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I think the medical school structure needs to be changed for many reasons (listed below). What do you think of this design?
M1:
A1.) Foundations in Human Biology (2 months/8 weeks):
Covers introductory concepts that recur in human medicine including cellular biology/biochemistry, histology, and physiology. Exams are Friday mornings.
A2.) Foundations in Clinical Medicine: (2 months/8 weeks):
For the first two months, a student is lectured on foundational concepts like the elements of the history and physical exam as well as preventative medicine concepts. Each week, there will be an OSCE on Friday afternoons with escalating level of sophistication. Emphasis will be placed on the art of doctoring as opposed to technical knowledge.
B1) Organ Systems (8 months/36 weeks) :
Each organ system will be covered from anatomy (prosection)/histology and progress to pathophysiology and pharmacology. Everything from Cardiology to Dermatology will be covered.
B2) Advanced Clinical Medicine (8 months/36 weeks)
Students will learn differential diagnosis skills through hybrid lecture/socratic discussions from clinical faculty in addition to interpretation of lab findings, treatment of common disorders (ex. anti-HTN agents). At the end of each organ system, there will be an OSCE (ex. 3 weeks for Cardiology, 1 week Dermatology) where a student will complete an H&P and be graded on his bedside manner, exam skills, data collection in the note, and assessment & plan. Students will also be graded on a separate verbal presentation to a preceptor who has not read their note.
Summer (2 months) : Students will sit for USMLE Step 1. Afterwards, they may use additional time to start work on research projects.
M2:
A1.) Internal Medicine Clerkship (2 months)
Students will pre-round, round on patients, and present them. Their patients will be rounded on and they will be dismissed for lunch.
A2.) Principles of Internal Medicine (2 months)
In the afternoons, students will solidify their clinical reasoning skills targeted at work-ups of common differentials such as chest pain, shortness of breath, anemia, etc. The final grade will be a mixture of a OSCE, NBME Exam, and Clinical Evaluations. Step 2 CK targeted material will be incorporated into the didactics.
B, C, D (8 months): Clerkships and Foundations Courses in General Surgery (3), Family Medicine (1), Neurology (1), Psychiatry (1), Pediatrics (1), and OB/GYN (1). Note that 2 weeks of IM, General Surgery; 1 week of Pediatrics, and Neurology will be ICU medicine.
E) Students will have 2 months to prepare and sit for USMLE Step 2 CK. Results will be provided in 2 weeks.
M3:
Students will rotate through structured electives. There will be required counts on hospital medicine, OR, clinic medicine, ICU, and night float. Formative and summative feedback will be provided to students during this time in the format of Standardized Letters of Evaluations. Competencies such as written documentation, verbal presentation, basic procedural capabilities will all be assessed. Students will obtain letters of recommendation at this stage.
M4:
All students complete a year long internship in either Medicine or Surgery effectively committing themselves to one or the other. Adequate time off will be provided for interview season. During the initial period, students can get an additional early letter that can be used for their residency application. Students will apply directly to advanced positions (PGY-2 IM/GS) or directly to Neurology, PM&R, Dermatology, Plastics, Neurosurgery, or Urology. Students must sit for USMLE Step 3 prior to December 31st of M4 year. If they fail, they will be enrolled in a intensive Step 3 USMLE prep course alongside clerkships to ensure passage prior to start of residency. By graduation, all students should be eligible to apply for a full medical license to work as a general practitioner.
Pros:
1. It saves a year in medical training. I think medical schools need to take more responsibility in the clinical training of their students. They will realize what their students struggle when doing the actual job and will adjust upstream accordingly.
2. It emphasizes clinical medicine as students are learn doctoring skills in M1, do half day clerkships in M2, and are ready to start applying everything in M3+
3. It creates a timeline more in line with the Step 2 CK focus.
4. Students have way more clinical experience before deciding on a field of choice.
5. It gives unmatched students the able to be licensed so they can do clinically relevant jobs while they are in the application cycle loop.
Cons:
1. The presentation of the basic material is obviously faster. I do think there are significant parts of the preclerkship curriculum that can be cut. I think this would be countered by having detailed didactics in M2 from the clinical perspective. Nonetheless, some students may not be able to tolerate such a fast pace in the material.
Nonetheless, the whole point is to speed up the minutiae everyone learns in medical school, but nevers sees again and slow it down in M2 and focus on what really matters...clinical medicine. More detailed mechanisms, applied physiology (ventilator medicine, acid&base) can be taught alongside M2 clerkships.
M1:
A1.) Foundations in Human Biology (2 months/8 weeks):
Covers introductory concepts that recur in human medicine including cellular biology/biochemistry, histology, and physiology. Exams are Friday mornings.
A2.) Foundations in Clinical Medicine: (2 months/8 weeks):
For the first two months, a student is lectured on foundational concepts like the elements of the history and physical exam as well as preventative medicine concepts. Each week, there will be an OSCE on Friday afternoons with escalating level of sophistication. Emphasis will be placed on the art of doctoring as opposed to technical knowledge.
B1) Organ Systems (8 months/36 weeks) :
Each organ system will be covered from anatomy (prosection)/histology and progress to pathophysiology and pharmacology. Everything from Cardiology to Dermatology will be covered.
B2) Advanced Clinical Medicine (8 months/36 weeks)
Students will learn differential diagnosis skills through hybrid lecture/socratic discussions from clinical faculty in addition to interpretation of lab findings, treatment of common disorders (ex. anti-HTN agents). At the end of each organ system, there will be an OSCE (ex. 3 weeks for Cardiology, 1 week Dermatology) where a student will complete an H&P and be graded on his bedside manner, exam skills, data collection in the note, and assessment & plan. Students will also be graded on a separate verbal presentation to a preceptor who has not read their note.
Summer (2 months) : Students will sit for USMLE Step 1. Afterwards, they may use additional time to start work on research projects.
M2:
A1.) Internal Medicine Clerkship (2 months)
Students will pre-round, round on patients, and present them. Their patients will be rounded on and they will be dismissed for lunch.
A2.) Principles of Internal Medicine (2 months)
In the afternoons, students will solidify their clinical reasoning skills targeted at work-ups of common differentials such as chest pain, shortness of breath, anemia, etc. The final grade will be a mixture of a OSCE, NBME Exam, and Clinical Evaluations. Step 2 CK targeted material will be incorporated into the didactics.
B, C, D (8 months): Clerkships and Foundations Courses in General Surgery (3), Family Medicine (1), Neurology (1), Psychiatry (1), Pediatrics (1), and OB/GYN (1). Note that 2 weeks of IM, General Surgery; 1 week of Pediatrics, and Neurology will be ICU medicine.
E) Students will have 2 months to prepare and sit for USMLE Step 2 CK. Results will be provided in 2 weeks.
M3:
Students will rotate through structured electives. There will be required counts on hospital medicine, OR, clinic medicine, ICU, and night float. Formative and summative feedback will be provided to students during this time in the format of Standardized Letters of Evaluations. Competencies such as written documentation, verbal presentation, basic procedural capabilities will all be assessed. Students will obtain letters of recommendation at this stage.
M4:
All students complete a year long internship in either Medicine or Surgery effectively committing themselves to one or the other. Adequate time off will be provided for interview season. During the initial period, students can get an additional early letter that can be used for their residency application. Students will apply directly to advanced positions (PGY-2 IM/GS) or directly to Neurology, PM&R, Dermatology, Plastics, Neurosurgery, or Urology. Students must sit for USMLE Step 3 prior to December 31st of M4 year. If they fail, they will be enrolled in a intensive Step 3 USMLE prep course alongside clerkships to ensure passage prior to start of residency. By graduation, all students should be eligible to apply for a full medical license to work as a general practitioner.
Pros:
1. It saves a year in medical training. I think medical schools need to take more responsibility in the clinical training of their students. They will realize what their students struggle when doing the actual job and will adjust upstream accordingly.
2. It emphasizes clinical medicine as students are learn doctoring skills in M1, do half day clerkships in M2, and are ready to start applying everything in M3+
3. It creates a timeline more in line with the Step 2 CK focus.
4. Students have way more clinical experience before deciding on a field of choice.
5. It gives unmatched students the able to be licensed so they can do clinically relevant jobs while they are in the application cycle loop.
Cons:
1. The presentation of the basic material is obviously faster. I do think there are significant parts of the preclerkship curriculum that can be cut. I think this would be countered by having detailed didactics in M2 from the clinical perspective. Nonetheless, some students may not be able to tolerate such a fast pace in the material.
Nonetheless, the whole point is to speed up the minutiae everyone learns in medical school, but nevers sees again and slow it down in M2 and focus on what really matters...clinical medicine. More detailed mechanisms, applied physiology (ventilator medicine, acid&base) can be taught alongside M2 clerkships.
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