Preclinicals: What's the real difference between studying science/for boards and studying to be a "good" physician? (And Poll)

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A (preclinical) medical student pursuing primary care & earning A/B's should largely be focusing on

  • classroom material that'll prepare them for Step 1, boards scores, "grades"

  • clinical skills, dx/tx/etc, being a "good"/well-rounded doc even at the expense of better GPA/boards

  • The two above are *mostly* one and the same; You can't significantly choose/study one over the other

  • The difference is moot given their grades; they're likely sufficiently prepared in both areas

  • ALSO: (I'm an attending/resident)

  • ALSO: (I'm non-clinical faculty, a PhD, admissions officer, etc.)

  • ALSO: (I'm other)

Results are only viewable after voting.


Poll assumptions (in case it changes your response):
-I tried to frame a successful but fairly average medical student, not pursuing a competitive specialty which would obviously require different priorities. I'm looking for what you'd have a typical, ideal medical student do.
-The student is striving to be considered an excellent physician by future peers and patients (private practice, non-academic)
-The student will study class material while in school and only study "for boards" during their dedicated study time of 4 weeks.
-The student is healthy and satisfied with life/school balance, not overly stressed by boards or schoolwork
-Assume their social/people skills are normal/fine

And the thread title question:

This comes up a lot in person at school but less so on SDN, I thought it deserved its own thread. At school PhDs will say, "the more you know about [this biochem/immuno/whatever science topic] the better physician you'll be," while in surgery/internal med classes and doctoring courses some doctors will (only somewhat jokingly) say, "None of that really matters," (understanding that they mean beyond passing and in general doing your best). And since most people agree that there's too much material in medical school to learn it all perfectly by rotations/residency, where should students focus their effort?

So what is it? How can students become the best doctors starting in preclinicals? Assuming already a 3.5+ GPA.

I'm led to believe given what those doctors say and that boards are becoming pass/fail that there is such a distinction between preclinical success on paper and being the best doctor in the future. Also I do think that the student in the poll (asking for friend/definitely not me) is in a position to just keep up their study schedule (if not relax a bit about biochem grades, etc) and practice physical exam skills or take that time to actually read the internal med text and not just study lecture (which itself affords A's/B's in the class), or practice doctoring skills or I dare say, OMM, more often than just the night before the test or patient encounter (again, enough for A's but practice would be more useful in the clinic). After all, if they're getting A's and B's in their classes, god forbid they take some time to do the fun stuff too, right? Or am I wrong and that they wouldn't gain much out of that given their GPA and likelihood of passing boards?

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Your preclinical years are for the knowing of Medicine

Your clinical years prepare you for residency and the doing of Medicine.

You learn your craft in residency.
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Practicing taking bp 50 times on each other won’t make you a better doc.
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A mentor once told me, “To be known as a good doc you have to connect with your patients, to be a great doc you have to connect with your patients and you have to know your ****”
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The best indicator is likely your fake empathy score from SP encounters.
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I mean, being a good internist requires a pretty strong and solid understanding of physiology and pathophysiology. Certainly I've forgotten the biochemistry of most systems I'm not directly interested in, but knowing their function makes it easier to understand a disease process and why it presents the way it does.

Remember that medicine isn't a trade. We're not teaching you to be able to do something. We're training you to be able to read and understand the situation comprehensively and then to do something about it. I can teach you the short hand of a complex disease. But until you really get it, you're going to be constantly looking for someone to make sure you're not missing something.
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You are way overthinking this friend.

Preclinical years your task is to learn as much as possible.

Clinical years your task is to learn as much as possible, but it's also about finding a way to do that without burning yourself out after a long day in clinic/inpatient. It's also about how you can communicate effectively with the medical team, working well with staff and patients, and learning to be comfortable with the gray areas of actual practice.

-On gen surg you'll learn the hardass surgeon may not do things the most up-to-date because he prefers the way he learned it and will skewer you for pointing it out

-On psych you'll see that some psychiatrists like the DSM-5, others will argue it doesn't actually exist and that nothing is real, and the 50 other factions in psychiatric theory never agree

-On IM you'll learn more about a single disease than you thought possible, only to realize that there are 20 more subsections of it that you had no idea existed. You will also have 15 patients on your team census and your attending will (at least pretend) to know everything about all of them because all of IM are sensitive but wonderful nerds

-On OB you'll see your attending bend the criteria for prescribing a certain birth control because they believe the risk of pregnancy outweighs the risk of increased bleeding. You'll also see why so many OBs are divorced when you're forced to study at 4am on your L/D rotations

-On EM you'll learn that some days are 90% lazy and others are 100% life and death and others are a feast/famine mix of both... but regardless every other department will crap on EM each and every day for not doing things exactly the way they want it

-On derm you'll learn that smart, rich, and outlandishly beautiful people who have it all really do exist and their biggest problem is deciding how little they want to work for however much money they decide. Meanwhile your problem in this context is that you likely will never be them

-On urology you will make penis jokes and do cool surgeries and learn more about pee and kidney stones than you wanted to and you'll still love it

-On peds you'll learn that kids are strong, resilient, nearly unbreakable creatures that can bounce back from the worst terrors imaginable while their Karen parents are the weakest, most easily traumatized and finicky personalities who need IM haldol just to discuss getting a flu vaccine

-On ortho you'll learn a little bit about trauma, osteoarthritis, bench pressing, and who the Stryker Rep at your hospital is and you'll be able to wow the whole team by stating literally any medical/non-ortho related medical trivia that they all forgot

-On neuro you'll learn everyone has carpal tunnel, nerves are impossible to learn in a month, and that most workups for rare disorders and complex strokes have no good solution but hey wasn't it an interesting mental exercise coming up with the diagnosis?


A future PCP takes something from every one of these rotations and hopes it sticks with you into application season, residency, and beyond. You will learn more than you know and forget even more than you thought possible while relearning it more times than you would like to admit.

The key is being okay with that, ignoring people who make fun of primary care and it's many challenges, and aim to do the most good with what you got.
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I'm still open to hearing your thoughts..What did you have in mind?;)

Oh sorry i have a bad habit of choosing all poll options :bag::sorry:

I don't think preclinical years are useful other than learning clinical skills to prepare for clerkships. The lectures are usually crap and much of the learning is done with Anki + B&B + Pathoma + questions. For someone interested in primary care (and really for anyone since Step 1 P/F), learning clinical skills would be helpful
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