Quality of medical education

[tyrsa]

---

Members don't see this ad.

Is anyone else not fully satisfied with the quality of medical education? For instance, why is lecture quality for many of the lectures so low? Instead of relying on textbooks that are well written, it seems that med schools tend to rely on lectures, many of which are really really bad.

Is there a reason for this? Given that medicine is so important for society, shouldn't education quality control be rigorous?

 

[libertyyne]

Look at the amount of content the instructors need to give you during lecture. Now look at how many pages of text books you would have to read to get the same amount of information. It would be incredibly difficult to get all the material you need to cover out if they relied on textbooks. I bet iff you increased the duration of lectures by 3x you would get some ammazing lectures. Some one like Dr.Najeeb does exactly that his lectures are excellent but they are three times as long. I think the current predicament is to reduce the number of lecture hours and allow the students to spend the time figuring stuff out and learning at their own pace. just my .02.

 

[wanderingorion]

We are responsible for a larger portion of our own learning now. The lectures are a great overview/introduction, but we have to utilize our own methods and resources to learn.

 

[tyrsa]

@wanderingorion Yea, but the exams test materials from lecture, so we have to study them

 

[wanderingorion]

@wanderingorion Yea, but the exams test materials from lecture, so we have to study them

What I'm saying is that there are resources that cover the same material your lectures do, but explain things better.

 

[Osteoth]

Is anyone else not fully satisfied with the quality of medical education? For instance, why is lecture quality for many of the lectures so low? Instead of relying on textbooks that are well written, it seems that med schools tend to rely on lectures, many of which are really really bad.

Is there a reason for this? Given that medicine is so important for society, shouldn't education quality control be rigorous?

I honestly believe if I could have just been left alone for the first two years with the only requirement being doctoring + shadowing once a month or something I would have been better able to learn the material on my own.

Half the time I felt like the school was holding me back by forcing me to learn from terrible teachers.

Look at the amount of content the instructors need to give you during lecture. Now look at how many pages of text books you would have to read to get the same amount of information. It would be incredibly difficult to get all the material you need to cover out if they relied on textbooks. I bet iff you increased the duration of lectures by 3x you would get some ammazing lectures. Some one like Dr.Najeeb does exactly that his lectures are excellent but they are three times as long. I think the current predicament is to reduce the number of lecture hours and allow the students to spend the time figuring stuff out and learning at their own pace. just my .02.

I think a better this vs. that comparison would be to the various lecture sources out there. If I could have used Boards & Beyond + Pathoma alone during preclinicals I would have much better prepared for STEP & wards.

@wanderingorion Yea, but the exams test materials from lecture, so we have to study them

This.

What I'm saying is that there are resources that cover the same material your lectures do, but explain things better.

But don't include the minutiae, random tidbits & research topics that we are tested on. The choice becomes AOA/Class rank or learning the material/STEP1.

 

[libertyyne]

I honestly believe if I could have just been left alone for the first two years with the only requirement being doctoring + shadowing once a month or something I would have been better able to learn the material on my own.

Half the time I felt like the school was holding me back by forcing me to learn from terrible teachers.



I think a better this vs. that comparison would be to the various lecture sources out there. If I could have used Boards & Beyond + Pathoma alone during preclinicals I would have much better prepared for STEP & wards.



This.



But don't include the minutiae, random tidbits & research topics that we are tested on. The choice becomes AOA/Class rank or learning the material/STEP1.

This is a false dichotomy.

For the most part Preclinical Grades/Performance is correlated with board scores.
Predictors of Scoring at Least 600 on COMLEX-USA Level 1: Successful Preparation Strategies | The Journal of the American Osteopathic Association
A Predictive Model for USMLE Step 1 Scores

It is a larger hole to dig out of during dedicated if you are not excelling at your pre-clinicals. Is it possible? Sure. But if you asked me to put money on people who will do well on Step I would say the people who are doing well in class on average will do better.

 

[theonlytycrane]

The lectures at my school are hit or miss. Some are great- others are really bad. It also depends on the lecturer. Sometimes it's a PhD or clinician with an awesome presentation. Sometimes it's a PhD that seems mad about their life and bitter towards med students.

 

[Foot Fetish]

Without exception, I see the school curriculum as nothing but a nuisance that detracts from my actual learning. From my perspective, its sole purpose is to impede my progress in preparing for the boards. I am at the point now where I literally do not look at a single school lecture until 2 weeks before the final, at which point I begrudgingly cram all the school-specific minitua in order to pass. Thankfully I go to a true pass/fail school, so my grades literally do not matter as long as I pass. I think I would go insane if I had to seriously focus on school material.

 

[allantois]

You should have gone to LECOM

 

[Foot Fetish]

You should have gone to LECOM

You're too young to be having these discussions. Come back when you're the urachus.

 

[wanderingorion]

But don't include the minutiae, random tidbits & research topics that we are tested on. The choice becomes AOA/Class rank or learning the material/STEP1.

Ah, well we're unranked P/F preclinical years, so I wander a little bit, haha

 

[wanderingorion]

You're too young to be having these discussions. Come back when you're the urachus.

A+ joke.

 

[a_flei]

This is a false dichotomy.

For the most part Preclinical Grades/Performance is correlated with board scores.
Predictors of Scoring at Least 600 on COMLEX-USA Level 1: Successful Preparation Strategies | The Journal of the American Osteopathic Association
A Predictive Model for USMLE Step 1 Scores

It is a larger hole to dig out of during dedicated if you are not excelling at your pre-clinicals. Is it possible? Sure. But if you asked me to put money on people who will do well on Step I would say the people who are doing well in class on average will do better.

I'm not too familiar with the data, so maybe someone can enlighten me, but i would question the validity of a correlation bw grades and board scores. Have they accounted for self reports on time spent studying? I would imagine people with higher grades tended to spend more time studying for exams as well as for the STEP exams, right? Point being I would more readily believe the real causal factor is time investment/effort put into studying.

 

[Osteoth]

This is a false dichotomy.

For the most part Preclinical Grades/Performance is correlated with board scores.
Predictors of Scoring at Least 600 on COMLEX-USA Level 1: Successful Preparation Strategies | The Journal of the American Osteopathic Association
A Predictive Model for USMLE Step 1 Scores

It is a larger hole to dig out of during dedicated if you are not excelling at your pre-clinicals. Is it possible? Sure. But if you asked me to put money on people who will do well on Step I would say the people who are doing well in class on average will do better.

This is actually something I'm fairly serious about so I'll delve more into what I actually meant by that comment. Was a bit brief I apologize.

I'll start off with your sources. The first one is based on COMLEX and I'm an allopathic student so I'm going to ignore it. Its also kind of oddly written, I don't understand why they don't give you the correlation coefficients for the results in the introduction results section at the beginning of the paper... But alas. The second one actually showed a fairly weak correlation between preclinical grades & getting at least a 240 on USMLE Step 1 (r=0.356), so I don't really believe it proves the point you were trying to make. Both studies also have a very small study selection (<200 students), where the number of medical students in the US today is over 20,000, so obviously I would point to a low power.

Anecdotally, I feel like the way that medical education system is set up right now is inherently flawed because there's no fluidity, at least at my institution and the other institutions my friends are at (n=5). You might have 5 people giving you a COPD lecture and bringing out different facts (Histo, Anatomy, Path, Physio), that they feel are important. As a result for a student you often times don't realize whats actually relevant or important about that organ system, so when you get to dedicated you're forced to basically re-learn the material from a clinical and USMLE standpoint.

Obviously you could say that you should be doing questions on the side, but the point that you're trying to make right now is that you shouldn't need to, as long as you work hard during preclinicals and do well in your class exams that should be enough. But in my experience it can be, but at the same time it can also be a difficult road to walk if you're not someone who inherently picks things up quickly.

Ah, well we're unranked P/F preclinical years, so I wander a little bit, haha

Lucky lol.

 

[valid username]

I honestly felt the lectures we had were very high quality. I was amazed at the skill of most of the instructors as individuals, but also as a group. Lectures complimented each other quite well. I am an m4 and can still remember lectures from my 1st semester.

I'm an IMG btw.

 

[libertyyne]

This is actually something I'm fairly serious about so I'll delve more into what I actually meant by that comment. Was a bit brief I apologize.

I'll start off with your sources. The first one is based on COMLEX and I'm an allopathic student so I'm going to ignore it. Its also kind of oddly written, I don't understand why they don't give you the correlation coefficients for the results in the introduction results section at the beginning of the paper... But alas. The second one actually showed a fairly weak correlation between preclinical grades & getting at least a 240 on USMLE Step 1 (r=0.356), so I don't really believe it proves the point you were trying to make. Both studies also have a very small study selection (<200 students), where the number of medical students in the US today is over 20,000, so obviously I would point to a low power.

Anecdotally, I feel like the way that medical education system is set up right now is inherently flawed because there's no fluidity, at least at my institution and the other institutions my friends are at (n=5). You might have 5 people giving you a COPD lecture and bringing out different facts (Histo, Anatomy, Path, Physio), that they feel are important. As a result for a student you often times don't realize whats actually relevant or important about that organ system, so when you get to dedicated you're forced to basically re-learn the material from a clinical and USMLE standpoint.

Obviously you could say that you should be doing questions on the side, but the point that you're trying to make right now is that you shouldn't need to, as long as you work hard during preclinicals and do well in your class exams that should be enough. But in my experience it can be, but at the same time it can also be a difficult road to walk if you're not someone who inherently picks things up quickly.



Lucky lol.

Another interpretation of the issue you bring up regarding differences in content taught might be that the knowledge base is soo broad and large that different lecturers can provide you with different aspects of it and it is still not cover everything that the usmle can test on. There are often reports of high scorers indicating that board review materials did not cover everything that they were tested on , or that there were instances of tidbits taught in class that showed up on the exam. You can still teach different things and still be within the cannon.

Now as for the correlation, sure that study is not perfect. Here are bunch more that show correlations in similar or larger sample sizes some as high as .75!
https://pdfs.semanticscholar.org/3146/ee078b8e37423208af27d820bdf3aaf22a54.pdf
Military Medicine - International Journal of AMSUS
http://files.eric.ed.gov/fulltext/EJ919575.pdf
Medical gross anatomy as a predictor of performance on the USMLE step 1
https://members.aamc.org/eweb/upload/Are Questions the Answer PPT 11-6-12 10PM.pdf

So one could choose to either
1. Try to bust one's ass during preclinicals
2. Ignore the only available studies on the question and try out sticking to board review materials. I know where I am putting my stock in.

 

[Osteoth]

Another interpretation of the issue you bring up regarding differences in content taught might be that the knowledge base is soo broad and large that different lecturers can provide you with different aspects of it and it is still not cover everything that the usmle can test on. There are often reports of high scorers indicating that board review materials did not cover everything that they were tested on , or that there were instances of tidbits taught in class that showed up on the exam. You can still teach different things and still be within the cannon.

Now as for the correlation, sure that study is not perfect. Here are bunch more that show correlations in similar or larger sample sizes some as high as .75!
https://pdfs.semanticscholar.org/3146/ee078b8e37423208af27d820bdf3aaf22a54.pdf
Military Medicine - International Journal of AMSUS
http://files.eric.ed.gov/fulltext/EJ919575.pdf
Medical gross anatomy as a predictor of performance on the USMLE step 1
https://members.aamc.org/eweb/upload/Are Questions the Answer PPT 11-6-12 10PM.pdf

So one could choose to either
1. Try to bust one's ass during preclinicals
2. Ignore the only available studies on the question and try out sticking to board review materials. I know where I am putting my stock in.

I actually agree with you, but your sources are garbage for the most part.

Source 1. Correlates only with a single pathology class, evidence is lacking to your point.
Source 2. Correlates with the MCAT, which is irrelevant.
Source 3: Maximum correlation is 17%, which is obviously weak.
Source 4: This is a good source that supports your point, however again the sample size is tiny, n=<100.

 

[libertyyne]

I actually agree with you, but your sources are garbage for the most part.

Source 1. Correlates only with a single pathology class, evidence is lacking to your point.
Source 2. Correlates with the MCAT, which is irrelevant.
Source 3: Maximum correlation is 17%, which is obviously weak.
Source 4: This is a good source that supports your point, however again the sample size is tiny, n=<100.

I never said it was a slam dunk case, its just that combing through the pitiful literature there is consistent correlation with supposedly hetrogeneous populations being studied. It is the best information we have. I am still waiting on you to provide sources that disprove the "garabage" I have provided.

Edit, I would also look at the MCAT study you are writing off. They give a table with correlations and the it gives correlation between PCGPA and Step one as .75 with statistically significant results in a population of about 800.

 

[Affiche]

My NBMEs skyrocketed when I stopped going to class, stopped looking at lectures, and started using textbooks. It's much faster for me to read through a chapter of text than to try and dissect a ****ty disorganized ppt, and I understand the material better. I use board review sources to help outline my notes or for a quick, concise lecture of what I'm reading.

Any lecture or lab my school gives is laughably inefficient or downright unhelpful. Except it's not laughable yet because it still stresses me out lol.

 

[theonlytycrane]

My school is trying to move to NBME tests for all classes (it's in trial for M1 classes right now). Does anyone else feel a disconnect between these tests and the material presented in lecture? Maybe I feel that way because I haven't bridged the gap with enough NBME style prep questions for these tests (they are practice for us).

 

[deleted407021]

Most of my professors are great, with a few exceptions who stand out by comparison. With the not so great lectures, I rely more on supplemental material. For pathology, I basically transcribe detail from lecture into Pathoma then use that as my master resource for review. For pharm I use Sketchy and kind of ignore my PhD’s pet topics if they aren’t reflected in the board prep material. I find I can work out most of the board review questions I do for exam prep. If there’s something I don’t recognize, it goes into the margins of Pathoma.

The point is med school is really a self-taught process as far as the basic sciences go. Lecture is where I get detail to add to my better resources and make them more complete.

 

[Anti-PD1]

That's what I tell premeds, figure out what kind of learner you are and factor that into med school choice. Some med schools are more hands on than others.

But either way, everyone learns the same material in two years.

 

[Osteoth]

I never said it was a slam dunk case, its just that combing through the pitiful literature there is consistent correlation with supposedly hetrogeneous populations being studied. It is the best information we have. I am still waiting on you to provide sources that disprove the "garabage" I have provided.

Edit, I would also look at the MCAT study you are writing off. They give a table with correlations and the it gives correlation between PCGPA and Step one as .75 with statistically significant results in a population of about 800.

When you first posted "This is a false dichotomy" it definitely made it seem as though you were stating fact and it was a foregone conclusion. I'm more than willing to concede that I could be wrong, but at the same time based on the literature it has not been proven that the correlation you mentioned is fact.

Also, scrolled through the MCAT study you were talking about and you're right, they show a stronger correlation than I previously though. You'll have to forgive me for reading the title of the paper and thinking it was irrelevant, though the power (n=340), is still questionable in my opinion.

 

[Goro]

My NBMEs skyrocketed when I stopped going to class, stopped looking at lectures, and started using textbooks. It's much faster for me to read through a chapter of text than to try and dissect a ****ty disorganized ppt, and I understand the material better. I use board review sources to help outline my notes or for a quick, concise lecture of what I'm reading.
Any lecture or lab my school gives is laughably inefficient or downright unhelpful. Except it's not laughable yet because it still stresses me out lol.

That's what I tell premeds, figure out what kind of learner you are and factor that into med school choice. Some med schools are more hands on than others.
But either way, everyone learns the same material in two years.

My young colleagues illustrate that there is no single, one size fits all approach to medical education. All students, being adult learners have to figure out what works for them. This is especially crucial because you are expected to be life-long learners.

Affiche's experiences also illustrate why I despise mandatory lecture attendance policies.

Some MD schools faculty may be poor lecturers because they were hired to do research first and foremost and get grants. To them, teaching is a necessary evil that they have to get out of the way so they can get back into the lab. This may be why some of you get research minutiae instead of which structures are most important in pain transmission from the lower back, for example.

I have a tiny handful of colleagues who routinely get destroyed in student evaluations. I don't think that it's a coincidence that they're primarily research faculty here. But one of our top lecturers, who the students just love to pieces, has an R21 or an R03 grant right now.

I've seen clinical faculty get into trouble because they teach to the level of OMS4 or even resident level, when they should have been at OMSI or II.

Having some leeway or "slippage" in covering material is fine. Before I joined our current faculty, I was very junior faculty at IUSM and the Faculty at the eight different medical schools agreed upon a joint exam in our subject matter. 80% of the exam had to be identical. That meant there was a 20% variation in the material the students needed to know, because each faculty member will have different ideas as to what's important. Never was a handicap to the students.

The only way your faculty will improve will be to give them constant constructive criticism. But merely saying "Dr Jones sucks" or Dr Jones is boring" isn't going to help you or your future peers any.

 

[Newyawk]

I honestly believe if I could have just been left alone for the first two years with the only requirement being doctoring + shadowing once a month or something I would have been better able to learn the material on my own.

Half the time I felt like the school was holding me back by forcing me to learn from terrible teachers.



I think a better this vs. that comparison would be to the various lecture sources out there. If I could have used Boards & Beyond + Pathoma alone during preclinicals I would have much better prepared for STEP & wards.



This.



But don't include the minutiae, random tidbits & research topics that we are tested on. The choice becomes AOA/Class rank or learning the material/STEP1.

I think a major issue is that students spend 4-8 hours per day in lecture that 1. Isnt that great to begin with and leaves a lot of gaps in knowledge and 2. Doesnt help students who have trouble concentrating for that long.
All students are then required to go home and learn essentially 98% of the material on their own. The students who went to class maybe gained 2% over the others who ditched, but also lost 4-8 hours of their day. not to mention the stress and exhaustion that comes with sitting through that much.

Ive always thought it would be much more productive to have the lecturers actually teach the students 2-3 major concepts per lecture that are difficult to understand instead of just throwing everything they believe should be covered for that lecture at them. Youre learning cardio phys? Spend an hour actually going through the frank starling curve and explaining it well. Then 2-3 weeks later hold a session where you test their understanding.

 

[Osteoth]

I think a major issue is that students spend 4-8 hours per day in lecture that 1. Isnt that great to begin with and leaves a lot of gaps in knowledge and 2. Doesnt help students who have trouble concentrating for that long.
All students are then required to go home and learn essentially 98% of the material on their own. The students who went to class maybe gained 2% over the others who ditched, but also lost 4-8 hours of their day. not to mention the stress and exhaustion that comes with sitting through that much.

Ive always thought it would be much more productive to have the lecturers actually teach the students 2-3 major concepts per lecture that are difficult to understand instead of just throwing everything they believe should be covered for that lecture at them. Youre learning cardio phys? Spend an hour actually going through the frank starling curve and explaining it well. Then 2-3 weeks later hold a session where you test their understanding.

I mean I feel like they do that, but the issue is that the people who are teaching us the material don't have agency for the way we're expected to learn it.

I learned alot of physiologically interesting/useful information during M1, and alot of clinically useful information during M2 from my professors, but the way we were taught was not how I was tested on the USMLE, so it's kind of an odd way of learning for schools that don't teach to the test.

You have to think like a basic scientist for a year, then think like a clinician for another year, then think like a test-maker for a couple months. Its hard to change your mentality like that so quickly.

 

[Quizlet04]

I'm incredibly disappointed with the quality of education I'm getting in my M3 and M4 years. To be honest more than half the time I've been in a hospital or clinic, I've not been taught at all. Residents are busy or disinterested, many attendings don't care at all. If I'm lucky, I'm able to chase down something but the rest of the time I might as well stay home and watch TV.

On my ED rotation, I would often look at the board, go see a patient, give her a report and list of potential test, and if I was lucky draw the blood myself...except for the two attendings who didn't want to interact with me at all or felt medical student should only shadow.