New 3rd year curriculum at USF

[anonymousmonkey]

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Just a biased opinion about our new 3rd year curriculum. Kind of wanting to vent and to see if anyone else has a similar curriculum.

So instead of the traditional bunch of 8 week blocks, (medicine, surgery, pediatrics, psych, ob/gyn etc) we have our 3rd year pretty much broken down into inpatient and outpatient blocks, as follows:

Med/Peds (4 weeks of medicine inpatient, 4 weeks of peds inpatient)
Surgery (4 weeks general, 2 weeks specialty and 2 weeks taken from OB to cover Gyn surgery)
Neuropsych (6 weeks of psychiatry, 2 weeks of neuro)
ER (4 weeks)
OB (4 weeks inpatient)
Ambulatory Care (4 Months outpatient clinics; pretty much covering the outpatient forms of the above blocks.)

When I first heard about this, I thought it sounded interesting, if a little strange. From the reports of last years class, I was looking forward to 3rd year, but was apprehensive about this new curriculum as we were the first class to go through it. Needless to say, for me, this has not been enjoyable and has certainly been, in many ways, a poor learning experience.

Don't get me wrong. I am an extremely hard worker, and am not complaining about the hours, getting pimped, etc. I am a little older than most 3rd years and have had my share of jobs and life experience, so found this aspect a lot easier than most. I am also (although I am sure you will find this difficult to believe after this diatribe!) a very positive person, certainly not one of those 'whiners!' you meet in med school!

Several problems, from my point of view, include -

Neurology in 3rd year. Interesting. And cut in half - only 2 weeks, and having to take the shelf, competing against 4th years nationwide who have had a full month. Not even 2 weeks, actually - some people were with community preceptors for as little as 6 days in total.

Taking the Medicine and the Pediatric shelves on the same day, after only 4 weeks inpatient each, without any outpatient experience.

Only 6 weeks of psychiatry.

8 weeks of surgery crammed into 6 weeks, with gyn surgery thrown in for 2 weeks.

A poorly balanced curriculum, overall. 8 months of inpatient medicine, back to back - can be exhausting. No outpatient clinic weeks to balance it.

Similarly, 4 months of Outpatient clinics, back to back. Can be boring. Easy life though, but again, makes for poor balance through the year.

The worst of the situation was the mixing of subjects (med/peds, neuro/psych, ambulatory outpatient care). For 8 months of the year, this made for a confusing time in practice; I was always told that one of the points of 3rd year was that you would see patients in the day, read about them at night, and be taught about them in lectures, each strengthening the other discipline. However, in reality, we would see medicine patients and have pediatric lectures (or have neurology lectures while we were in psychiatry.) No better than 2nd year, in reality. The ambulatory care block was just awful in this regard; we would see pediatric patients in the morning, sports medicine patients in the afternoon, psychiatry clinic the next morning, womens health the next afternoon - this made for a very disjointed learning experience, and in a word, sucked.

True, I am biased right now. I am a little bitter about this new curriculum and feel that I would have learned a lot more the traditional way. I am also a little angry that we were not given a choice as to whether or not we have this curriculum - it was not what we signed up for, at the very least. (There may even be some legal issue regarding the changing of a curriculum so drastically, when our admission catalog described it otherwise.) However, there are some good points of the curriculum - I really enjoyed ER, and think that is a great idea to have (although not necessarily in 3rd year, maybe early 4th.) Also, I bear in mind that we are the first year to undergo such a change and that some bugs may be worked out.

We were told that many medical schools have this type of curriculum, and that this is 'the future' of 3rd year medical school. What are your experiences? Anyone else going through something like this?

 

[pillowhead]

Just a biased opinion about our new 3rd year curriculum. Kind of wanting to vent and to see if anyone else has a similar curriculum.

So instead of the traditional bunch of 8 week blocks, (medicine, surgery, pediatrics, psych, ob/gyn etc) we have our 3rd year pretty much broken down into inpatient and outpatient blocks, as follows:

Med/Peds (4 weeks of medicine inpatient, 4 weeks of peds inpatient)
Surgery (4 weeks general, 2 weeks specialty and 2 weeks taken from OB to cover Gyn surgery)
Neuropsych (6 weeks of psychiatry, 2 weeks of neuro)
ER (4 weeks)
OB (4 weeks inpatient)
Ambulatory Care (4 Months outpatient clinics; pretty much covering the outpatient forms of the above blocks.)

When I first heard about this, I thought it sounded interesting, if a little strange. From the reports of last years class, I was looking forward to 3rd year, but was apprehensive about this new curriculum as we were the first class to go through it. Needless to say, for me, this has not been enjoyable and has certainly been, in many ways, a poor learning experience.

Don't get me wrong. I am an extremely hard worker, and am not complaining about the hours, getting pimped, etc. I am a little older than most 3rd years and have had my share of jobs and life experience, so found this aspect a lot easier than most. I am also (although I am sure you will find this difficult to believe after this diatribe!) a very positive person, certainly not one of those 'whiners!' you meet in med school!

Several problems, from my point of view, include -

Neurology in 3rd year. Interesting. And cut in half - only 2 weeks, and having to take the shelf, competing against 4th years nationwide who have had a full month. Not even 2 weeks, actually - some people were with community preceptors for as little as 6 days in total.

Taking the Medicine and the Pediatric shelves on the same day, after only 4 weeks inpatient each, without any outpatient experience.

Only 6 weeks of psychiatry.

8 weeks of surgery crammed into 6 weeks, with gyn surgery thrown in for 2 weeks.

A poorly balanced curriculum, overall. 8 months of inpatient medicine, back to back - can be exhausting. No outpatient clinic weeks to balance it.

Similarly, 4 months of Outpatient clinics, back to back. Can be boring. Easy life though, but again, makes for poor balance through the year.

The worst of the situation was the mixing of subjects (med/peds, neuro/psych, ambulatory outpatient care). For 8 months of the year, this made for a confusing time in practice; I was always told that one of the points of 3rd year was that you would see patients in the day, read about them at night, and be taught about them in lectures, each strengthening the other discipline. However, in reality, we would see medicine patients and have pediatric lectures (or have neurology lectures while we were in psychiatry.) No better than 2nd year, in reality. The ambulatory care block was just awful in this regard; we would see pediatric patients in the morning, sports medicine patients in the afternoon, psychiatry clinic the next morning, womens health the next afternoon - this made for a very disjointed learning experience, and in a word, sucked.

True, I am biased right now. I am a little bitter about this new curriculum and feel that I would have learned a lot more the traditional way. I am also a little angry that we were not given a choice as to whether or not we have this curriculum - it was not what we signed up for, at the very least. (There may even be some legal issue regarding the changing of a curriculum so drastically, when our admission catalog described it otherwise.) However, there are some good points of the curriculum - I really enjoyed ER, and think that is a great idea to have (although not necessarily in 3rd year, maybe early 4th.) Also, I bear in mind that we are the first year to undergo such a change and that some bugs may be worked out.

We were told that many medical schools have this type of curriculum, and that this is 'the future' of 3rd year medical school. What are your experiences? Anyone else going through something like this?

If it makes you feel any better, Neuro has always been a 3rd year course at my school (although it's 4 weeks, not two), and Psych has always been six weeks, too.

I think your eight weeks of surgery sounds just fine and broken up in the right distribution, too. You really don't need more than that.

I would be concerned with having to take two shelf exams (Peds and Med) on the same day. And 4 weeks of inpatient medicine quite frankly isn't enough preparation for the shelf. I think you need eight weeks of inpatient medicine, and I don't even particularly like medicine.

4 months of outpatient clinics back to back does sound painful. Easy lifestyle, but that's just too long. One month at a time is good.

 

[Samoa]

Seriously. It probably looked good on paper, and your class unfortunately got stuck being the guinea pigs. However, the school is probably committed at least to the basic outline of outpatient blocks and inpatient blocks, and the time spent on each. So probably the best thing you can do is offer suggestions for rational changes within the basic overall structure. For example:

Make med/peds a four month long block, alternating inpatient with outpatient (i.e. inpatient medicine-->outpatient medicine-->medicine shelf-->inpatient peds-->outpatient peds-->peds shelf)

Ask for neuro to be changed to 2 weeks inpatient-->2 weeks outpatient-->shelf exam. You're not adding 2 weeks, since it's ambulatory; you're just moving it around to a place where it makes more sense (and will likely give your school higher shelf scores).

4 weeks of EM seems like a lot to me. We have a 2 week rotation and that's plenty. We also have 2 weeks of radiology, which from what I gather has always been mostly a vacation. Like your setup, I'm sure it looked good on paper.

We only have 4 weeks of psych at my school, and personally I think the 6 weeks at your school sounds exactly right. Meanwhile, we have 6 weeks of Family Medicine, on top of 8 weeks of inpatient medicine and 4 weeks of ambulatory medicine. Major overkill. We could probably spare those extra 2 weeks on family for psych instead. We already have 4 weeks of neuro, and it seems to work out just fine.

We also have 8 weeks of inpatient surgery (4 weeks general, 2 x 2 weeks of subspecialties) and 2 weeks of outpatient surgery. In all cases, we take our shelf exams before our outpatient rotations, and it just means we have to learn that material on our own. I'd certainly rather take the shelf after my inpatient rotation than wait until months later when I've taken the outpatient one too.

So I think with a little tinkering here and there, your school's 3rd year could be really good.

 

[DrRobert]

4 weeks of EM seems like a lot to me. We have a 2 week rotation and that's plenty. We also have 2 weeks of radiology, which from what I gather has always been mostly a vacation. Like your setup, I'm sure it looked good on paper.

We only have 4 weeks of psych at my school, and personally I think the 6 weeks at your school sounds exactly right.

4 weeks of Psych is more than enough.

EM should be four weeks as well. That rotation is invaluable for Step 2. 80% of the question stems begin with "Patient presents to the ER..."

 

[anonymousmonkey]

Thanks for the input. I agree with all the comments made, and appreciate them. S'funny, Samoa, if they did do what you recommended, i.e. what makes sense, (such as 4 weeks medicine inpatient/4 weeks outpatient and same for peds, 4 weeks for Neurology, and the rest) then that would pretty much equal the previous curriculum. Sigh - change for changes sake, I think. 😳

 

[Joel Fleischman]

Just to make you feel better---
USF is not the only school switching to this..

 

[anonymousmonkey]

Good to feel that I am not alone, but I think it is a shame. It is such a disjointed way to experience things, and although I am almost finishing the 3rd year, I really feel that I haven't learned a whole lot. A decent amount, yes, but damn, not that impressed. Little scary, actually.

 

[docinfla]

I think the USF curriculum is actually a great improvement from what I hear about in the past. The majority of my class spends their time complaining about it, rather than focusing on studying and learning. Yes at times I've been frustrated with it, but you know what? 3rd year is a hard, strenous year however you look at it. Our shelf scores have been solid, as in the past, and having ER in the 3rd yr is such an advantage. One month of inpt med is enough, 1 month of inpt peds is enough. One could have three months and still not do well on the shelf, because they are tough. How much time on a given rotation does what you are doing on a daily basis actually help you answer a question on the shelf? if anything you probably get more opinion on a service that complicates the answers on the test. 3rd year is 3rd year, the purpose is to learn and figure out what you want to do as a career and USF does this well. Thanks.

 

[anonymousmonkey]

I think the USF curriculum is actually a great improvement from what I hear about in the past. The majority of my class spends their time complaining about it, rather than focusing on studying and learning. Yes at times I've been frustrated with it, but you know what? 3rd year is a hard, strenous year however you look at it. Our shelf scores have been solid, as in the past, and having ER in the 3rd yr is such an advantage. One month of inpt med is enough, 1 month of inpt peds is enough. One could have three months and still not do well on the shelf, because they are tough. How much time on a given rotation does what you are doing on a daily basis actually help you answer a question on the shelf? if anything you probably get more opinion on a service that complicates the answers on the test. 3rd year is 3rd year, the purpose is to learn and figure out what you want to do as a career and USF does this well. Thanks.

Good way to look at it, and I don't disagree with everything that you have to say, apart from one huge point (see below.) There is too much complaining, I agree. (This has been my only vent, so far.) Having ER in 3rd year is an advantage, to which I agree also. I don't actually think that it has been too strenuous, however. Manageable, for the most part, and no more difficult than I thought it would be.

Most of my complaints are not about the amount of the time spent on a service (I agree that 1 month of inpatient medicine is enough), I believe that it is the shuffling of the curriculum that made things disjointed/awkward. I really don't see the point, and think it sounds good on paper, but has not really worked well in practice. I can see how the inclusion of ER is an improvement on the past curriculum, but can't see how this strange mixing of the curriculum is a step forward.

 

[Obedeli]

Doesn't ANYONE see the pattern in this curriculum?!?! For or better or worse (worse for those not interested in family practice) it is a entire third year of family practice.

 

[Obedeli]

I think the USF curriculum is actually a great improvement from what I hear about in the past. The majority of my class spends their time complaining about it, rather than focusing on studying and learning. Yes at times I've been frustrated with it, but you know what? 3rd year is a hard, strenous year however you look at it. Our shelf scores have been solid, as in the past, and having ER in the 3rd yr is such an advantage. One month of inpt med is enough, 1 month of inpt peds is enough. One could have three months and still not do well on the shelf, because they are tough. How much time on a given rotation does what you are doing on a daily basis actually help you answer a question on the shelf? if anything you probably get more opinion on a service that complicates the answers on the test. 3rd year is 3rd year, the purpose is to learn and figure out what you want to do as a career and USF does this well. Thanks.

Can anyone say TOOL. I wonder who's suckin up to get AOA (my OTHER classmates are complaining but not me, look at me everyone) SHEESH!
Every bad idea has its cheerleaders.

A year of family practice will drive students AWAY from primary care.


Interesting this poster has less than 10 posts... 🙄 HMMmmm

 

[stickydick]

Can anyone say TOOL. I wonder who's suckin up to get AOA (my OTHER classmates are complaining but not me, look at me everyone) SHEESH!
Every bad idea has its cheerleaders.

A year of family practice will drive students AWAY from primary care.


Interesting this poster has less than 10 posts... 🙄 HMMmmm

Obedeli, you may be my new personal hero. Fantastic observation.

Interestingly, USF has less people than ever before going into family practice and internal medicine. There are an unusual amount of students going into unusual specialties - around 20 people trying for ER, and more than 10 going into pathology. As you said, the curriculum is almost driving people away from primary care.

 

[REL]

Obedeli, you may be my new personal hero. Fantastic observation.

Interestingly, USF has less people than ever before going into family practice and internal medicine. There are an unusual amount of students going into unusual specialties - around 20 people trying for ER, and more than 10 going into pathology. As you said, the curriculum is almost driving people away from primary care.

That is one interpretation. I guess another could be that with of the vast array of specialty medical facilities available in the bay area, coupled with the curriculum which puts you with live patients and a real doc on a weekly basis, that you get to see and experience more of medicine. In these experiences you will interact with a large population of very diverse peoples. It may be that this total experience helps you to make a more informed decision about your career in medicine. I hope that we can agree that specialty choice is a function of the medical student making a choice. I think that choice is heavily influenced by what that student has seen and done. If they have been restricted to smaller populations and lesser clinical opportunities they may be more likely to select the primary care specialties that the routinely see. Possibly a reason why UM/USF (larger population bases and more medical facilities) seem to put less in primary care?? I think residency match is way over-rated in selection of a medical school (especially in Florida) since the three established schools are so equal in this regard -- FSU is just starting out in the residency game, but has had some good matches, and shows to be quite strong in the near future too.

 

[Obedeli]

The main problem that I observe with the situation is the LACK of specialty immersion. Medicine AND peds in the same week?!?! The only people who do that are FPs (and med-peds of course). For crying out loud, the difference and breadth in the scope of material is enormous!?! I just don’t think the faculty who recommended this change remember what it was like to be a medical student.

I agree that more floor time doesn’t equal better shelf scores. You will see CHF all day but never see leptospirosis (guess which one USMLE tests 😉 ). But time spent immersed in the specialty does! That is why I hated family medicine as a medical student because I felt I could never fully get a hold of the material. I know, I know, the art to FP is knowing key concepts in all specialties and knowing when to refer but as a medical student there is a tremendous drive and almost expectation (at least from yourself) to be able to know it all (within reason). You brush up on some optho only to have derm type patients all day with no readings on that subject. YECCH! When you are in one specialty, it is all you think about and it is how you identify yourself for that period. When you introduce yourself to families in the ED, you say “I am with medicine.” Under the current situation, you say “I am with medicine…. No wait I mean peds… I dunno, whatever the flavor of the day is.”

In the end all that matters to the individual is how they like to learn. Maybe the cheerleader is the only one who likes it. Well, if that's the case, then good for them. However, a curriculum change should be helpful to more than a rare few and the jury is still out. USMLE step 2 scores will give some objectivity to all the speculation and discussion. Everybody likes their own research and pouring over data, but nobody likes to be the data (guinea pig), especially a medical student.

And to all prospective students, take this debate lightly. Pissing and moaning is elevated to an art form in medical school. No matter what school you talk about, give the students a moment, especially after the first block exam, and watch the bitchin begin. It costs so much grief and rarely produces any meaningful results. I don't know how the professors put up with all those egos sometimes (mine included).