Step 2 ck score raised...

[Elisabeth Kate]

Except in this case, it's actually true. Before you could graduate med school, do a 1 year internship, and set up shop. There's no way you can do that now. Requirements have been going up ever since.

True, and that one-year internship involved 120 hours a week instead of the new 16-hour rules for interns. What I'm saying is that medical training has and always will be hard. Everyone thinks they have it the worst, but the truth is that when you're going through it, you can't imagine how anyone could ever have a harder time.

In 10 years, it could take 5 years of residency (with reduced hours) and paying tuition to the hospital to become a FM doc and those interns will laughing at us for having it so easy.

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[Psai]

Let's be real, most people weren't posting up 120 hours a week unless they were neurosurgery or something like that. And those 120 hours a week had fewer patients who were less sick and less bs documentation involved.

 

[DermViser]

True, and that one-year internship involved 120 hours a week instead of the new 16-hour rules for interns. What I'm saying is that medical training has and always will be hard. Everyone thinks they have it the worst, but the truth is that when you're going through it, you can't imagine how anyone could ever have a harder time.

In 10 years, it could take 5 years of residency (with reduced hours) and paying tuition to the hospital to become a FM doc and those interns will laughing at us for having it so easy.

Uh, no. People were MUCH less sicker back then, and only certain specialties were pulling 120 hour weeks - definitely not FM.

 

[Elisabeth Kate]

Let's be real, most people weren't posting up 120 hours a week unless they were neurosurgery or something like that. And those 120 hours a week had fewer patients who were less sick and less bs documentation involved.

Not true. The long work hours in many specialties were under scrutiny when the work-hour changes first implemented in the early 2000s. It's ridiculous to assume it was only happening in neurosurgery.

Uh, no. People were MUCH less sicker back then, and only certain specialties were pulling 120 hour weeks - definitely not FM.

No one said FM was working 120 hours a week. And where are either of you getting that patients were "much less sicker back then"? Once again, you're proving my point. Every generation thinks they have it worse than others.

 

[DermViser]

Not true. The long work hours in many specialties were under scrutiny when the work-hour changes first implemented in the early 2000s. It's ridiculous to assume it was only happening in neurosurgery.



No one said FM was working 120 hours a week. And where are either of you getting that patients were "much less sicker back then"? Once again, you're proving my point. Every generation thinks they have it worse than others.

Are you kidding me? Everyone (except apparently you) knows that back in the 60s - that people were much less sick than they are now when a person has at least 5 comorbid conditions. Look at the rise in obesity-related illnesses which were virtually low in frequency back generations ago. We also didn't have as advanced treatments back then. Perfect example: coronary artery bypass. People are living longer now, so what would have taken out someone before, no longer does. Are you purposefully being obtuse?

 

[Elisabeth Kate]

Are you kidding me? Everyone (except apparently you) knows that back in the 60s - that people were much less sick then they are now when a person has at least 5 comorbid conditions. Look at the rise in obesity-related illnesses which were virtually low in frequency back generations ago. We also didn't have as advanced treatments back then. Perfect example: coronary artery bypass. People are living longer now, so what would have taken out someone before, no longer does

Exactly, we didn't have advanced treatments, which means that people with COPD, DM, CHF, and all the other frequent fliers we see these days were hospitalized in just as bad or worse condition. Sure, they may have more co-morbid illnesses these days, but that doesn't mean they're necessarily sicker than they were then. Doctors were just as busy then as they are now.

Are you purposefully being obtuse?

Your standard line whenever someone doesn't agree with you because God forbid your opinion not be universal.

 

[Psai]

Dude have you even seen the graphs that show the rise in obesity trends? People are living longer with more and better medications. That means that when they get sick, they will be way more sick with a bunch of comorbidities. Which specialties were pushing 80+ hours before the work hour restrictions?

 

[DermViser]

Exactly, we didn't have advanced treatments, which means that people with COPD, DM, CHF, and all the other frequent fliers we see these days were hospitalized in just as bad or worse condition. Sure, they may have more co-morbid illnesses these days, but that doesn't mean they're necessarily sicker than they were then. Doctors were just as busy then as they are now.

Yes, we didn't have many advanced treatments back then, and people died much sooner. People didn't live up to 90 years old with reams of adding comorbidities, which makes one sicker and less likely to recover. The frequency of those illnesses, in general, and thus the sequelae of those diseases was much less. Combine this with the now aging of baby boomers and yes, people coming in are much sicker now than they were in 1960.

Dude have you even seen the graphs that show the rise in obesity trends? People are living longer with more and better medications. That means that when they get sick, they will be way more sick with a bunch of comorbidities. Which specialties were pushing 80+ hours before the work hour restrictions?

I think you're referring to this, which has an excellent map of how much obesity has become a problem.
http://www.cdc.gov/obesity/data/adult.html

 

[Elisabeth Kate]

Dude have you even seen the graphs that show the rise in obesity trends? People are living longer with more and better medications. That means that when they get sick, they will be way more sick with a bunch of comorbidities

What it means is what it's always meant -- people will get very sick, some more than others. I will concede that a person with COPD and comorbidities is likely to get much sicker than a person with COPD alone. However, we have better medications and better treatments these days, so a person with a COPD exacerbation these days doesn't necessarily get as sick or sicker than a person with a COPD exacerbation in the 1960s.

Which specialties were pushing 80+ hours before the work hour restrictions?

You're not the least bit familiar with the history of work hour restrictions, are you?

https://www.acgme.org/acgmeweb/Portals/0/PDFs/jgme-11-00-5-11[1].pdf

 

[Psai]

I'm still not seeing the whole 120 hour work week that you brought up

 

[NotAProgDirector]

N=1, but I did my training in the mid-late 1990's, before any work hour limits, in Internal Medicine. I routiunely worked 100-120 hours, q3 call with a full post call day (i.e. 36 hour shifts). All documentation on paper, so no notes to copy, had to write everything out. All D/C summaries were dictated, which meant that you couldn't start them earlier and finish at discharge. No patient caps, so rountinely managing 12-15 patients as an intern, 25-30 as a resident.

So, I think it is true that patients have become more ill over time, and more complicated. I can't speak to the 1960's. But back then q2 call was common which sounds pretty horrible.

So why don't we all agree that training as a resident is hard. It's pointless to try to describe what is "harder". Volumes have come down, but complexity has gone up. Work hours have gone down, but now is spread more evenly (i.e. night shifts often added during elective blocks).

 

[Elisabeth Kate]

I'm still not seeing the whole 120 hour work week that you brought up

Read more. Google is your friend. You asked me "which specialties were pushing 80+ hours before the work hour restrictions?" and that document makes it clear that quite a few did. If all your questions aren't answered, then I suggest researching it.

N=1, but I did my training in the mid-late 1990's, before any work hour limits, in Internal Medicine. I routiunely worked 100-120 hours, q3 call with a full post call day (i.e. 36 hour shifts)

How's that for you @Psai? If you read enough about the work hour history, you WILL see stories like @aProgDirector's.

So why don't we all agree that training as a resident is hard. It's pointless to try to describe what is "harder". Volumes have come down, but complexity has gone up. Work hours have gone down, but now is spread more evenly (i.e. night shifts often added during elective blocks).

Well said.

 

[Psai]

Except aProgDirector has actually lived it instead of being a DO student that just comes onto allo to argue random things that no one cares about while being generally unpleasant to everyone.

 

[Elisabeth Kate]

Except aProgDirector has actually lived it instead of being a DO student that just comes onto allo to argue random things that no one cares about while being generally unpleasant to everyone.

Did I ever say I lived it? You don't have to go through something personally to know it existed. I said it happened. You challenged that. I showed you evidence of specialties pushing the 80-hour mark even after the rules were changed and you still challenged it, at which point I told you to research it on your own. I don't think any of my posts were out of line.

And since when is the allo forum restricted to only allo students? And FYI, I reply to posts directed at me, especially when the person posting is wrong (as you so often are). If you consider that being unpleasant, so be it. There's an ignore function on this forum. Use it.

 

[tco]

The necrobumps that have been popping up throughout the past few weeks make me long for the old days. What the heck is happening in this thread?

 

[Psai]

This happens in every thread elisabeth graces. Probably has something to do with an inferiority complex

 

[Elisabeth Kate]

It's interesting that you accuse me of inappropriate behavior, yet you're the one personally attacking me instead of actually replying to posts in this thread. I could have sworn that was a TOS violation.

 

[Smurfette]

This thread is supposed to be about Step 2 CK scores. Please keep it on topic from this point on.

 

[link2swim06]

I think test scores are raising in part to more efficient learning.

20 years ago you couldn't wikipedia something in 5 seconds and figure it out. It might take 5 minutes looking it up in a giant book.
Likewise there wasn't a uworld qbank which teaches you how to take the test. It was basically listen to lectures, read a textbook and then take the test.

I don't think that is all of it....the landscape IS getting more competitive but it is certainly multifactorial.

 

[DermViser]

I think test scores are raising in part to more efficient learning.

20 years ago you couldn't wikipedia something in 5 seconds and figure it out. It might take 5 minutes looking it up in a giant book.
Likewise there wasn't a uworld qbank which teaches you how to take the test. It was basically listen to lectures, read a textbook and then take the test.

I don't think that is all of it....the landscape IS getting more competitive but it is certainly multifactorial.

Mainly due to more resources, whether they be review books, Qbanks, and of course the Internet to clear up confusion and misconceptions. Heck 20 years ago, First Aid probably didn't exist.

 

[BobbyB]

we are just smarter than all previous generations

 

[tco]

Mainly due to more resources, whether they be review books, Qbanks, and of course the Internet to clear up confusion and misconceptions. Heck 20 years ago, First Aid probably didn't exist.

Like I said...Stop using UWorld, people!

I did see a First Aid for step 1 from quite a few years ago. Not sure of the year, but I'm thinking it was about a decade old. It was about the size of the biochemistry and maybe one or two organ sections put together.

 

[Elisabeth Kate]

Likewise there wasn't a uworld qbank which teaches you how to take the test.

This is the main thing. Imagine taking Step 1 without UWorld or NBME practice exams.

 

[Psai]

I think test scores are raising in part to more efficient learning.

20 years ago you couldn't wikipedia something in 5 seconds and figure it out. It might take 5 minutes looking it up in a giant book.
Likewise there wasn't a uworld qbank which teaches you how to take the test. It was basically listen to lectures, read a textbook and then take the test.

I don't think that is all of it....the landscape IS getting more competitive but it is certainly multifactorial.

Uworld has been very valuable for me, now I can tell you everything there is to know about turner's syndrome such as the cystic hygromas, 45,x, shield chest, streak ovaries, etc. as well as for cystic fibrosis and its position 508 phenylalanine deletion, poor molecular folding that keeps the channel from getting to the membrane, that it's an ATP binding cassette protein, all of which I'm sure will be high yield for the boards and wards.

 

[NickNaylor]

Uworld has been very valuable for me, now I can tell you everything there is to know about turner's syndrome such as the cystic hygromas, 45,x, shield chest, streak ovaries, etc. as well as for cystic fibrosis and its position 508 phenylalanine deletion, poor molecular folding that keeps the channel from getting to the membrane, that it's an ATP binding cassette protein, all of which I'm sure will be high yield for the boards and wards.

We talk about these things everyday on rounds regardless of specialty. Don't worry, it's totally worth.

 

[DermViser]

We talk about these things everyday on rounds regardless of specialty. Don't worry, it's totally worth.

You owe me a new monitor.

 

[DermViser]

Uworld has been very valuable for me, now I can tell you everything there is to know about turner's syndrome such as the cystic hygromas, 45,x, shield chest, streak ovaries, etc. as well as for cystic fibrosis and its position 508 phenylalanine deletion, poor molecular folding that keeps the channel from getting to the membrane, that it's an ATP binding cassette protein, all of which I'm sure will be high yield for the boards and wards.

I loved the MS-3 idiots who used MS-1/MS-2 diseases as part of their differential. They thought quite highly of themselves, not realizing the residents and interns were laughing behind their back.

 

[KinasePro]

This is the main thing. Imagine taking Step 1 without UWorld or NBME practice exams.

I don't know, I still think there is a lot of placebo going on with the different Qbanks and NBMEs. On both of my step exams, I walked out feeling like Uworld and the NBMEs were only mildly helpful at best. Maybe it's helpful bc it forces you to review all the material and reminds you where you are weak. But in terms of duplicate or near-duplicate questions/concepts showing up on the real deal, it's very low yield. I did very well on both steps using the Qbanks, but I also know multiple people in my class who got >250 without touching them.

IMO first aid is the real game-changer. The boards would be unfathomably difficult if we didn't have a resource like that to put our faith in.

 

[Nidor]

.

 

[Elisabeth Kate]

I don't know, I still think there is a lot of placebo going on with the different Qbanks and NBMEs. On both of my step exams, I walked out feeling like Uworld and the NBMEs were only mildly helpful at best. Maybe it's helpful bc it forces you to review all the material and reminds you where you are weak. But in terms of duplicate or near-duplicate questions/concepts showing up on the real deal, it's very low yield. I did very well on both steps using the Qbanks, but I also know multiple people in my class who got >250 without touching them.

IMO first aid is the real game-changer. The boards would be unfathomably difficult if we didn't have a resource like that to put our faith in.

I think a lot of this depends on what kind of tests you're used to and what kind of test taker you are. If your school is giving you rote memorization questions (as some here claim), then having UWorld to get used to application questions is imperative. Also, many learn from being quizzed as opposed to reading. Myself, I never got through a full read of First Aid. I just don't learn like that. I skimmed here and there and read parts of the chapters I was weak on, but it was UWorld that really nailed down the concepts for me.