Philosophical discussion about students in bottom half of class…

Discussion in 'Medical Students - DO' started by danzman, Dec 16, 2008.

  1. danzman

    danzman The Ace of Spades
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    I had an interesting discussion with another student today about the effects of class rank on residency selection. He was of the opinion that the students at the bottom half of the class would be forced into doing a residency in some sort of primary care field even if they didn’t want to. At first I argued that board scores were much more important, which I do believe, but then I got to thinking about this a little more. Since there are so few spots in specialties other than primary care (FM, peds, etc’), and since placement into those spots is so competitive, do you think that people who just “get by” in school will be forced into them? I was under the impression that board scores and third year grades trump everything, but as he argued, few people in the bottom half of the class will do well on the boards. After looking at the allo match stats, I am of the opinion now that he may be right. Unfortunately I can’t find any meaningful stats on DO residencies that would support or negate this. So what do you think? Do students who just get by in there classes, and score maybe a little below the average on boards have any chance at anything other than primary care medicine?
     
  2. DOinMS

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    Most "guides" to residency selection will tell you that core rotation and board scores are the most important criteria followed by elective rotation scores and GPA. This probably depends on the specific program, but in general it seems to be true. The ultimate solution is to go to a school like mine where the class is not ranked (per the administration at least). I forgot to say that if the above criteria are good enough to get the interview, the ultimate deciding factor is what the folks in the program think of you. I have been told by multiple PDs that the ultimate deciding factor is whether or not they think you can work with the team. So even if your scores are stellar (4.0 GPA, 99 on steps, high pass in rotation), if you are a total jerk, then you will probably not be selected.
     
    #2 DOinMS, Dec 16, 2008
    Last edited: Dec 16, 2008
  3. Lamborghini1315

    Lamborghini1315 Sleep deprived
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    You want a straight up answer...NO!
     
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  4. bkpa2med

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    I've heard that these students make excellent cadavers.
     
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  5. IDBasco

    IDBasco Atypical agent
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    With all due respect, how is it logical that someone in the bottom part of the class will all of a sudden pull out great board scores- better than those of the people who were getting better grades all along? As far as step 1 goes, anyway...

    I think I agree with your friend.
     
  6. JeffLebowski

    JeffLebowski Just got Nard-dogged
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    It depends on the specialty, the program, the applicant pool, and a number of less tangible factors that are hard to assess.

    You can't just generalize and say: here's the order of importance, with relative weight of each. I don't know anything about DO residencies, but allopathic residencies vary widely in what they value. The best approach is to read Charting Outcomes.

    But I agree with the statement of another poster that class rank alone does not predict match success nor does it limit you to primary care as a specialty.
     
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  7. fireflygirl

    fireflygirl The Ultimate Blindian
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    We actually had a residency director for Einstein's ED program that is also an alum come to our school recently and talk about this kind of stuff. One of the things that he said was that it was pretty critical to stay in the top half of the class. He said that while board scores and rotation grades were very impt, they often questioned applicants who were not in the top half of their class. You don't have to be top 10% but they very much prefer that you maintain a B avg. They usually get 700 applications for about 12 spots, and they interview abut 160 for those. Anyone that didn't have at least above avg board scores, strong rotation recs, and wasn't in the top half of their class was automatically rejected.

    When we questioned him further about the issue of school grades, because many of us were under the impression that they weren't as impt, he countered it by saying that while it wasn't at the top of the list, it certainly helped eliminate candidates. They would definately interview a candidate that had better grades with equally good scores and recs before they interviewed someone else with mediocre grades. However, in the grand scheme of things board scores and rotation recs are critical. He even commented that extra cirrics weren't a big deal unless you were applying to an academic hospital and had a ton of research under your belt or had some publications. But doing other things like president of clubs or tour guide....etc I guess is not considered as impt.

    Based on what he said, many of us were a bit suprised. A lot of us were under the impression that if you could rank the top 5 things that go intobeing a strong residency candidate, grades were #5 behind extra cirrics and other things already mentioned. And I have heard conflicting stories from a number of different people, but none of those people were residency directors - they were current docs or friends of mine that did above avg on the boards and did fairly well in med school...
     
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  8. JeffLebowski

    JeffLebowski Just got Nard-dogged
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    Yeah, but you can't just take one program director at one program and say "oh gosh, I didn't realize this was the way it is". If anyone on this board honestly thinks that grades are NOT IMPORTANT in residency selection is totally deluding themselves. And don't get me wrong, I am well aware that med students are notorious for deluding themselves in that way. "Oh, grades don't really matter, just crush Step I" (as if that's just a walk in the park, especially if you're not proven to be a strong student) is a common belief among med students, and in my experience & from all that I've heard/know, that's just not true. I mean it's a (somewhat) objective measure of your performance in medical school....come on does anyone out there actually think that's not of interest to residencies? BTW extracurriculars in general don't count for anything, I'm surprised anyone anywhere thinks they rank above grades in importance. Sounds like naive premed mentality. And just to clarify research is not "extracurriculars", some programs highly value good research/pubs/presentations experience in med school. That's not what people generally mean when they talk about extracurriculars.

    So let's just clear that up right now: **** yes grades matter. How much they matter, however, again - it depends. On the program & specialty.
     
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  9. dozitgetchahi

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    It would certainly make sense to me that at least some residencies are only interested in candidates ranking the top 50% of their med school classes. In effect, their reasoning is that there may not be too much difference between, say, the top 5% and 15% of a medical school class - but that there's probably a bit more of a difference between students in, say, the top 15% and the top 50%. Think about this concept in relation to, say, the SAT (for instance). I don't have all that much faith in the ability of a standardized test to do some kind of fine-scale discrimination between the abilities and/or "quality" of students in general, and I think quite a few people would agree that there probably isn't too much difference between somebody who scored a 1400 on that test versus somebody who scored a 1300. We, however, would probably be more in agreement that there's a clearer difference between somebody who scored a 1400 and somebody who could only manage a 950. That's all they're saying here - that any reasonably strong med student should be able to get themselves into the top half of their med school class, and that anybody who couldn't get to at least that minimum standard probably wasn't being as serious about med school as they could have (or should have) been.
     
  10. danzman

    danzman The Ace of Spades
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    While all of this may be true, does this in fact mean that all (or most) of these students will be forced into a primary care field? Or would they still be competitive for middle of the road type spec's like ER or Gas? Just from looking at the numbers it seems that nearly all students who do well on the boards will choose something other that primary care medicine, as there are so few applicants to any of them with scores above 230 on USMLE step 1 (again I cant find COMLEX info). If we assume that students who do above average on the boards will be above average (top half) of their class, then you could say that there would be no spots left for the bottom half of the class in anything but FM, peds etc'. It just seems that since only about 2% of students are going into primary care these days, the numbers dont add up. Also, I understand that most students go into IM and many of them could choose to move into a more specialized area, but still...
    I am a bit confused about the chances of a middle of the road student, or maybe even the bottom quarter of the class doing anything other than primary care stuff.
     
  11. Animus

    Animus I won't deny it...
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    Apparently you were not versed well in reading comprehension. The entire OP was asking whether or not they matter enough to RUIN the possibility of getting a specific residency. To that I would answer, no. They, like any part of your application are just one portion, do well on the others you have a great shot. Besides flunking classes or being at the very bottom of your class I cannot see being below average taking away from your spot if you are a great candidate in all other respects.
     
  12. bigDinLV

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    it depends on the program and the applicant. One program I interviewed at said they grant interviews to the top 25% of applicants, about 115 interviews for 6 positions. This was for a MD anesthesia program.. Sooooo unless you know somebody then you have less of a chance.


    If you happen to be in the bottom half of the class. It doesn't really mean you will be a bad doctor. Some people have great clinical skills (despite grades that aren't great), people skills, their patients love them and they build a great reputation based on this and nobody ever knows they were in the bottow half. Look at some of the negative short replies on here, they might be in the top of their class but they are obviously douchebags. I'd rather work with a great person in the bottom half than a douche at the top. So just remember one thing, if you can get the to interview you won't have any problem beating out people like some of those that replied here.

    Now to get that interview despite being in the bottow half... Go to the program and rotate there!!!!!!! Work your butt off and impress them, let them see that you have more to offer than grades and scores and you might just end up with the job.
     
  13. fireflygirl

    fireflygirl The Ultimate Blindian
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    Apparently another misconception as per our dean and the doc from Einstein. Apparently most candidates end up being residents in hospitals that they have never rotated at. So while it isgood to make the connection at the hospital of your choice, and it certainly can't hurt you, it really is not as big of a deal as I previously thought....again just food for thought!
     
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  14. JeffLebowski

    JeffLebowski Just got Nard-dogged
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    And I agree with that, Mr. Reading Comprehension.
     
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  15. zmeister22

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    It all depends. Direct quote from PD at a level 1 trauma center allopathic EM residency: "I don't care about your grades. I don't care if you are a DO or an MD. If you are smart enough to pass, you are smart enough to look something up if you don't know it. I want to see WHY you want EM. How have you worked to better your community? How have to participated in EM/EMS before? What motivates you?"

    He said that board scores were important as a cut off only. Once you were in the group of interviewees, they go off of personality, letters, performance on audition rotations, etc.
     
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  16. Old_Mil

    Old_Mil Senior Member
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    Class rank reported by DO schools is a bit deceptive. Rolled into that GPA is a tremendous amout of OMM, a class that is notoriously subjective when it comes to evaluations and weighted very heavily.

    A student whose grasp of medicine and surgery is below average, with didactic grades that reflect this, may have a class rank artificially inflated by high OMM grades. Likewise, a student whose grasp of medicine and surgery is above average may have his class rank lowered significantly by OMM grades.

    The same thing is true when comparing COMLEX scores to USMLE scores.

    ...don't count on a DO school's deans office to draw attention to the above, however.

    The best indicator of how strong a DO candidate actually is comes in the form of an apples-to-apples comparison of USMLE scores.
     
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    #16 Old_Mil, Dec 18, 2008
    Last edited: Dec 18, 2008
  17. fireflygirl

    fireflygirl The Ultimate Blindian
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    One of the thing I talked to our Dean about and some other residency directors about is just this issue with the COMLEX vs. USMLE thing. And while there is still a tremendous amount of work to be done, there are some allo residencies out there apparently that are beginning to understand the difference between the scores and how a USMLE score correlates to a similar score on the COMLEX. Some of the primary care residencies that gets lots of competitive applicant from both schools have begun to understand the difference and while the movement is small and slow, there are a number of residency directors out there that are moving towards not caring about which score you submit. At some point, one residency director told me, that he would like to see that you can just submit one score and all the other factors previously mentioned by zmeister will help one candidate stand out from another.....
     
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  18. Old_Mil

    Old_Mil Senior Member
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    Actually, as a DO, I am glad to see that more allopathic PDs *aren't* willing to accept Comlex.

    Reality: Comlex is an inferior exam in every sense. Plus, your Comlex score includes a good number of questions related to OMT, in some cases as much as 10%-20% of the exam. So it's like comparing a test graded on a curve (COMLEX) with one that's not (USMLE).

    So there's really no good way to try and compare the two...and accepting DOs into allopathic residencies with only a COMLEX score is an affront both to MDs and to the increasing number of DOs who have proven themselves by taking, passing, and even excelling on MD licensing exams.

    The AOA has lowered the bar in medicine enough through their efforts. I don't think we should be acting as enablers in that effort.
     
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  19. medicine1

    medicine1 Senior Member
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    :thumbdown:
     
  20. medicine1

    medicine1 Senior Member
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    DOs like you need to be removed from the profession, especially since you do not profess what you received your degree in. You have no respect for your profession. The best thing you could do, is give up your DO title because you do not deserve it.
     
    #20 medicine1, Dec 19, 2008
    Last edited: Dec 31, 2008
  21. Animus

    Animus I won't deny it...
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    You are a moron. You think someone with a differing view from your own does not deserve something. Welcome to the land of bigotry. Perhaps you could enlighten us to some of the terrible reasoning you went through to arrive at this conclusion.
     
  22. wingbowlchamp3

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    i think the advice from the dean at pcom is the best advice for getting whatever residency you want...

    "do the best you can every time you interact with curriculum"

    i worry the only reason people try to figure out what's not important is so they can blow that off. they're trying to take "the path of least resistance" or "the easy way out" instead of just working hard all the time. my evidence for this is everyone tries to downplay the importance of the most difficult thing to accomplish in 1st/2nd year and maybe all of medical school...getting consistently good grades.

    even if residency programs don't look at pre-clinical grades...it's your first and best opportunity to learn medicine...and the smarter you become...the better you'll do on boards and rotations.
     
  23. bigDinLV

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    One huge thing here, we are talking about people in the bottow half of their class. These are people that may not get the interviews or positions that they really want otherwise. The fact they may be a weaker applicant on paper, but possibly awesome in person. To these applicants it is more important to get out there and rotate at programs. Now if someone was in the 99th percentile then they may very likely have their choice of programs even if they did not rotate there.

    Now there is some common sense food for thought. I can't tell you how many times I have heard things from a Dean that just don't work out in reality.
     
  24. Bleurberry

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    great post, thanks.
     
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  25. bigDinLV

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    One of the most unfortunate things about our profession is that we have people such as yourself that discredit us and try to make the things we do seem inferior, from the inside.

    You should have went to a MD program my friend.

    I'm more than willing to bet that you are a person that went straight from high school, to college, to med school with your parents taking care of things along the way. No sense of pride for your brothers that have had to work and struggle every bit of the way. I was a Marine Corps rifleman for a while. Now let me tell you what it means to truly have a sense of pride in what you do and a sense of brotherhood, back then your life was truly in the hands of someone else. I still carry something similar to that today, perhaps it is our patients lives though. I see all of the DO's out there as my co-workers, my DO family, my freinds. (granted, I am actually not an OMM lover, but everything has it's place). Even if you disagree with things, sometimes it is better to keep them to yourself rather than cut down my profession internally. Plus, shouldn't you want a little pride in what you do yourself? I'm proud of what we do, IMO we can actually hang with the MDs, at least the people I know can.
     
  26. zmeister22

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    First of all, the AOA has not lowered the bar. They have their own bar on their own jungle gym. MDs and DOs are both doctors. Done deal.

    Whatever. I think whatever each program decides to accept is fine. If you want to apply to a program that only takes USMLE, take the USMLE. If you only take the COMLEX, don't complain about programs that don't take you. Their program, their choice.

    About taking away someones DO degree... serious?. All physicians-in-training will receive training that is not relevant to their chosen specialty. Just because you learn how to do something does not mean that you HAVE to use if when you get to your profession. It is yet another tool in our bag of medicine and if everyone doesn't whole-heartedly embrace what you hold dear, who cares? They are practicing medicine for themselves, not for you. Don't berate, but don't expect everyone to do the same thing.

    Best quote I have every heard: "People don't care if you are a DO. People don't care if you are an MD. They do care if you are dumb. Don't be dumb."


    Now, about being in the lower half of the class... I am a little nervous, but my grades will speak for themselves. Our transcripts show percentages, not just HP/P/F. I have received all As and Bs, except one C (78%). I am pretty sure that I am in the bottom of the class. This year's program is excelling. Are average GPA and MCAT scores are the highest yet for the school, and test scores are phenomenal. For the last three years, the average on the anatomy final (because of the 7 tests in two weeks) has been between 65% and 71%. Our class got 83%. We consistently perform well. Even with my good grades, I'm pretty sure I'm not in the top half, as all but 2 of my A grades have been below the class average.
     
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  27. Lamborghini1315

    Lamborghini1315 Sleep deprived
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    How do grades in school accurately reflect your knowledge huh? Most of the stuff you are presented in medical schools are presented in powerpoints with slides that might have a few buzz words that really hold weight. How many people really read text books? How many of you really put in time doing questions? How many of you really understand the pathophys of a presented topic? How many of you really spend time going over material you screwed up on? I mean there are a lot of gaps in medical school grading..the stuff will reflect your ability to retain massive amounts of material and your ability to understand the body of work without any level of absolute proficiency! If you said yes to some of my questions than you will be ok in the longrun simply because you have invested time where it really matters and will fetch you during board time. In DO schools you have an extra subject called OMM to account for there's more time being spent memorizing more slides, more practicals and perhaps compromising some time spent memorizing your biochem. So whatever grade you might have on biochem is that an accurate reflection of your true grade? My point is that class grades are just a test of your ability to handle professional work load, rotations won't be any easier but it doesn't tell me if you have truly mastered medicine compared to someone that has..hence we have boards. I will take you seriously if you did great on your boards compared to your class ranking, i mean it! I must add its easier to get an A in any of your medical school courses but its not even close when you have to replicate that on boards..if you can't integrate everything you have learned and put it all together on the beast, you are kidding yourself if you claim oh i had an A on cardio i wonder if boards truly reflect my knowledge.
     
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    #27 Lamborghini1315, Dec 20, 2008
    Last edited: Dec 20, 2008
  28. bigDinLV

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    ^^^^^ Yea, we all take at least the COMLEX.
     
  29. theraball

    theraball Panned
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    op, you will want to work toward the specialty that you choose. If you choose, say, radiology, then you should be working toward that goal wholeheartedly because of the competitive nature of the specialty. Try to get a summer research position in radiology, for example, and try to rotate at the facilities that you would most like to apply to.

    Regarding top half, bottom half, DO vs MD: be the best doctor you can be. It's the old story. Work hard in class, do your personal best on the national boards, and get excellent recommendations. There's nothing more you can do (or should be expected to do).

    OMM is a specialty of osteopathic physicians. In the old days, it's probably true that DOs were seen as a sort of last choice to fill a slot, but increasingly, allopathic physicians are recognizing OMM as a valuable asset that you bring to their programs. I know of several people who have reported such an experience in their residencies.

    But if you go into your allopathic residency interview and say, yeah, I blew off OMM because I'm an MD wannabe and OMM is a total waste of time, well, I would hope that an intelligent program director would dismiss your application immediately because you have demonstrated intellectual dishonesty toward yourself and your profession.

    I've heard it said by more than one physician that they would never want one of the top 10 in their graduating class for their doctor. What does that say about the cut-throat nature of the profession at the topmost levels?

    The other day our school had a free buffet lunch for the students. When they opened a second line, a few students ran to be first in line. Crass. At orientation I saw one guy cut in line when the opportunity presented itself. I have little doubt that these same students obsess over class rank and competitive position regarding residencies--and will probably do whatever it takes to get in.

    On the other hand, I know students who get solid C's and B's and are warm, compassionate, intelligent people who will make excellent physicians someday. Will they be dermatologists or plastic surgeons? Probably not. Will they make a difference in the world? Definitely.

    Best of luck,
    TB
     
  30. JeffLebowski

    JeffLebowski Just got Nard-dogged
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    For the record, there's nothing mutually exclusive about being a good doctor and having a high class rank. I realize you're highlighting the fact that a lot of the stuff that makes up a "good doctor" has nothing to do with GPA, but it's kind of a residual naive premed mentality to imply that it's one or the other.
     
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  31. theraball

    theraball Panned
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    Well, I wasn't trying to say that it has to be one or the other (good doc versus high class rank). But there is a fair amount of anecdotal evidence that gunners don't make the best docs.

    But let's just say for the sake of argument that you're right--students with top grades can and do make great docs, the kind who are willing to work in a rural community or an inner city district with disadvantaged populations. The kind who aren't in it for the money. The kind who have great social skills, are genuinely interested in their patients. The kind of whom people say "I love my doctor".

    Now, does that sound like the top crust of gunners at your school? The ones who run to the front of the line, and are always first at the exam review challenging every answer? The ones who are unavailable to help?

    Or by great docs, would you mean the ones who make ace surgeons and top notch radiologists? There's quite a spectrum of professions under the medical umbrella.
     
  32. Lamborghini1315

    Lamborghini1315 Sleep deprived
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    Why make generalizations?!? Just like there can be dumb cocky doctors there can be intelligent down to earth type's. Doctors come in all shapes and styles..your gunning mentality or laid back i am ok with passing styles doesn't determine your makeup as a clinician. If we all just wanted compassionate docs with poor grades can you imagine how many malpractice lawsuits this country has to deal with, how many cancers that might go unnoticed? While if we all just had bunch of smarty pants with no heart can you comprehend ever being taken care of when your cardiac output is down the drain or you just been told the most devastating news of your life? So yea there can be extremes but there are also plenty of docs that bring the best of both worlds.
     
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  33. theraball

    theraball Panned
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    I agree with 97% of your posting :)

    But I would argue about the ones with lower grades being more likely to misdiagnose. There are plenty of counter-examples, and the hot shots sometimes are so important and busy that they may not spend that extra five minutes with the patient to get to know them and pick up those extra hidden nuggets of medical history that can be so critical. I've had personal experience with this. Then there's the whole thing about people who have to struggle harder in med school to make it through tend to be the ones who are most passionate about doctoring.

    But, as you say, generalizations are dangerous. I'd rather be Dr. Welby than Dr. House, myself, but there's room for both in this world.
     
  34. andexterouss

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    I understand the point you are trying to make but in my limited experience, doctors like Dr. House(genius smarts) are mostly in academic medicine and regular folks don't have access to them anyway unless they have a unique case/prognosis.


    Also money talks. I remember when I was on some ****ty insurance, the doctors treated me like a "number". Basically, I sat in the waiting area for over 40 minutes before I could be seen and when I was seen, it was a quicky(hurried out). Couple of years later, as I got a much better quality insurance and job, I barely spend 5 minutes waiting and most of the services have been great. The doctors treated me(or my wallet) with great respect and care. Personalized medicine is on the rising since people are beginning to realize the economics of medicine:You can get all the care and compassion you want from your doctor.......all at the right pri$$e. Think about this last paragraph carefully.
     
    #34 andexterouss, Dec 23, 2008
    Last edited: Dec 23, 2008
  35. zmeister22

    2+ Year Member

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    Please keep in mind the correlation between compassion/communication and malpractice suits.

    http://www.nextwave.info/whitepapers/Malpractice-Communication%20with%20the%20Patient2.pdf

    Compassion and communication are actually going to be your best tools against malpractice.
     
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  36. BCLumas

    BCLumas Member
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    Although emotional, I believe Lamborghini is onto something here. From what I understand about medical school exams, they are designed in such a way that they will be "Board-style questions." They require not only comprehension of the material, but oftentimes a dissection and integration of the material presented to you. A typical medical school examination might present like this:


    • 50% of the questions are simple "Comprehension"
    • 20% of the questions are simple "Integration"
    • 10% of the questions are challenging "Dissection/Integration"
    • 10% of the questions are challenging "(n+1)-Ordered"
    • 10% of the questions are complex "Dissection/Integration-(n+2)-Ordered"
    Albeit arbitrary, it presents a valid argument and a complement to Lamborghini's ideas. Students that are simply able to comprehend the material but not integrate it into simple clinical understanding oftentimes do poorly or underpreform. From there, students that are able to simply integrate the ideas together, but have not yet grasped an understanding of complex integration and dissection of material might find it a bit harder to excel at a particular exam. This trend continues in such a way that the students that consistently score in the top percentile (mid-80s to high-90s) have gained a more full understanding of conecpt-integration. When board exams arrive, oftentimes, those students who were able to allign and have a working understanding of the material they learned over the course of 2 years score higher. Conversely, those students which tend to underachieve and underpreform do not generally score as well. Is this true of all students? Absolutely not. However, as an overall trend, I think they correlate well.

    So, to get the point of the OPs conversation: the lower your class rank, the lower people tend to do on Board exams. With lower exam scores, oftentimes to only place to match (or scramble) is into primary care. I think that the best way to avoid such a scenario is to work as hard as you can without burning out and do as well as you can. This obvious advice may seem simple, but, as was aforementioned, the volume of material presented to you comes just short of consuming the entire Milky Way--and I don't mean the candy bar.

    Good luck.
     
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