I think he is proposing that there is zero reason why we pay for the first 2 years of med school or even have it taught formally. Apart from gross and physical diagnosis everything I learn is on my own.
Most med students dont go to lecture and many study from review books. Why should it cost me $40,000 a year to sit in my apartment and read a review book?
Furthermore I think a handful of people could learn the first 2 years in less than 10 months if allowed to self study at their own pace. If I was given the option to buy a couple hundred dollars of review books and the ability to complete the first 2 years in 10 months I would choose that option.
Hell if it replaced it with the MCAT I could have just spent my senior year of college preparing for STEP 1 and then start third year right after college graduation.
I find it highly unlikely that true self directed study will get you what you need. The level of non-linear thinking required in the first two years is simply absent in undergraduate courses. We basically are left with two options - make a true "pre med major" which is significantly more difficult than normal majors. For example, I have a BS in chemistry. The people I graduated with who wanted to go work for a production lab for some random company like budweiser or some cosmetic or ag company did not need nor was it very likely that they would have succeeded in a curriculum oriented around 3rd and 4th order questions. If we left undergrad the way it is the physician deficit will explode. Most text books do not put the material together in a clinically useful way. Without having heard it from a professor in medical school, what is the likelihood that you would have thought to consider, for example, splenic artery bleeds with pyloric ulcers? Its a simple example and MAYBE you would get it. but if you just go through a gross anatomy book and arent constantly tested and reminded of 3d relationships you will fail as a physician. many mid-level practitioners do this. They have extensive "name that thing" tests, and then like to talk about how they go into further detail than the med students with their anatomy curriculum. This isnt true. I dont care if you can name the 5th order branches of CNV3. That is trivial but not really useful.
The ability to name every note on every fret of every string of a guitar does not grant you the ability to make music.
So we can expect students to master Chemistry and Calculus beforehand, but asking them to learn anatomy and physiology is just insane? Yea, ok. Glad we can arbitrarily draw the line between medical school and not medical school based on historic precedent and act like it's some inherent and obvious rule.
Medical education is the clinical component. Everything else is just foundations ; It's important stuff but I value learning the material over paying tuition.
as I alluded to in a previous post, we dont expect mastery of these things in undergrad. Most bachelors require a C average to pass, and most med students have a lower sGPA than cGPA. aside from the higher degree of weeding out due to using clinical basic knowledge (and it is.... USMLE will have a large amount of clinical vignettes and clinical correlations) as the entry exam we also lose roundedness which is something we look for in US medical students. Whether that is right or wrong is debatable (usually only to med students and even more by pre meds
) but if we want a step1 level knowledge at graduation then we are asking undergrads to provide a curriculum which can achieve that. I dont see this as practical
It's about learning the science of medicine while third and fourth year focus more on the art of medicine. Step 1 (and all other steps for that matter), as it has been pointed out on this thread, was/were designed to ensure "minimal competence" to practice medicine. Also, one can have very high step 1 scores with very little understanding of what's going on as it is seen on daily basis on the wards.
Stop it. I feel dirty whenever we agree
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The STEP 1 hasn't been used as a minimal competency exam since the day it was created. Why do you guys insist on staying in denial on its purpose? It evaluates your comprehension of basic science instruction from the first two years of medical school. It is the most important thing you do in four years of medical school and it is the single most important purpose of the first two years.
I have to be honest with you - I would highly distrust a doctor who didn't have a good understanding of the basic medical sciences. This is my major beef with mid level practitioners entering into solo primary care. What you are suggesting is that health care providers need only memorize a string of symptoms and basically turn into diagnostic machines. Input symptoms.... calculating... calculating.... output diagnosis. This is fine for most cases, but if we lost basic sciences we would be harming the patients that don't present normally or who dont' have enough primary literature describing them to land us in the proper diagnosis. As absurd as "House" is (and with as much flak as I stand to get for using this as an exampl lol) I DO ascribe to a technique that relies more on an understanding of the anatomy, phys, and pathology, than on a memorized list of mnemonics: SMART - Shuffling gaint, Mask-like face, Akinesia, Rigidity, Tremor. Cool, parkinsons. But if this is your primary go-to for diagnosis over the basic sciences and some clinical exam tools I think you stand to miss diseases until they are obvious and late. Clinical knowledge IMO should supplement the basic sciences. EBM, IMO is an example of how our clinical knowledge falls short of basic science. By that I mean that every time EBM shows we have been doing something stupid, had we possessed the basic science knowledge it would have been avoided all together. as basic scientific understanding expands we can do our job better by being on top of it and applying what we see in the clinic
So it's a bad idea because paying tuition magically makes you learn more and some people are incapable of learning without someone holding their? That's the argument? Remind's me of a comment on churches and garages by C.S. Lewis.
The first two years are about building a strong foundation in the material needed to learn clinical medicine. Step 1 is a test of competence and readiness to move on to the clinical part of our education, the part that actually makes the M.D. There's no reason that can't be done well through other channels than a classroom.
For many people, being freed from the constant inane multiple choice tests and memorizing the useless facts you'll forget 6 months later would leave them free to focus on the larger concepts and come out of the process more prepared. This isn't about a school being good or bad, it's about being free to individualize to your own rate and style of learning.
I'm sorry if some of you take your professional pride from how long you paid tuition for instead of by what you learned and what you were required to master...
Maybe it is my own experience.... but I think the "self study" people across the board are underestimating the amount of information they get from professors either through notes provided, recorded lectures, in-person lectures, or out of class question help. In addition there is a peer teaching component that most medical students take advantage of. To say your entire basic science medical training was done solo is highly unlikely. And if you happen to be an outlier or a prodigy of sorts, you forget that many people, myself included, thrive in an environment with shorter milestones. I don't think most people would do well handling all of the material of the first 2 years with the only goal being test day. If I'm right about this then your proposed plan would only serve to slash the number of graduating doctors by an unreasonable number.
