There's no purpose to the first 2 years of medical school. Change my mind.

[Cassowary]

Really frustrated with all the mandatory classes my school requires so I needed to vent, ****post, and fantasize about my ideal medical school preclinical situation.

Why can't all medical schools:
-Assign UFAPS for years 1 and 2 and make learning entirely independent
-Never have a mandatory lecture
-Save us thousands of $$$ for all the resources this would remove the need for
-Probably have all the students destroy step
-Increase the productivity of PhD professors wasting their time with the same lecture year after year allowing them to pursue something more positive

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[manofsteel9]

What about this? Make med school two clinical years and replace the MCAT with STEP 1 for admissions. Saves everyone money and time.

 

[Obnoxious Dad]

The streaming video, the power points, and the outlines could be done better and cheaper by two or three competing companies. However, no one in a position of relevant authority cares about the delivery of efficient medical education because they know they have a ready supply of applicants to accept their terms. The deans and LCME don't care that some of you at the end of your residency will be $600,000 in debt. They might pay lip service to the problem, but what do they actually do about it?

You could have witnessed an analogous phenomenon in nursing education in the 1970s. Historically, most registered nurses trained on the job at hospitals for three years and earned a diploma which entitled them to take the nursing boards. In Michigan between 1967 and1970 nursing students at hospital based programs paid $500 per year for room, board and tuition while students in BSN programs paid three times as much per year and took four years to finish. Most older nurses, including BSNs, will tell you that these hospital trained nurses coming out of training could actually do a better job than new BSNs of taking care of sick people. Well the Nurse Ratched types who ran the BSN programs at four year colleges decide that effective, low cost nursing education had to go the way of the dodo bird. They pressured hospitals across the country to close their diploma programs. In 1970 there were 1,300 diploma programs and now there are less than 50.

 

[meronebib]

What about this? Make med school two clinical years and replace the MCAT with STEP 1 for admissions. Saves everyone money and time.

I don't know if sarcastic or not, but this actually sounds like a good idea.

 

[manofsteel9]

I don't know if sarcastic or not, but this actually sounds like a good idea.

No sarcasm- the only drawback to this idea would be the lack of cadavers for anatomy, but I think the recent development of VR/AR/holograms can be an even better option for anatomy and physiology education.

 

[theKingLT]

What about this? Make med school two clinical years and replace the MCAT with STEP 1 for admissions. Saves everyone money and time.

I support this except I think you would need some sort of financial support system. Like fafsa for step studying even though you're not technically in school.

 

[Goro]

Really frustrated with all the mandatory classes my school requires so I needed to vent, ****post, and fantasize about my ideal medical school preclinical situation.

Why can't all medical schools:
-Assign UFAPS for years 1 and 2 and make learning entirely independent
-Never have a mandatory lecture
-Save us thousands of $$$ for all the resources this would remove the need for
-Probably have all the students destroy step
-Increase the productivity of PhD professors wasting their time with the same lecture year after year allowing them to pursue something more positive

Are you at an MD school?

What penal colony is this???

Mandatory lectures are so 19th Century....med schools should NOT treat adult learners like children. You have my sympathies.

Alas, the problem with your idea is that then we'll have a generation of excellent test takers who have memorized everything and learned nothing.

The preclinical years aren't just about learning insertions and origins, or what oncogenes do, but about learning how to apply.

Medical knowledge is but one of six required competencies for both medical students and doctors. The other five are humanistic domains.

Strongly suggest that you show your curriculum deans the latest data about the efficacy of active learning and how it is superior to passive learning. This is why multiple schools have shifted to TBL or PBL curricula, even my DO school.

 

[NITRAS]

While I agree there are faults with meds schools, I think it’s a fallacy to believe that being good at STEP 1 means you are a good physician.

 

[ricksimmonsrafowens]

it grinds my gears that not all schools use NBME exams in MS1 & MS2. All schools should switch to NBME subject exams in pre-clinicals MS1 and MS2. No professor written exams since the NBME compose great standardized pre-clinical exams.

 

[7331poas]

does your school not do clinical skills during the first two years? Also there are other requirements that the AAMC requires in the first two years such as professionalism and wellness (which I know are bull**** but still).

Personally I def needed clinical skills and preceptorships before clerkship.

 

[Cassowary]

Are you at an MD school? Mandatory lectures are so 19th Century....med schools should NOT treat adult learners like children. You have my sympathies.

Alas, the problem with your idea is that then we'll have a generation of excellent test takers who have memorized everything and learned nothing.

The preclinical years aren't just about learning insertions and origins, or what oncogenes do, but about learning how to apply.

Medical knowledge is but one of six required competencies for both medical students and doctors. The other five are humanistic domains.

Strongly suggest that you show your curriculum deans the latest data about the efficacy of active learning and how it is superior to passive learning. This is why multiple schools have shifted to TBL or PBL curricula, even my DO school.

Yes, US MD student. Appreciate it but if I'm not mistaken, you're not a student but an administrator. And with all due respect, administrators are some of the most out of touch people with regards to what works best for us students. "learning" and "applying" is a false dichotomy. If you learn, you can apply. Also, those "humanistic domains" which schools work so hard to instill cannot be taught. You can't teach a robot social skills. Most people have them, and if you don't, then good f*ing luck.

While I agree there are faults with meds schools, I think it’s a fallacy to believe that being good at STEP 1 means you are a good physician.

Preclinicals is not about being a good physician.

 

[Dr G Oogle]

I think you need the knowledge gained in preclinical to practice as an effective; 3rd and 4th year are just about learning how to evaluate patients the first 2 years are about understanding disease processes and if you think that’s not useful than that can’t be helped. I do however think that US medical education should catch up to the rest of the world and skip the undergrad requirement and consolidate pre-residency education into 5 or 6 years. I’d also get rid of biochemistry.

 

[Goro]

Yes, US MD student. Appreciate it but if I'm not mistaken, you're not a student but an administrator. And with all due respect, administrators are some of the most out of touch people with regards to what works best for us students. "learning" and "applying" is a false dichotomy. If you learn, you can apply. Also, those "humanistic domains" which schools work so hard to instill cannot be taught. You can't teach a robot social skills. Most people have them, and if you don't, then good f*ing luck.



Preclinicals is not about being a good physician.

Administrator@!!!???

I'm no administrator....I work for a living. I teach medical students.

Given your attitudes here, you have yet to learn anything.

 

[7331poas]

Administrator@!!!???

I'm no administrator....I work for a living. I teach medical students.

Given your attitudes here, you have yet to learn anything.

faculty = administration

at my school, even some of the course directors play a role in voting for policies.

 

[DrDarce]

Theres less purpose to the first 2 years that you described. My first two years were fine. Lectures streamed online and not mandatory, weekly or biweekly mandatory events such as clinical skills or group case review, NBME final exams. You could essentially do what you're describing, UFAP and learn independently. Sounds like your school sucks donkey balls

 

[Goro]

faculty = administration

at my school, even some of the course directors play a role in voting for policies.

In my book, administration = Deans.

 

[Raney Schauer]

There's no purpose to the first 2 years of medical school. Change my mind.

I get zero value out of trying to change your mind. Change my mind.

 

[mvenus929]

it grinds my gears that not all schools use NBME exams in MS1 & MS2. All schools should switch to NBME subject exams in pre-clinicals MS1 and MS2. No professor written exams since the NBME compose great standardized pre-clinical exams.

I’d argue that MCQ should be replaced by essay style questions. Or oral exams. The NBME doesn’t need more money, and being good at Step 1 doesn’t make you a good physician.

 

[Terry Toma]

What about this? Make med school two clinical years and replace the MCAT with STEP 1 for admissions. Saves everyone money and time.

This wouldn't really save everyone money and time. Thousands of people would spend 1-2 years preparing for STEP 1 and then not end up getting into med school. I like having the gatekeeping up front so that you don't start down the path in earnest until you know with a great degree of certainty that you are going to become a physician. I definitely wouldn't want to jump into STEP prep without a med school acceptance in hand.

 

[Tenk]

Are you at an MD school? Mandatory lectures are so 19th Century....med schools should NOT treat adult learners like children. You have my sympathies.

Alas, the problem with your idea is that then we'll have a generation of excellent test takers who have memorized everything and learned nothing.

The preclinical years aren't just about learning insertions and origins, or what oncogenes do, but about learning how to apply.

Medical knowledge is but one of six required competencies for both medical students and doctors. The other five are humanistic domains.

Strongly suggest that you show your curriculum deans the latest data about the efficacy of active learning and how it is superior to passive learning. This is why multiple schools have shifted to TBL or PBL curricula, even my DO school.

I know when a patient comes into the emergency department a question stem always pops up and then I have to choose the best answer then it’s off to the next patient!

 

[mehc012]

I’d argue that MCQ should be replaced by essay style questions. Or oral exams. The NBME doesn’t need more money, and being good at Step 1 doesn’t make you a good physician.

Our school actually does this. We have only essay exams for preclinicals, and then we are required to take the practice NBME MCQs as well just for your own benefit to get used to the format, but those don't affect our grades. You could get 0% on the NBME and the admins would probably talk to you to make sure things were OK, but as long as you passed the essay test, you technically pass the block.

 

[LebronManning]

What about this? Make med school two clinical years and replace the MCAT with STEP 1 for admissions. Saves everyone money and time.

Literally the best idea ever

 

[Little Green Mensch]

My school had non-mandatory lectures, which were of varying quality. To their credit, our faculty and administrators were pretty active about soliciting feedback and attempting to improve things from year to year. Almost half our class time was spent on PBL/TBL with cases that dovetailed reasonably well with the lecture material and the anatomy curriculum. The bulk of our exams were predominantly NBME subject tests, but we had short-answer and non-NBME MQC tests as well.

Our clinical skills were reasonably well-taught, but our OSCE examinations were a little too focused on miming the appropriate technique as opposed to actually auscultating, etc. I wish we'd had more SPs with actual physical findings, or diagnosis rounds at the hospital, to keep people on their toes and better hone their physical exam skills.

On the whole, I thought my preclinical training did a very good job of preparing me both to sit the USMLE and perform reasonably well on the wards.

Though I'd disagree that the preclinical years are useless, I sympathize with OP's dissatisfaction with the ballooning cost of medical education, which has risen substantially faster than inflation. As long as student loans provide an infinite source of cash, however, there won't be any real pressure to contain costs.

 

[puahate]

I don't think undergrad education prepares most people well enough to take a clincal heavy exam like STEP1. Most of the prerequisites learned in undergrad are basic science.

 

[carrots28]

It is school dependent but the one I attend has a lot of clinical training in the first two years to prepare for third year. I have mandatory classes which I sometimes find annoying but overall made me accountable for my learning and use of time.

 

[theKingLT]

I don't think undergrad education prepares most people well enough to take a clincal heavy exam like STEP1. Most of the prerequisites learned in undergrad are basic science.

This is a good point. Plus many schools are moving to doing STEP1 after core clerkships!

 

[CherryRedDracul]

I'm an independent learner, and yes, a lot of lectures and whatever were a waste of time, but I honestly found a lot of the material invaluable, or presented in a slightly different matter that helped it stick. Also, I had quite a bit of clinical skills work and consolidative active learning also as well in school.

I don't think that first 2 years is anywhere close to worth the current US tuition rates, but I just UFAP'd, I'd have a shaky foundation of medical knowledge.

 

[7331poas]

I know when a patient comes into the emergency department a question stem always pops up and then I have to choose the best answer then it’s off to the next patient!

...sure, but you have to walk before you can run

Should we start every eventual surgeon off with the *easy* surgeries in M1?

 

[DrDarce]

I'm an independent learner, and yes, a lot of lectures and whatever were a waste of time, but I honestly found a lot of the material invaluable, or presented in a slightly different matter that helped it stick. Also, I had quite a bit of clinical skills work and consolidative active learning also as well in school.

I don't think that first 2 years is anywhere close to worth the current US tuition rates, but I just UFAP'd, I'd have a shaky foundation of medical knowledge.

Agree. UFAP is really good review of the material and not so much a primary learning resource. There will definitely be gaps in your knowledge if that's all you do.

 

[manofsteel9]

This wouldn't really save everyone money and time. Thousands of people would spend 1-2 years preparing for STEP 1 and then not end up getting into med school. I like having the gatekeeping up front so that you don't start down the path in earnest until you know with a great degree of certainty that you are going to become a physician. I definitely wouldn't want to jump into STEP prep without a med school acceptance in hand.

What about the thousands of people who spend 1-2 years preparing for the MCAT and then not ending up getting into med school? STEP 1 could be the new gatekeeper.

 

[Cassowary]

Agree. UFAP is really good review of the material and not so much a primary learning resource. There will definitely be gaps in your knowledge if that's all you do.

Tell that to the numerous people who score 250+ consistently year after year using nothing but UFAP and zanki

There's no purpose to the first 2 years of medical school. Change my mind.

I get zero value out of trying to change your mind. Change my mind.

First off f- your b- and the clique u claim

 

[DeucesHigh3]

I'm an independent learner, and yes, a lot of lectures and whatever were a waste of time, but I honestly found a lot of the material invaluable, or presented in a slightly different matter that helped it stick. Also, I had quite a bit of clinical skills work and consolidative active learning also as well in school.

I don't think that first 2 years is anywhere close to worth the current US tuition rates, but I just UFAP'd, I'd have a shaky foundation of medical knowledge.

I'll second this. I remember hating all of the minutiae and "low-yield" lectures, and focusing 80% of my energy toward Step 1. I got bent out of shape about every mandatory lecture or lab that would make me drag my butt to campus, and wished I could just be hitting the high-yield material.

Now that I'm two months from being a PGY-5, I still run into situations daily where I'm thankful for the knowledge and esoteria I acquired in medical school (preclinical years, specifically), or wish I had placed into long term memory back at that time (instead of cramming for exams). The review resources are great (apparently uworld, first aid, and pathoma now have an acronym?), but they're really not the point. They are a means-to-an-end to do reasonably well on Step 1, which is not the end -- or even the START -- of a career in medicine.

P.S. Just memorize those MEN1/MEN2s now and be done with it. It'll come up enough in the next 10+ years to be worth it.

 

[Terry Toma]

What about the thousands of people who spend 1-2 years preparing for the MCAT and then not ending up getting into med school? STEP 1 could be the new gatekeeper.

Preparing for the MCAT and preparing for STEP are just two completely different things. When I say 1-2 year of STEP prep, I mean 1-2 years of making STEP prep your full-time job.

I also wonder how competitiveness creep would come into play if STEP was removed from the context of med school. Everyone wants to outdo everyone else. If you let people prepare for STEP on whatever timeline they choose rather than within the constraints of a med school curriculum, there is a good chance that they will all actually end up spending more time getting ready for it. If you're going to do 2 years of independent study for STEP, I'll do 3 so that I can get into a better school than you. But then everyone starts to think this way, and suddenly you have to do 3 years of prep just to be competitive, and your time saving innovation has just added a year to the process for the average student.

 

[Cassowary]

I'll second this. I remember hating all of the minutiae and "low-yield" lectures, and focusing 80% of my energy toward Step 1. I got bent out of shape about every mandatory lecture or lab that would make me drag my butt to campus, and wished I could just be hitting the high-yield material.

Now that I'm two months from being a PGY-5, I still run into situations daily where I'm thankful for the knowledge and esoteria I acquired in medical school (preclinical years, specifically), or wish I had placed into long term memory back at that time (instead of cramming for exams). The review resources are great (apparently uworld, first aid, and pathoma now have an acronym?), but they're really not the point. They are a means-to-an-end to do reasonably well on Step 1, which is not the end -- or even the START -- of a career in medicine.

P.S. Just memorize those MEN1/MEN2s now and be done with it. It'll come up enough in the next 10+ years to be worth it.

As a PG-5, are you familiar with Sketchy and Zanki? Lots have been released since you graduated

 

[docbsb2015]

Having Step 1 as a prereq to medical school is literally one of the dumbest things I've ever read.

 

[700825]

While I agree there are faults with meds schools, I think it’s a fallacy to believe that being good at STEP 1 means you are a good physician.

The same could be said about being good at the first 2 years of medical school. Both require test taking skills and the ability/desire to cram ridiculous amounts of minutiae, neither of which seems all that relevant to actually being a good doctor

 

[965978]

Having Step 1 as a prereq to medical school is literally one of the dumbest things I've ever read.

I think you probably didn’t understand what he’s trying to say. He is saying that we should teach the first two years of medical school in undergrad and then use STEP1 as the exam in the admission process to see who gets into med school (which would hypothetically be 2 years).

 

[docbsb2015]

I think you probably didn’t understand what he’s trying to say. He is saying that we should teach the first two years of medical school in undergrad and then use STEP1 as the exam in the admission process to see who gets into med school (which would hypothetically be 2 years).

Mehh. I could potentially buy that. I personally think Step 1 and 2 should be taken after clinical years. While Step 1 is much more of a basic science exam, it would have helped me immensely if taken after 3rd year. A few of my friends took it after 3rd year (DO school) and they absolutely killed it and were glad they waited.

 

[DrDarce]

Tell that to the numerous people who score 250+ consistently year after year using nothing but UFAP and zanki

Although I've read that online, the people I know in real life who score in 250s use more than UFAP and zanki. That's not even really the point though, I said you would have gaps in your knowledge if that's all you use.

 

[siliso]

It’s more to life than step 1 scores, believe it or not and I’m sure many don’t. What about learning anatomy (in person not on flash cards) and pathoogy (real pathology not just HIYield flashcard material) and taking a history and doing a physical exam and talking to actual patients and colleagues? A person who’s done nothing but cram factoids in total isolation for two years is going to be a nightmare on the wards, far beyond the average medical student with some experiences with actual human patients and colleagues. Those normal students need to be pulled up and mentored and encouraged to learn how to learn on the fly/in the course of patient care - but the person who’s still obsessively slamming FA and uworld qs in every spare or actually not spare and obtrusively inappropriate moment is much more a challenge.

 

[MEN2C]

My med school did not teach to step 1. We learned a lot of details that could have been omitted - and we would have done better on Step 1. I hated it at the time - why not just teach the material we will be tested on.

Looking back, I'm so happy that we taught medicine and physiology, and not how to score high on step 1.

 

[nimbus]

My medical school did not have mandatory lecture attendance. As a class we took turns writing up lecture notes. I probably attended 10% of the lectures during the preclinical years and fell asleep in half of them. A parasitology lecture is the only one I still remember.

 

[anon6134]

Everyone gets so bent out of shape about this.

Guys, "preclinical" is preclinical for a reason. Until you are in the "clinic" and are "clinical", you have to know what the hell you are looking for otherwise you are a nurse doing an H&P to check your stupid admin mandated boxes. Anyone that remembers taking an H&P first year of school remembers having no clue what to ask for ROS or what symptoms/presentations means what.

On rotations you will see hundreds of patients with hundreds of diseases. Before that you need to learn about all of these diseases. Just learn the material and STFU about whats relevant or not because you have no idea whats important 5 months into medical school

 

[965978]

Mehh. I could potentially buy that. I personally think Step 1 and 2 should be taken after clinical years. While Step 1 is much more of a basic science exam, it would have helped me immensely if taken after 3rd year. A few of my friends took it after 3rd year (DO school) and they absolutely killed it and were glad they waited.

The biggest drawback is that you are risking doing less than your best during the M3 clerkships, which are arguably more important that the STEP1 score.

 

[docbsb2015]

The biggest drawback is that you are risking doing less than your best during the M3 clerkships, which are arguably more important that the STEP1 score.

Nah. Not sure what year you are but Step 1 and 2 are the most important thing you will do unfortunately.

 

[Eyeronic]

The 2 years of pre-clinical work is good preparation for the way things are truly going to be when you are out there on your own. The volume will be too much and you will have to fight it and not get intimidated. There will be too many due dates and timelines, but instead of days to prepare you will have minutes. There will be a few times where you do feel partially isolated. You will be stressed. You will have less control over your own schedule and your own enjoyment. Repeatedly. You will have bad days, bad weeks, and possibly even bad months. Guess what? You still have to show up and not just "do your job" but do it well.

Do all the minutiae I learned in years 1 and 2 make their way into my daily conversations with patients? No. But that's not the point of it. If you can't handle the first 2 years, then I don't want you treating my loved one 10 years from now when they develop a rare serious disease and need help beyond the bread and butter protocols, and you just happen to get the phone call about it at a less-than-convenient time. The time commitment for our training is worth something. It is a lot more "skin in the game" than just doing clinical work and learning things superficially.

On a more cynical note, those 2 years with books, books, and more books will make you thrilled to enter the wards in Year 3 and speak to any delirious, encephalopathic, narcotic-seeking, non-adherent person you can find. It will all be better than feeling isolated and cooped up at your cubicle with a pair of headphones and an energy drink.

 

[carrots28]

@ClamShell agree with you. Letters of rec and evaluations come from our performance in 3rd and 4th year. It’s the second most important part if not equally important as Step when it comes to residency applications

 

[sloop]

On a more cynical note, those 2 years with books, books, and more books will make you thrilled to enter the wards in Year 3 and speak to any delirious, encephalopathic, narcotic-seeking, non-adherent person you can find. It will all be better than feeling isolated and cooped up at your cubicle with a pair of headphones and an energy drink.

Maybe I’m weird but the first two years were my favorite years of medical school, looking back on it (other than 4th year of course but that barely counts because other than sub-Is and maybe one rotation, there was almost no expectation from me. It’s like comparing full time work to part time work with the same pay).

My favorite time of medical school was Step 1 dedicated because I had complete control over my schedule. I only took one full day off a week but it could be any day I wanted and I could change what day that was on a whim. I enjoyed my schedule of rolling out of bed in the morning, stopping at the Wawa for some iced coffee and maybe some breakfast, finding some empty room in my med school, eating breakfast, watching some pathoma, reading a bit, doing some questions and going home. It was predictable and put me in a casual but productive zone that I enjoyed. Plus I did well on the test so it was definitely a good experience.

I also think that the stuff I learned in the preclinical years was the essential foundation for learning clinical medicine, but that perception may be colored by the fact that I didn’t encounter a ton of difficulty learning it.

I love my job and have posted a lot about that, but I love it for many of the humanistic reasons that make medicine worth it. That being said, what I hate about my job is the unpredictability. If you get a late admission, a normal day can turn into a 12+ hour day and there is no way to know this will happen in advance. I can’t ever plan anything unless the other people know my participation is tentative. The hospital keeps piling on expectations but does not account for the fact that there is no time to actually carry them out. I have to see outpatients while I’m getting hammer paged about stuff for my inpatients. This stuff sucks a lot and there are days where I would give anything for a week where I knew that all I had to do was study and take a test.

 

[docbsb2015]

Maybe I’m weird but the first two years were my favorite years of medical school, looking back on it (other than 4th year of course but that barely counts because other than sub-Is and maybe one rotation, there was almost no expectation from me. It’s like comparing full time work to part time work with the same pay).

My favorite time of medical school was Step 1 dedicated because I had complete control over my schedule. I only took one full day off a week but it could be any day I wanted and I could change what day that was on a whim. I enjoyed my schedule of rolling out of bed in the morning, stopping at the Wawa for some iced coffee and maybe some breakfast, finding some empty room in my med school, eating breakfast, watching some pathoma, reading a bit, doing some questions and going home. It was predictable and put me in a casual but productive zone that I enjoyed. Plus I did well on the test so it was definitely a good experience.

I also think that the stuff I learned in the preclinical years was the essential foundation for learning clinical medicine, but that perception may be colored by the fact that I didn’t encounter a ton of difficulty learning it.

I love my job and have posted a lot about that, but I love it for many of the humanistic reasons that make medicine worth it. That being said, what I hate about my job is the unpredictability. If you get a late admission, a normal day can turn into a 12+ hour day and there is no way to know this will happen in advance. I can’t ever plan anything unless the other people know my participation is tentative. The hospital keeps piling on expectations but does not account for the fact that there is no time to actually carry them out. I have to see outpatients while I’m getting hammer paged about stuff for my inpatients. This stuff sucks a lot and there are days where I would give anything for a week where I knew that all I had to do was study and take a test.

THIS. For me, I hated being stuck in a room studying all day for Step 1 so dedicated sucked. But aside from dedicated the first two years of med school were dope for the above reasons. You can do whatever you want. Basically college on steroids.

 

[RNthenDoc]

There are 3-year programs in reputable schools... that alone should be enough to make everyone else ask why they are forking over many thousands of extra tuition dollars if the outcome is the same.

And if the argument is that they are lesser physicians... I’m gonna’ need to see data to prove it.

I think the real answer is simpler