Nope nope nope nope nope nope

 

[Psai]

But memorizing minutiae or your professor's research is a good use of your tuition dollars?

You're an ms1 with approximately 2 months of medical school under your belt. You have no clue what minutiae is
You need to know details. When people on the wards ask you about some little detail of a disease, are you going to tell them that you don't know what it is because you didn't think it was worth knowing?

 

[circulus vitios]

You're an ms1 with approximately 2 months of medical school under your belt. You have no clue what minutiae is
You need to know details. When people on the wards ask you about some little detail of a disease, are you going to tell them that you don't know what it is because you didn't think it was worth knowing?

"I'll look it up." And then I probably won't look it up because they'll have forgotten about it by tomorrow and no one outside of academics gives a **** about it.

 

[Psai]

"I'll look it up." And then I probably won't look it up because they'll have forgotten about it by tomorrow and no one outside of academics gives a **** about it.

You have no idea what you're talking about
I thought you figured it out when everyone told you that med school and manual labor don't compare and you couldn't stop talking about it
then you come crying about how hard med school is
now you're trying to pretend that none of the stuff you're learning matters

you're going to shocked when it does

 

[circulus vitios]

You have no idea what you're talking about
I thought you figured it out when everyone told you that med school and manual labor don't compare and you couldn't stop talking about it
then you come crying about how hard med school is
now you're trying to pretend that none of the stuff you're learning matters

you're going to shocked when it does

This is categorically false.

#1 Preclinical information is largely irrelevant on the wards. Yes, there is foundation that one needs, but certainly not to the level that is typically required to honor a class.

#2 Doing well in 3rd year typically requires two things. Doing well on the wards and doing well on the shelf. Doing well on the wards has nothing to do with how much knowledge you accumulated in your pre-clinicals. Yes, better students will do better in pre-clinicals and their shelves, but there is a very large component of clinical grades, if not the vast majority that do not depend on minutia or the studying of minutia. This is why clinical grades are far more important than pre-clinical. Because they tell you a lot more about the student.

#3 You can call it a 'myth' all you want. I know many students who honored very few to none of their pre-clinical classes, did well on Step 1 (240+), honored the majority, if not all of their clinical rotations and matched competitively. I can think of 6-7 people off the top of my head at a couple different schools, which is pretty good considering that I never really hung out with or talked about grades with people at school.

#4 The people who were at the top of pre-clinicals can struggle in clinicals. I was pretty good friends with the two curve setters in my class. Both of them struggled in clinicals. They studied a lot harder than most people for their shelves (like they did in their pre-clinicals) and still had a hard time making the cuts in clinicals. Do not misinterpret. I am not saying that top of pre-clinicals = bad at clinicals. I'm saying that they are different animals and to somehow try to connect the two is folly.

.

edit: As an anecdote, I was talking to my clinical preceptor (who is involved in teaching FM residents) about CYP2C9/VKORC1 gene variants and recommended warfarin dosage, something we covered in class. He had no idea what I was talking about and said "we don't use that information in the real world."

 

[Kahreek]

nah

 

[Psai]

He can say that as a resident looking back. You can't say anything as an m1 with barely any experience in medical school. shelf exams depend heavily on the knowledge you accumulate in preclinical and they count in your evaluation. it is difficult to honor in third year even if you honor clinically if you don't do well on the shelf. also clinical grades can be very arbitrary depending on the attendings and residents you work with. these are things you will discover in third year. even if someone else is saying the same thing as you, your words about things outside your experience have absolutely no merit

in regards to his other points, people who did poorly in medical school and poorly on step 1 won't be telling anyone about their experience. if someone did poorly preclinically and did well on step 1, they're more likely to talk about it. it's simple self selection. it may also be a result of where he is doing his residency. low step scores will shut doors, low preclinical grades do not directly do so.

 

[spik]

Where do I sign up for this great career?

 

[spik]

He can say that as a resident looking back. You can't say anything as an m1 with barely any experience in medical school. shelf exams depend heavily on the knowledge you accumulate in preclinical and they count in your evaluation. it is difficult to honor in third year even if you honor clinically if you don't do well on the shelf. also clinical grades can be very arbitrary depending on the attendings and residents you work with. these are things you will discover in third year. even if someone else is saying the same thing as you, your words about things outside your experience have absolutely no merit

in regards to his other points, people who did poorly in medical school and poorly on step 1 won't be telling anyone about their experience. if someone did poorly preclinically and did well on step 1, they're more likely to talk about it. it's simple self selection. it may also be a result of where he is doing his residency. low step scores will shut doors, low preclinical grades do not directly do so.

I agree. Pre-clinical years, especially second year, are vital to one's success on the wards.

 

[circulus vitios]

He can say that as a resident looking back. You can't say anything as an m1 with barely any experience in medical school. shelf exams depend heavily on the knowledge you accumulate in preclinical and they count in your evaluation. it is difficult to honor in third year even if you honor clinically if you don't do well on the shelf. also clinical grades can be very arbitrary depending on the attendings and residents you work with. these are things you will discover in third year. even if someone else is saying the same thing as you, your words about things outside your experience have absolutely no merit

in regards to his other points, people who did poorly in medical school and poorly on step 1 won't be telling anyone about their experience. if someone did poorly preclinically and did well on step 1, they're more likely to talk about it. it's simple self selection. it may also be a result of where he is doing his residency. low step scores will shut doors, low preclinical grades do not directly do so.

You haven't figured out by now that I absolutely do not care about honoring or pursuing competitive specialties or competitive programs? Outside of SDN, there are large numbers of people like me in medical school: students who want to learn medicine, but refuse to slave away for diminishing returns for one reason or another. Somehow they manage to pass Step 1, match somewhere, and become practicing physicians at the conclusion of their residency training.

 

[spik]

Somehow they manage to pass Step 1, match somewhere, and become practicing physicians at the conclusion of their residency training.

Yes, they manage to pass Step 1, match somewhere, and become mediocre physicians. If that's what you want, you are all set!

 

[circulus vitios]

Yes, they manage to pass Step 1, match somewhere, and become mediocre physicians. If that's what you want, you are all set!

The unimaginable horror of mediocrity!

If it was such a terrible level of achievement then maybe the threshold of competency, as determined by passing grades in medical school curriculum and the licensing exams, should be changed.

 

[spik]

The unimaginable horror of mediocrity!

If it was such a terrible level of achievement then maybe the threshold of competency, as determined by passing grades in medical school curriculum and the licensing exams, should be changed.

Maybe they should be changed; passing Steps is really not difficult at all.

 

[Psai]

mediocrity hurts patients. it's not about scoring well on tests or aiming for a competitive field/location. it's about having work ethic and knowing things so that you can provide quality care for your patients. the fact that your only aim is to tiptoe over a low barrier is scary. you have a lot of maturing to do

 

[circulus vitios]

mediocrity hurts patients. it's not about scoring well on tests or aiming for a competitive field/location. it's about having work ethic and knowing things so that you can provide quality care for your patients. the fact that your only aim is to tiptoe over a low barrier is scary. you have a lot of maturing to do

You're assuming that minute details -- the details that often form the strata between pass, high pass, and honors -- are necessarily relevant to clinical practice, or are necessary components of the foundation upon which clinical medicine is built. If I'm passing my classes, then I presumably have (or am forming) the foundation that is necessary to safely practice clinical medicine. It's not a matter of maturation, it's a matter of looking at the benefits of slaving away and destroying my mental sanity to score an extra 5 percentage points on an exam -- cramming small details that in all likelihood will be irrelevant to how I will choose to practice medicine.

 

[Psai]

You're missing the big picture. I've already said that it's not about memorizing the tiny details, not that you would know what will be relevant for your patients. But it's about your attitude towards learning.
I'm not making assumptions about clinical practice. I'm in clinics and on the wards where I actually see patients all the time. Every day shows me how much I've forgotten already and how much I still don't know. It's very humbling and makes me want to work harder to learn and relearn medicine. We earn the title of doctor by sacrificing a lot to learn things for the benefit of others. It's why patients respect us, not because we put in minimum effort to pass a degree program. This is what the people who convert their programs to doctorates to try to get that same amount of respect don't understand. Your attitude is an embarrassment.

 

[circulus vitios]

You're missing the big picture. I've already said that it's not about memorizing the tiny details, not that you would know what will be relevant for your patients. But it's about your attitude towards learning.
I'm not making assumptions about clinical practice. I'm in clinics and on the wards where I actually see patients all the time. Every day shows me how much I've forgotten already and how much I still don't know. It's very humbling and makes me want to work harder to learn and relearn medicine. We earn the title of doctor by sacrificing a lot to learn things for the benefit of others. It's why patients respect us, not because we put in minimum effort to pass a degree program. This is what the people who convert their programs to doctorates to try to get that same amount of respect don't understand. Your attitude is an embarrassment.

Spare me.

 

[Psai]

That's the whole point kid

 

[DermViser]

Spare me.

The information we learn (or what you call minutiae) does benefit others. If you don't like it, why go to med school? Just become a PA.

 

[circulus vitios]

That's the whole point kid

Learning to help people, sure. Sacrificing "a lot?" Hahahaha.

 

[DermViser]

Learning to help people, sure. Sacrificing "a lot?" Hahahaha.

You don't think you're sacrificing a lot going to med school and eventually residency?

 

[spik]

You're assuming that minute details -- the details that often form the strata between pass, high pass, and honors -- are necessarily relevant to clinical practice, or are necessary components of the foundation upon which clinical medicine is built. If I'm passing my classes, then I presumably have (or am forming) the foundation that is necessary to safely practice clinical medicine. It's not a matter of maturation, it's a matter of looking at the benefits of slaving away and destroying my mental sanity to score an extra 5 percentage points on an exam -- cramming small details that in all likelihood will be irrelevant to how I will choose to practice medicine.

As @Psai has noted, the issue here is your attitude towards learning. I am also quite irritated with your complacency with mediocrity. Whatever you do, I hope you will stay far away from where I live or practice.

 

[spik]

Learning to help people, sure. Sacrificing "a lot?" Hahahaha.

You are a complete idiot.

 

[notbobtrustme]

I agree. Pre-clinical years, especially second year, are vital to one's success on the wards.

no it's not. Staying awake in your pharm class and having a rudimentary understanding of pathology is what you really need. You can talk all you want about the factors involved in lung fibrosis (TNF-a and all that jazz), but can you interpret a spirometry report? Likewise, you can know all about how IgG is made in the endoplasmic reticulum, followed by glycosylation in the Golgi apparatus, but can you interpret a Rubella titer of 1:6 in a pregnancy and what to do about this? Knowing what phase of the cardiac myocyte's contraction is governed by what ion channels is great for Step 1, but can you read an echocardiogram worth a damn? And before you talk to me about how anti-arrhymatic therapy can be guided by this knowledge, know that 95% of all problems can be solved by either amiodarone, lidocaine or a beta blocker. We know a bunch of useless facts about warfarin, but we can't even dose warfarin properly. Valuable lecture time is spent on how warfarin inhibits vitamin K epoxide reductase but not what an INR of 6 means and how to approach this problem.

The first two years spend so much time on worthless minutia, but we can't cover the basics of how to approach a patient in septic shock. A new M3 is less than useless when confronted with such a scenario. No one gives a rat's ass that you know LPS stimulates TNF receptors, causing massive vasodilation and shock. That's a worthless factoid that's worth great points on Step 1 but utterly meaningless for patient care.

The first 2 years are hyped up big time by professors who either have zero clinical experience or spent the past 20 years researching a problem of tangential importance to clinical care. That's why a fresh MD graduate is literally worth less than a new NP or PA. The fresh MD can't get a job without a massive government subsidy, otherwise the hospital wouldn't be able to justify the cost of teaching us. That, despite the fact that we spend >2x the time on patient care than a new NP or PA. However, a new NP or PA commands a salary double that of a resident's while working half as much. A fresh MD is literally worth less than 1/4th a new NP or PA. You can put anyone through residency training and have them be as qualified as a physician despite the fact that they will have very little basic science training.

 

[circulus vitios]

You don't think you're sacrificing a lot going to med school and eventually residency?

Absolutely, but I'm minimizing the sacrifice while still meeting the benchmarks of competency, and I aim to continue this trend by choosing a specialty that is conducive to a good lifestyle.

 

[circulus vitios]

The first 2 years are hyped up big time by professors who either have zero clinical experience or spent the past 20 years researching a problem of tangential importance to clinical care. That's why a fresh MD graduate is literally worth less than a new NP or PA. The fresh MD can't get a job without a massive government subsidy, otherwise the hospital wouldn't be able to justify the cost of teaching us. That, despite the fact that we spend >2x the time on patient care than a new NP or PA. However, a new NP or PA commands a salary double that of a resident's while working half as much. A fresh MD is literally worth less than 1/4th a new NP or PA. You can put anyone through residency training and have them be as qualified as a physician despite the fact that they will have very little basic science training.

This x1000. I wish clinicians taught pre-clinical coursework.

 

[spik]

no it's not. Staying awake in your pharm class and having a rudimentary understanding of pathology is what you really need. You can talk all you want about the factors involved in lung fibrosis (TNF-a and all that jazz), but can you interpret a spirometry report? Likewise, you can know all about how IgG is made in the endoplasmic reticulum, followed by glycosylation in the Golgi apparatus, but can you interpret a Rubella titer of 1:6 in a pregnancy and what to do about this? Knowing what phase of the cardiac myocyte's contraction is governed by what ion channels is great for Step 1, but can you read an echocardiogram worth a damn? And before you talk to me about how anti-arrhymatic therapy can be guided by this knowledge, know that 95% of all problems can be solved by either amiodarone, lidocaine or a beta blocker. We know a bunch of useless facts about warfarin, but we can't even dose warfarin properly. Valuable lecture time is spent on how warfarin inhibits vitamin K epoxide reductase but not what an INR of 6 means and how to approach this problem.

The first two years spend so much time on worthless minutia, but we can't cover the basics of how to approach a patient in septic shock. A new M3 is less than useless when confronted with such a scenario. No one gives a rat's ass that you know LPS stimulates TNF receptors, causing massive vasodilation and shock. That's a worthless factoid that's worth great points on Step 1 but utterly meaningless for patient care.

The first 2 years are hyped up big time by professors who either have zero clinical experience or spent the past 20 years researching a problem of tangential importance to clinical care. That's why a fresh MD graduate is literally worth less than a new NP or PA. The fresh MD can't get a job without a massive government subsidy, otherwise the hospital wouldn't be able to justify the cost of teaching us. That, despite the fact that we spend >2x the time on patient care than a new NP or PA. However, a new NP or PA commands a salary double that of a resident's while working half as much. A fresh MD is literally worth less than 1/4th a new NP or PA. You can put anyone through residency training and have them be as qualified as a physician despite the fact that they will have very little basic science training.

I guess it depends on the school. At my school, second year had a strong clinical tilt, and I felt very well prepared for the wards.

 

[spik]

no it's not. Staying awake in your pharm class and having a rudimentary understanding of pathology is what you really need. You can talk all you want about the factors involved in lung fibrosis (TNF-a and all that jazz), but can you interpret a spirometry report? Likewise, you can know all about how IgG is made in the endoplasmic reticulum, followed by glycosylation in the Golgi apparatus, but can you interpret a Rubella titer of 1:6 in a pregnancy and what to do about this? Knowing what phase of the cardiac myocyte's contraction is governed by what ion channels is great for Step 1, but can you read an echocardiogram worth a damn? And before you talk to me about how anti-arrhymatic therapy can be guided by this knowledge, know that 95% of all problems can be solved by either amiodarone, lidocaine or a beta blocker. We know a bunch of useless facts about warfarin, but we can't even dose warfarin properly. Valuable lecture time is spent on how warfarin inhibits vitamin K epoxide reductase but not what an INR of 6 means and how to approach this problem.

The first two years spend so much time on worthless minutia, but we can't cover the basics of how to approach a patient in septic shock. A new M3 is less than useless when confronted with such a scenario. No one gives a rat's ass that you know LPS stimulates TNF receptors, causing massive vasodilation and shock. That's a worthless factoid that's worth great points on Step 1 but utterly meaningless for patient care.

The first 2 years are hyped up big time by professors who either have zero clinical experience or spent the past 20 years researching a problem of tangential importance to clinical care. That's why a fresh MD graduate is literally worth less than a new NP or PA. The fresh MD can't get a job without a massive government subsidy, otherwise the hospital wouldn't be able to justify the cost of teaching us. That, despite the fact that we spend >2x the time on patient care than a new NP or PA. However, a new NP or PA commands a salary double that of a resident's while working half as much. A fresh MD is literally worth less than 1/4th a new NP or PA. You can put anyone through residency training and have them be as qualified as a physician despite the fact that they will have very little basic science training.

Yes I could interpret spirometry report and ECG during my second year. That's what was tested on our exams. I also was taught about the limited utility of anti-arrhythmic medications. I don't see warfarin dosing as a challenge. Your medical school must really suck.

And Step 1 has become clinically oriented in recent years as well. I did not review anatomy or biochemistry at all for Step 1 and did very well.

 

[notbobtrustme]

In fact, the first 2 years puts you in false sense of security.

We all know that DMII is a risk factor for CVD/CAD/atherosclerosis because of glucose toxicity right? So it stands to reason that aggressively treating DMII would reduce the number of complications and improve people's lives. If you said this to any of your pre-clinical professors, they would agree wholeheartedly with you. Glucose toxicity = more CAD/atherosclerosis. Period. Controlling sugars aggressively to be in the normal range (for non-diabetics) would be ideal, right?

Well if you did that, you would be killing patients because that's not what the real clinical evidence is saying.

Getting diabetics to a normal H1AC resulted in more complications and more deaths than a conservative treatment that kept diabetics' A1c's at a diabetic level. The lower your A1c (6.4% vs 7.5%), the worse the populations did.

http://www.nejm.org/doi/full/10.1056/NEJMoa0802743

As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events. These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes.

If you are using only the first 2 years to guide patient care, you are doing your patients a disservice. The real world is paradoxical, it's non-intuitive and it works against what you can reason out.

 

[Psai]

no it's not. Staying awake in your pharm class and having a rudimentary understanding of pathology is what you really need. You can talk all you want about the factors involved in lung fibrosis (TNF-a and all that jazz), but can you interpret a spirometry report? Likewise, you can know all about how IgG is made in the endoplasmic reticulum, followed by glycosylation in the Golgi apparatus, but can you interpret a Rubella titer of 1:6 in a pregnancy and what to do about this? Knowing what phase of the cardiac myocyte's contraction is governed by what ion channels is great for Step 1, but can you read an echocardiogram worth a damn? And before you talk to me about how anti-arrhymatic therapy can be guided by this knowledge, know that 95% of all problems can be solved by either amiodarone, lidocaine or a beta blocker. We know a bunch of useless facts about warfarin, but we can't even dose warfarin properly. Valuable lecture time is spent on how warfarin inhibits vitamin K epoxide reductase but not what an INR of 6 means and how to approach this problem.

The first two years spend so much time on worthless minutia, but we can't cover the basics of how to approach a patient in septic shock. A new M3 is less than useless when confronted with such a scenario. No one gives a rat's ass that you know LPS stimulates TNF receptors, causing massive vasodilation and shock. That's a worthless factoid that's worth great points on Step 1 but utterly meaningless for patient care.

The first 2 years are hyped up big time by professors who either have zero clinical experience or spent the past 20 years researching a problem of tangential importance to clinical care. That's why a fresh MD graduate is literally worth less than a new NP or PA. The fresh MD can't get a job without a massive government subsidy, otherwise the hospital wouldn't be able to justify the cost of teaching us. That, despite the fact that we spend >2x the time on patient care than a new NP or PA. However, a new NP or PA commands a salary double that of a resident's while working half as much. A fresh MD is literally worth less than 1/4th a new NP or PA. You can put anyone through residency training and have them be as qualified as a physician despite the fact that they will have very little basic science training.

I understand what you're saying here but you need to know about tnf-a to understand how drugs like infliximab and etanercept work. You need to know about how warfarin inhibits vitamin k epoxide reductase to understand that you need vitamin k as part of the treatment for having too much warfarin. Your complaint is that the preclinical years aren't teaching what you're supposed to learn in the clinical years. There's a reason why medical school is 4 years long and why it doesn't end as soon as you take step 1. We should know about the underlying pathophysiology of disease. Understanding the difference between septic shock, cardiogenic shock, hypovolemic shock will change your management of the patient. It's not just drown them with fluids and pressors. If you want to know how to treat people without understanding what you're doing, there are alternate pathways for that. The bad thing about medical school is that the clinical years have been diluted down with much less teaching and active learning which has been supplanted by more wasted time with documentation than ever before. An MD gets the practical experience in residency training, that's why it's there.

Not everything you learn in school will be 100% up to date. Things change based on what we learn and our understanding changes. Not everything is certain and the literature can conflict. What we do is to look at things, try to understand them and apply that knowledge to our patients.

Also I did come across that fact about hga1c in the preclinical years

 

[spik]

This x1000. I wish clinicians taught pre-clinical coursework.

At least 30% of my second-year curriculum was taught by clinicians.

 

[spik]

In fact, the first 2 years puts you in false sense of security.

We all know that DMII is a risk factor for CVD/CAD/atherosclerosis because of glucose toxicity right? So it stands to reason that aggressively treating DMII would reduce the number of complications and improve people's lives. If you said this to any of your pre-clinical professors, they would agree wholeheartedly with you. Glucose toxicity = more CAD/atherosclerosis. Period. Controlling sugars aggressively to be in the normal range (for non-diabetics) would be ideal, right?

Well if you did that, you would be killing patients because that's not what the real clinical evidence is saying.

Getting diabetics to a normal H1AC resulted in more complications and more deaths than a conservative treatment that kept diabetics' A1c's at a diabetic level. The lower your A1c (6.4% vs 7.5%), the worse the populations did.

http://www.nejm.org/doi/full/10.1056/NEJMoa0802743



If you are using only the first 2 years to guide patient care, you are doing your patients a disservice. The real world is paradoxical, it's non-intuitive and it works against what you can reason out.

WRONG! I was taught in my pre-clinical curriculum against aggressive A1c targets for everyone. It depends on the age of the patient and other comorbidities.

 

[Kahreek]

you dont want be the guy who puts the 90 year old lady in a coma just because you wanted the 6% A1c