P=MD is the biggest lie ever told

[docscience]

Okay I'm no elitist, but I tend to agree that no one wants the person ranked 120 out of a class of 120 for his doctor, that's not hard to understand. I mean come on, you know those people in your class, you'd never want them treating your cancer, diagnosing your neurological disorder, or patching up your aorta. And you'd never refer a family member to them later in life, would you?

However, based on your example of a test with a class average of 95%...that means that the exam was really ****ing easy. Like really easy. So how comfortable are you with the fact that your doctor was so far below the average on such an easy test?

JeffLebowski...once again..not to be an ass, but when you go see any doc, do you ask him/her what their class rank was? Do you know what he/she got on the MCAT/USMLE?

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[docscience]

Also, doesn't someone HAVE to be last in their class?

I hope you understand that I am not arguing that one should just pass, but I think there is a lot more than basic sciences in the first year and standardized tests that make a good physician/clinician, etc. A well rounded clinical experience, passion, drive, etc. also contribute.

And those who do not achieve academic greatness might excel in the much needed role of the MD who fills the role of business/health administrator, etc. Not everyone strives to be an academic giant who then gets into Derm at Harvard.

One more thing to consider is that not everyone has the same lifestyle either. Some have kids, jobs, research, etc. that they have to balance also...and sometimes that means slipping down in the class ranks.

 

[Rhapsode]

Also, doesn't someone HAVE to be last in their class?

Of course, and for the most part they will be fine physicians. In theory the passing grade range is a range of competence--it runs from adequate to brilliant, not from inept to brilliant. Med schools set up their systems so that the minimum Pass is indicative of perfectly sufficient knowledge, skills and general competence, ready to be further forged in the fires of residency. The person with a 70% in every single course is at the bottom of the pile, but it's the bottom of competence, at least in theory, leaving incompetence in the Fail pile.

I can very honestly say that there are quite a few people in my class who are lower in class rank than I am, but whom I would trust much more with my loved ones than I would trust myself in terms of intellect and clinical reasoning. I will continue to train and exercise my mind, improve my skills, but they will always be smarter and more able than I am. Not to say that there isn't a strong correlation between grades and intelligence/ability, mind you, but it's far from a perfect correlation. Grades are a more concrete and achievable goal than intelligence for the driven person, though the latter can be cultivated.

One more thing to consider is that not everyone has the same lifestyle either. Some have kids, jobs, research, etc. that they have to balance also...and sometimes that means slipping down in the class ranks.

I know several people who have sacrificed performance in med school to some non-critical degree because of family considerations. They'll take a bit longer to reach their full potential (and for now their grades suffer for it), but once they reach that potential they will be significantly more capable physicians than I will likely ever be.

Again, I don't mean to say that there aren't a few people in med school who leave me a bit worried, and they do tend to be pretty low in the class rank. But there are also some extremely smart and capable people "slumming" with them at the bottom of the list.

 

[Rhapsode]

I disagree with the title of this thread. The biggest lie is the "The hardest part is getting in" thing they tell gullible premeds.

I'll send out an AMEN to that, and also to the bit about "Don't stress the details, just know the concepts." Getting into med school was an epic endeavor for me (in part because I came to the notion late and didn't lay the groundwork for my campaign throughout undergrad), and I was sure that getting through the gateway would be the toughest challenge. Not even close.

 

[JeffLebowski]

JeffLebowski...once again..not to be an ass, but when you go see any doc, do you ask him/her what their class rank was? Do you know what he/she got on the MCAT/USMLE?

Of course not. But in the initial scenario you set up, we were assuming that it was information we knew for some reason. Applying that to a realistic situation, I suggested that we all probably know one or two people who are really close to the bottom of the class, and I think most of us would never refer patients to them later in life. Is it unfair? In some cases, maybe. Is it unrealistic? Sort of. I mean it just goes to show you that your actions in med school do have a bearing on your career, even though people love to say "grades don't matter" and stuff. There's people who I know are lazy, who I know are aloof and lackadaisical, and who may very well turn into competent physicians, but they'll never get referrals from me. Maybe that's the cost of being that well-known "slacker, who cares, I'll just try to ace Step I" student...100 former-classmate doctors who don't feel comfortable sending referrals to you.

Now, a whole 'nother issue is what that means for public health & justice in health care - i.e. since the NBME & LCME declares someone competent to practice medicine, shouldn't that be enough for physicians and the public alike? And do doctors who were in the bottom 5% of their class in med school have worse outcomes or patient satisfaction, etc.? But I say those discussions are a little beyond the scope of this thread and frankly would just obscure the issue. I will say I think that in your suggestion that "we don't know our doctors' class rank", it becomes a moot point and yes, in that instance we can probably just say it's not fair to assume you'll get incompetent care (lacking studies to suggest it).

 

[radslooking]

Yes, but that is the whole point to the "firewall", to attempt to weed out the people that administrators do not feel will perform well in medical school and afterwards as a doctor. That way resources aren't wasted on people that are just going to fail/drop out.

My point is that once you are in, you are generally in, nearly regardless of how bad you try to screw up once your in. These students could be more than capably replaced by those who couldn't get in in the first place, but they are not. They are coddled, hands-held, given many second chances until they make it, whether they should or not.

 

[PeepshowJohnny]

My point is that once you are in, you are generally in, nearly regardless of how bad you try to screw up once your in. These students could be more than capably replaced by those who couldn't get in in the first place, but they are not. They are coddled, hands-held, given many second chances until they make it, whether they should or not.

I have to agree with this. There is a real dichotomy between how selective and capricious medical school interviews can be versus how you're treated once you're in.

 

[187502]

It all depends on what your goals are, if you want a non-comp specialty and are only looking for a community placement for residency then it's not so much of a worry.

 

[Asp]

Who cares if P=MD, the real question is whether P=NP

 

[yaah]

I disagree with the quote that Step I has nothing to do with what you learn in M1 and M2, but other than that, good points. If you don't pay attention during M1 and M2 and only go to the required doctor/patient courses, then yes, step I will have little to do with M1 and M2.

I always hated the P=MD quote, along with the "what do you call the person who finishes last in their med school class? Doctor!" quote.

 

[ellia08]

That is because m1 year is like licking syrup off a supermodel in hawaii compared to m2 and boards.

lol!

I'm still stuck on "the biggest lie ever told".... really?... the biggest lie ever? I mean even if you limit it to med school its still a poor candidate.

By frequency its probably something along the lines of "no that was great" or "this wont hurt a bit" or "you'll wear that fugly and hideously expensive bridesmaids dress again".

Other more medical favorites include "I got this STD from a toilet seat" or "our child has an autosomal recessive disease when you arent a carrier because of a random germ line mutation" or "yes doctor, now that *you* tell me to implement a lifestyle intervention, I really want to"

 

[45408]

My point is that once you are in, you are generally in, nearly regardless of how bad you try to screw up once your in. These students could be more than capably replaced by those who couldn't get in in the first place, but they are not. They are coddled, hands-held, given many second chances until they make it, whether they should or not.

Fine, but don't forget that 100% of med students were accepted into med school. For them, the acceptance rate is irrelevant - only the difficulty. I didn't have any trouble getting into the school I'm at right now, so the hard part was most certainly what came after the white coat ceremony.

 

[45408]

or "yes doctor, now that *you* tell me to implement a lifestyle intervention, I really want to"

Actually though, once some people hear it from their doctor, they take it seriously. I had a PCP tell me that she had a patient who had a number of complications from smoking who just wouldn't quit, and the doc just got fed up with it. She raised her voice and said "If this doesn't make you quit, then I don't know if anything ever will!" A few months later, the patient came back for a routine visit and the doc asked her about her smoking, and the patient said "Oh, I threw out the cigarettes after I left your office last time. How could I go back to smoking after that confrontation?"

 

[JeffLebowski]

Actually though, once some people hear it from their doctor, they take it seriously. I had a PCP tell me that she had a patient who had a number of complications from smoking who just wouldn't quit, and the doc just got fed up with it. She raised her voice and said "If this doesn't make you quit, then I don't know if anything ever will!" A few months later, the patient came back for a routine visit and the doc asked her about her smoking, and the patient said "Oh, I threw out the cigarettes after I left your office last time. How could I go back to smoking after that confrontation?"

Yeah, it happens. And even though we get frustrated that SO MANY people are going to drink themselves to death no matter what you say or do, smoke themselves to death no matter what you say or do, or eat themselves to death no matter what you say or do, I think our own frustration is a small price to pay for the few that really do follow "doctor's orders" and we are still totally justified in counseling our patients in whatever way we see as appropriate and in a way that reflects our clinical judgment. The "number needed to treat" to get a better outcome on counseling patients on lifestyle changes may be high, but the "number needed to harm" is exorbitantly higher. Plus it's the cheapest thing you can do for a patient's health and could be the best thing you can do for their health.

 

[Feynmann]

Fine, but don't forget that 100% of med students were accepted into med school. For them, the acceptance rate is irrelevant - only the difficulty. I didn't have any trouble getting into the school I'm at right now, so the hard part was most certainly what came after the white coat ceremony.

Hey be humble.Kerrigan Hall is awesome, not to talk of HRC.

 

[Feynmann]

jj

 

[ellia08]

Actually though, once some people hear it from their doctor, they take it seriously. I had a PCP tell me that she had a patient who had a number of complications from smoking who just wouldn't quit, and the doc just got fed up with it. She raised her voice and said "If this doesn't make you quit, then I don't know if anything ever will!" A few months later, the patient came back for a routine visit and the doc asked her about her smoking, and the patient said "Oh, I threw out the cigarettes after I left your office last time. How could I go back to smoking after that confrontation?"

Very true. Intervention is key. Studies support that the most effective time to hit someone with advice on a lifestyle intervention is after an adverse event. It dramatically increases patient compliance (although "compliance" is not my favorite word in this setting.)

Lifestyle changes are HARD to implement for anyone and a desire to implement them *is* the first step.

Sometimes though a person just doesnt want another lecture from you on smoking/overeating/exercise ... which is really what I was referencing.

Hopefully its obvious that physicians should still try to intervene! (for all the reasons mentioned by others.)

 

[Doublecortin]

Its even bigger then the "don't worry about the details just understand the concept" lie told by professors

So for all you new M1s please before you adopt the P=MD mantra realize that...

What you they teach you in M1 and M2 is tested on Step I. A poor to average Step I score can close doors to competitive specialties. Even if your sure you want to go into something that isn't competitive, a higher score might get you the better residency program/location of your choice.

In case your new to science understand that learning is circular in the sense that you keep revisiting topics over and over again with more detail each time. What you learn in a textbook or lab the first two years comes back in a clinical form years 3 and 4. The more you learn now the easier it will be to learn later with the added details. So enjoy school but aim high to reach and exceed your potential.

yeah, I hear ya, man. Our dean for basic sciences was telling us at orientation how we had to distinguish ourselves to get into med school, but now that we are in, we shouldn't worry about distinguishing us from our classmates, that trying to do that could actually hurt us. Ah, yeah, thanks, for the advice, dude! I guess he is not contemplating applying for derm or plastics so it's easy for him to say that

I think one of the reasons they say that is to avoid creating an uber competitive, gunner atmosphere in the class.

But I would bet most people who want to go into something competitive know full well they need to do well AND distinguish themselves. I mean, c'om on, people are smart, they are not fooling anyone

 

[alfonzarel]

"P=MD is the biggest lie ever told"

this is not a true statement.

 

[freelove]

And we are receiving this public service announcement because.....?

 

[ElZeekio]

This whole thread is cracking me up. I do find it disturbing that over on this side of the pond, the minimum pass rate at most schools is 40%. So you only need to know 40% to become a practicing doc!? We have no national qualifying exam and so it's up to each school to determine whether or not their graduates are fit to practice. This is of course overseen by the General Medical Council.

I've not heard of anyone asking their doctor prior to consultation where they went to med school nor residency, let alone what their ranking in the class was. They may ask how many times the doctor has seen or treated this condition or maybe performed a certain procedure. Unless they're another med student or pre-med student who's curious about their doc.

Passing a MCQ exam and brown-nosing your way to honours does not necessarily make one a competent physician. It helps, but it's not enough. Similarly, a good physician may not have the academic skills to have done well during their studies. Just as getting into Harvard requires a certain skill set, so too does getting into certain residencies. Going to Harvard isn't going to *necessarily* make someone a better physician, nor is getting into a more competitive residency going to make someone a better physician.

 

[JeffLebowski]

Passing a MCQ exam and brown-nosing your way to honours does not necessarily make one a competent physician. It helps, but it's not enough. Similarly, a good physician may not have the academic skills to have done well during their studies. Just as getting into Harvard requires a certain skill set, so too does getting into certain residencies. Going to Harvard isn't going to *necessarily* make someone a better physician, nor is getting into a more competitive residency going to make someone a better physician.

Alright, I'll bite. I agree with you for the most part....but let me ask you this: if none of those things "make someone a better physician", what does? I think you're going a little overboard with the way you're minimizing the impact of passing knowledge-based exams, attending strong schools, and being trained at a strong residency. Those are significant factors and definitely do contribute positively to the development of a lot of "better" physicians.

 

[MSHell]

Alright, I'll bite. I agree with you for the most part....but let me ask you this: if none of those things "make someone a better physician", what does? I think you're going a little overboard with the way you're minimizing the impact of passing knowledge-based exams, attending strong schools, and being trained at a strong residency. Those are significant factors and definitely do contribute positively to the development of a lot of "better" physicians.

MCQ is not the only format of knowledge-based exams. It is the easiest to grade, standardize and pass. But essay questions and viva voce exams are more difficult.

 

[ElZeekio]

Alright, I'll bite. I agree with you for the most part....but let me ask you this: if none of those things "make someone a better physician", what does? I think you're going a little overboard with the way you're minimizing the impact of passing knowledge-based exams, attending strong schools, and being trained at a strong residency. Those are significant factors and definitely do contribute positively to the development of a lot of "better" physicians.

First off, thank you for giving me the opportunity to think about this a little more deeply. I wasn't trying to downplay knowledge and education, nor the difference between the education one receives at Harvard versus Podunk U. I love education and am a big fan of knowledge, and I'm attending a top-tier medical school (and yet I also believe that one gets out of an education what one puts into it, so a good education is available anywhere). I plan to work hard on being in the top quartile on the USMLE. I also want to get into one of the "better" residencies. But it seems as though there's a disproportionate amount of focus on grades and doing well on exams, which aren't necessarily good measures of one's performance as a physician, especially considering the variety of medical specialties. These exams indicate a certain skill set (knowledge and ability to take MCQ), but largely ignore another. Different specialties require different skills, so even though one specialty is more selective based on USMLE scores, it doesn't necessarily select for the skills that are required during the practice of that branch of medicine. Oftentimes, the more selective specialties are the higher-paying (and thus more popular) ones, rather than the ones demanding higher knowledge of clinical science. I think that's what I mean to say.

What I think makes a better physician is the ability to synthesize information, see past the layers of extraneous information the patient presents with to get at the salient factors, the ability to communicate clearly with them and really hear what it is their symptoms are saying, then turn this into a clear picture of the problem, come up with a reasonable and realistic treatment plan and communicate that plan to the team of caregivers as well as the patient. And do this all with an air of authority, yet compassion for the patient. To treat this patient as though they were her or his grandma, and give them the utmost attention and care possible. To be absolutely vigilant in their search for the disease and a perfectionist in their performance of effecting a cure, no matter the specialty. To know the limits of their own knowledge and ability and know where to refer to. A physician who would inspire such confidence in the patient that they'd believe they were already half-cured. Maybe I've just been reading too much Gawande. Perhaps they teach these things better at Harvard. Perhaps that's what the USMLE is really testing. A recent study at UCSF found a stronger correlation for medical board disciplinary action with unprofessional behavior at medical school than lower exam scores, though:
http://content.nejm.org/cgi/content/short/353/25/2673

 

[werd]

back to the original post, i agree that the "P = MD" saying is a little deceiving. i think it comes from the fact that you have med school classes composed entirely of "A" students in college, whereas in med school not everyone can be above average. so you have former stars working their tails off to get average scores at best... it's a reminder to ppl in this sort of situation that as long as you're passing you're still heading towards your goals and intentions. given the profile of med students, it's the minority that actually get sucked into "just scraping by" because of statements like P=MD. werd.

 

[JeffLebowski]

First off, thank you for giving me the opportunity to think about this a little more deeply. I wasn't trying to downplay knowledge and education, nor the difference between the education one receives at Harvard versus Podunk U. I love education and am a big fan of knowledge, and I'm attending a top-tier medical school (and yet I also believe that one gets out of an education what one puts into it, so a good education is available anywhere). I plan to work hard on being in the top quartile on the USMLE. I also want to get into one of the "better" residencies. But it seems as though there's a disproportionate amount of focus on grades and doing well on exams, which aren't necessarily good measures of one's performance as a physician, especially considering the variety of medical specialties. These exams indicate a certain skill set (knowledge and ability to take MCQ), but largely ignore another. Different specialties require different skills, so even though one specialty is more selective based on USMLE scores, it doesn't necessarily select for the skills that are required during the practice of that branch of medicine. Oftentimes, the more selective specialties are the higher-paying (and thus more popular) ones, rather than the ones demanding higher knowledge of clinical science. I think that's what I mean to say.

What I think makes a better physician is the ability to synthesize information, see past the layers of extraneous information the patient presents with to get at the salient factors, the ability to communicate clearly with them and really hear what it is their symptoms are saying, then turn this into a clear picture of the problem, come up with a reasonable and realistic treatment plan and communicate that plan to the team of caregivers as well as the patient. And do this all with an air of authority, yet compassion for the patient. To treat this patient as though they were her or his grandma, and give them the utmost attention and care possible. To be absolutely vigilant in their search for the disease and a perfectionist in their performance of effecting a cure, no matter the specialty. To know the limits of their own knowledge and ability and know where to refer to. A physician who would inspire such confidence in the patient that they'd believe they were already half-cured. Maybe I've just been reading too much Gawande. Perhaps they teach these things better at Harvard. Perhaps that's what the USMLE is really testing. A recent study at UCSF found a stronger correlation for medical board disciplinary action with unprofessional behavior at medical school than lower exam scores, though:
http://content.nejm.org/cgi/content/short/353/25/2673

Okay, I agree with you.

The only other thing I'll add is that I think this is a pretty tenuous concept. I mean the field is kind of split on things like tracking patient outcomes and pay-for-performance (though most physicians oppose these things), which would be objective (although perhaps unfair) measures of physician performance. So while there are objective measures of a physician's career performance, including medical school track record, I agree that it's likely that they correlate poorly to the amorphous concept of "being a good physician", which is generally accepted to be a qualitative judgment call. And even if they did somehow, it's very possible we put too much emphasis on them during medical school.

 

[Jwax]

P may equal MD, but I wouldn't want the people from the bottom 5% or so of my class treating me, my family, my friends...or anyone, anywhere, for that matter.

I believe at one point I was uncomfortable with the notion of anyone in the bottom half of the class being capable of good physicians. This was until I realized that it is all too easy to be in the bottom half with A's and B's. I think an A & B student is entirely capable of being a good physician. I've also found that the biggest difference btwn an A and a B is how many details you can memorize; details which seems like they will have little purpose in real life unless you are House.

Also - don't worry, the bottom 5% will all end up working at the VA .

If you slack b/c you figured out just the right amount of studying to get you your 71, you're a douche bag and a half. Interestingly, these are usually the people sporting the P = MD rhetoric.

It seems like this was pointed out already, but studying enough to get through med school with a pass isn't douche worthy. Many people feel that there is more to life than acing medical school and learning every nit-picky bs fact that we will never use in the real world. Plus I don't think anyone is clever enough to figure out exactly how much it takes to get a 71. At least I'm not that clever. I study, study, study and never know whether it will be enough to pass let alone enough to ace it. After almost every exam I think... we'll that could earn me an A, B, or C.... just depends on how many details I screwed up on.

 

[JeffLebowski]

It seems like this was pointed out already, but studying enough to get through med school with a pass isn't douche worthy. Many people feel that there is more to life than acing medical school and learning every nit-picky bs fact that we will never use in the real world. Plus I don't think anyone is clever enough to figure out exactly how much it takes to get a 71. At least I'm not that clever. I study, study, study and never know whether it will be enough to pass let alone enough to ace it. After almost every exam I think... we'll that could earn me an A, B, or C.... just depends on how many details I screwed up on.

I agree that it's hard to gauge what grade you're headed for, but I disagree with your implication that the difference between an A/B/C is therefore arbitrary. "Just passing" and getting the bare minimum to continue on gets the bare minimum of respect. Writing it off as "there's more to life than medical school, therefore my C's are okay" and "gosh, the difference between an A/B/C is just little unimportant details" is ridiculous.

 

[Doctor Bagel]

I agree that it's hard to gauge what grade you're headed for, but I disagree with your implication that the difference between an A/B/C is therefore arbitrary. "Just passing" and getting the bare minimum to continue on gets the bare minimum of respect. Writing it off as "there's more to life than medical school, therefore my C's are okay" and "gosh, the difference between an A/B/C is just little unimportant details" is ridiculous.

So you're Mr. Lebowski and not the dude? You seem to have a very undudelike attitude.

 

[Jwax]

I agree that it's hard to gauge what grade you're headed for, but I disagree with your implication that the difference between an A/B/C is therefore arbitrary. "Just passing" and getting the bare minimum to continue on gets the bare minimum of respect. Writing it off as "there's more to life than medical school, therefore my C's are okay" and "gosh, the difference between an A/B/C is just little unimportant details" is ridiculous.

Just to clear up, I think the difference between a high B and low A is the unimportant details. I think pulling a C accomplishes exactly what it is meant to: learning enough of this mountain of material to not kill patients due to lack of knowledge. If you needed more than a C to function as a doctor, they would force us to earn more than that.

 

[MrBurns10]

So little of first and second year (especially first) is actually stuff you're going to use once you're a physician. Med school is for learning the basics, residency is where you become a "good" physician. I couldn't care less if my doctor got all passes first and second year if he studied hard during residency to become a solid board-certified physician in his/her field.

 

[VincentAdultman]

"P = MD" saying is a little deceiving.

What part of P = MD is deceiving? If you pass, you get your degree.

I don't see the words "ortho" or "plastics" in there anywhere.

 

[JeffLebowski]

Just to clear up, I think the difference between a high B and low A is the unimportant details. I think pulling a C accomplishes exactly what it is meant to: learning enough of this mountain of material to not kill patients due to lack of knowledge. If you needed more than a C to function as a doctor, they would force us to earn more than that.

Yeah, but you could say that about anything...there's a fine line between the actual numerical demarcation, therefore the difference is negligible? Where's the line? If someone got a few points higher than me on Step I, I wouldn't discount their accomplishment by saying, "yeah, but the questions you got right were unimportant", for all I know I missed an important concept that I should have learned. You make it sound like a B student is wiser than an A student by ignoring "unimportant details", which is just not true.

 

[Jwax]

Yeah, but you could say that about anything...there's a fine line between the actual numerical demarcation, therefore the difference is negligible? Where's the line? If someone got a few points higher than me on Step I, I wouldn't discount their accomplishment by saying, "yeah, but the questions you got right were unimportant", for all I know I missed an important concept that I should have learned. You make it sound like a B student is wiser than an A student by ignoring "unimportant details", which is just not true.

Nope, just saying it as justification that the difference in quality between a high B / low A doctor is negligible. I can't imagine you really think someone is capable of being a much higher quality doc just because they got one more concept or 5 more details pounded out of our education. I say kuddos to those who do better than myself, but I don't feel that I should cower in their almighty presence for their marginally better accomplishment.

The only purpose (I see) for academic demarcation as you called it is to give residency programs a way to compare applicants (it is gives us something to strive for, but I doubt that's its purpose). Does the likely negligible difference between my high B and your low A mean I won't be just as good as a doctor as you? No, but it may very well mean you'll get that residency spot I was hoping for so I'll have to go somewhere else... a consequence that I find acceptable.

 

[PeepshowJohnny]

If someone got a few points higher than me on Step I, I wouldn't discount their accomplishment by saying, "yeah, but the questions you got right were unimportant", for all I know I missed an important concept that I should have learned. .

Well to be fair, test to test variability for Step 1 is like 5-6 points so someone a few points ahead or below you is not statistically different.

 

[WhereDoesItHurt]

It's all about perspective. If you just want to be a "regular doc" then P=MD but let's face it, all of the smart, antisocial people who study 24/7 will be surgeons anyways. So everything has a way of working itself out

 

[michaelrack]

lol!



Other more medical favorites include "I got this STD from a toilet seat"

I guess that's better than getting an STD from a tractor
http://en.wikipedia.org/wiki/The_Burning_(Seinfeld_episode)

 

[Samus Aran]

This whole thread is cracking me up. I do find it disturbing that over on this side of the pond, the minimum pass rate at most schools is 40%. So you only need to know 40% to become a practicing doc!? We have no national qualifying exam and so it's up to each school to determine whether or not their graduates are fit to practice. This is of course overseen by the General Medical Council.

I've not heard of anyone asking their doctor prior to consultation where they went to med school nor residency, let alone what their ranking in the class was. They may ask how many times the doctor has seen or treated this condition or maybe performed a certain procedure. Unless they're another med student or pre-med student who's curious about their doc.

Passing a MCQ exam and brown-nosing your way to honours does not necessarily make one a competent physician. It helps, but it's not enough. Similarly, a good physician may not have the academic skills to have done well during their studies. Just as getting into Harvard requires a certain skill set, so too does getting into certain residencies. Going to Harvard isn't going to *necessarily* make someone a better physician, nor is getting into a more competitive residency going to make someone a better physician.

wait..what?? i don't have time to read through this thread right now b/c i have a monster anatomy exam in the morning, but what schools have a 40% pass rate?! at my school we fail if we're under 75%...

edit: n/m, i just figured out what you meant *d'oh*

 

[bcat85]

Its even bigger then the "don't worry about the details just understand the concept" lie told by professors

So for all you new M1s please before you adopt the P=MD mantra realize that...

What you they teach you in M1 and M2 is tested on Step I. A poor to average Step I score can close doors to competitive specialties. Even if your sure you want to go into something that isn't competitive, a higher score might get you the better residency program/location of your choice.

In case your new to science understand that learning is circular in the sense that you keep revisiting topics over and over again with more detail each time. What you learn in a textbook or lab the first two years comes back in a clinical form years 3 and 4. The more you learn now the easier it will be to learn later with the added details. So enjoy school but aim high to reach and exceed your potential.

As may have been established (as I didn't feel the need to read the whole thread), P DOES in fact equal MD. P does not equal dermatology or orthopedics, but if you wish to be a family practice physician or anything else that isn't really competitive, a pass will make you a doctor.

 

[Goober]

I didn't find getting in to be all that difficult. I played sports, went out regularly, slept a lot, complained when I had to study more than 3 hours in a day. Sure applying was a bit stressful but no where near as stressful as taking STEP I, trying to stay sane when studying an absurd amount during the first two years, getting pimped by an attending on a subject you probably should know more about than you do. Then if you want to do a semi-competitive residency in a desirable location (like Cali) you have even more to worry about.

Looking back on things, I would have to agree with you. Applying was somewhat stressful, but not really that much. I was pretty sure I was going to get in, it was just a matter of where.

Med school was 100x the stress and stretched out over a much longer time.

 

[dienekes88]

How about this idea: studying enough to do well (better than just passing; after all, a lot of this stuff is way cool), but keeping in mind that this is a marathon not a sprint. You don't do well in a marathon by running your 5k personal best in the first 5k of the race...

Along those lines, getting 99% on every exam in the pre-clinical years but then burning out (complete with a post on SDN about how tired/unhappy/unmotivated I am) is not a good idea. I actually did this in high school to get into college, and it was awful.

Could I study my butt off and get freakin' high scores across the board? Maybe. However, I have no idea, 'cause I haven't tried. Why don't I try harder? Because I'm learning a lot, I'm doing fine in my classes, and I know that this is very easily a sustainable rate of work. I'm working harder than I did in college, but I did a bunch of extracurricular stuff at the time. Seeing a few of my classmates tear their hair out even though it's P/F for the first two years makes me so sad. It's a recipe for disaster for the average med student. Some people can be freakin' intense all the time... most people don't have the energy for it. In the end, those incapable of this sustained insanity are sabotaging themselves with all that stress and lack of sleep.

Oh. One of the cardiac fellows I met got an abysmally low score on his first biochem exam, but he apparently did really well on Step 1, rotations, residency, research, etc. Would some of you not let him operate on you?

 

[45408]

Could I study my butt off and get freakin' high scores across the board? Maybe. However, I have no idea, 'cause I haven't tried. Why don't I try harder? Because I'm learning a lot, I'm doing fine in my classes, and I know that this is very easily a sustainable rate of work.

Sustainable is good. I could study more at night during my rotations, but then it'd be a lot harder for me to be enthusiastic and alert during rounds. Some people can do both, but I know that I'd be a lot more miserable without some time for my wife and my video games.

 

[Knicks]

........(and yet I also believe that one gets out of an education what one puts into it, so a good education is available anywhere)........

Yes.

 

[coldweatherblue]

I have no problem with someone who works really hard and passes with a 71% or so in their classes. That's great, they passed med school, good for them.

However, I do disagree with those who flirt with the fail line because they don't care enough about their education to make a real effort. It's not about knowledge it's about respecting yourself and your career enough to at least take it semi-seriously.

I'm a very chill person but still it's good to bust ass, work hard, and hold your head high at the end of the day knowing that you've done your best, no matter what the result may be. Once you start thinking with the mindset of doing as little as possible just to get by, it affects everything you do. Being apathetic is not a very worthwhile attitude.

 

[scotties123]

ur confusing MD with residency placement. u pass u get ur MD. pass = md. u = confused.

 

[Doublecortin]

ur confusing MD with residency placement. u pass u get ur MD. pass = md. u = confused.

 

[supernareg]

actually, here at SGU, C=/=MD.... you have to get a minimum of 2.5 to be able to graduate.... rule was just implemented with my class and here on after.

 

[njbmd]

Those who get "As" in medical school become academic physicans.
Those who get "Bs" in medical school become department chairs.
Those who get "Cs" in medical school become rich.

P=MD from coursework to boards. You have to pass everything to graduate. Fortunately for the vast majority of folks out there who graduate from medical school, they go on to have the career that they want. Regardless of the grumbling, most people settle into some and get the job done. Sooner or later, you have to stop comparing yourself to the rest of your class and get on with the practice of medicine.

 

[Doctor Bagel]

Sustainable is good. I could study more at night during my rotations, but then it'd be a lot harder for me to be enthusiastic and alert during rounds. Some people can do both, but I know that I'd be a lot more miserable without some time for my wife and my video games.

Right there with you. I could always study more, but I place some value on not entirely hating my life. Honestly, I think it's reasonable to make some trade off between not doing the absolute best possible and maintaining your sanity.

 

[incubate6times]

I don't want to give excuses that I'm not an A-list honors student (quite frankly the honors students I knoew creep me out because they are either show signs of being the bureaucratic red-tape officials of tomorrow or they're creepy workaholics); but to say someone is an unworthy doctor because they didn't get 10's in every exam (in which they could have either cheated, they were just plain lucky or they memorized it and forgot the content the next day) isn't objective. That's one thing I like about oral exams. You can't cheat on them because the teacher is in front of you and it's a situation in which either you know the subject content or you don't. I had a classmate who had an insanely good grade average in her first 2 years of med school (and was as far as I know an honest student) and she bombed her oral bar exam because she got nervous.

And then I've heard of people who didn't have amazing grades in med school, but they had a great internship where they busted their rears working and did amazingly well on the bars. Lest to say, the girl that bombed her exam has to retry all of the 3 bar exams spending quite some cash and if she fails the bar again, she's banned from becomming an MD for life. I came to watch the oral bar exam a few weeks ago as an observer and knew almost all of the answers (I would have done pretty subpar on one exam because the doctor asking questions made it so damn difficult; but the other 4 exams were quite easy). And I'm not even officially an intern yet. Just shows that the bar is both a great way to see if you know the stuff or not, if you can control your emotions like a doctor should and that insanely good grades on memorization tests doesn't guarantee you can get the degree. Fail the bar twice and you're out, they don't care if you're #1 in your class.

what's up all the bar exam talk, you mean boards, right?