Thoughts on streamlining medical education

[deleted500612]

---

Members do not see this ad.

I'm sure many of you have noticed how much irrelevant material is taught in medical school compared to what you will actually need to know as a practicing physician. A lot of time is wasted studying material you will never look at or think about again, depending on which specialty you go into. Given the added fact that medicine is getting so advanced, and branching out into so many specialties and sub-specialties that it doesn't really make sense any more to have one med school degree to cover everything. I mean, we've had separate schooling for teeth docs for ages now... By streamlining medical education in other specialties as well we could reduce the amount of time spent in medical school to 3 years and/or reduce post-grad years, reduce the amount of student debt, while increasing the knowledge and expertise of students specific to their specialty. Here's one example:

Split medical school entry into separate streams based on general field. Example:

Primary care stream (prerequisite for GP, EM)

Medicine stream (prerequisite for IM and most IM subspecialties, anesthesiology, etc.)

Surgery & Imaging stream (prerequisite for surgical specialties and rads)

Pathology stream (prerequisite for pathology, dermatology, immunology, microbiology/ID, rad onc)

Neurological medicine stream (includes psych, neurology)

Now I'm not saying it should be broken down exactly like this, it's just a general example of the idea. I think it would allow doctors to waste less time in school learning irrelevant material, graduate with less debt, and be even better at what they do. Only negative I can think of would be that you'd have to decide on your general area of specialization much sooner... but lets be frank here, in virtually every other profession in existence you have to decide on what you want to do as a career before you go to school for it, not after.

 

[mcloaf]

The direction my school is heading in is to accelerate preclinical education and get required rotations over with faster to allow students a lot more time to explore their particular clinical interests. The overall time frame is the same, though, so I guess that doesn't address your desire to decrease training length. I'm not sure it's reasonable to expect people to know what they want to do coming in, at least half the docs I know had no idea they'd ever have ended up in the specialty where they are now.

 

[DermViser]

NYU has a special program in which you get to CHOOSE THE RESIDENCY OF YOUR CHOICE after completing the MD in 3 years: http://school.med.nyu.edu/student-resources/medical-education/md-curriculum/three-year-md-degree. Definitely an innovative school which is ahead of the curve.

 

[Wordead]

Lol no psych or micro for surgery, but lots of micro for pathologists

Must be a M1

 

[evilbooyaa]

Micro is super important for surgery. Wound infections and stuff.

Rad/Onc isn't in the same discussion as path. Gross anatomy (at least radiologic observation of it) is paramount.

The issue with this thought process is that most medical students aren't sure what they want to do prior to MS3.

For example - Students routinely decide between surgery and Anesthesia (which would be different paths) or something comparable.

I think doing a 3-year curriculum (0.5 year for MS1, 1 year for MS2, 1 year for MS3, 6 months for MS4) is reasonable, but not with the current state of interview invites/rank lists/etc. Starting 4th year in December would make the residency interview process impossible.

The NYU program is interesting as it eliminates the residency interview process entirely. Wonder how many people they take each year for that program, and if there's any competition within that (incase they all want to go into Derm/Ortho or something).

 

[deleted500612]

Micro is super important for surgery. Wound infections and stuff.

Rad/Onc isn't in the same discussion as path. Gross anatomy (at least radiologic observation of it) is paramount.

I just divided them into categories as a quick example, as i stated that doesn't have to be the actual way it is divided, it is just the concept I am trying to point out.

The issue with this thought process is that most medical students aren't sure what they want to do prior to MS3.

For example - Students routinely decide between surgery and Anesthesia (which would be different paths) or something comparable.

I think doing a 3-year curriculum (0.5 year for MS1, 1 year for MS2, 1 year for MS3, 6 months for MS4) is reasonable, but not with the current state of interview invites/rank lists/etc. Starting 4th year in December would make the residency interview process impossible.

The NYU program is interesting as it eliminates the residency interview process entirely. Wonder how many people they take each year for that program, and if there's any competition within that (incase they all want to go into Derm/Ortho or something).

Yeah, the timeline for residency interviews and such would have to be reworked also. As far as not being sure what you want to do... yeah it is not ideal, but that is how it is in all professions, and yet they still have to pick a career stream before their education, not after. In engineering for example, you have to choose whether you want to do mechanical, aerospace, civil, electrical, etc. before you enrol, without having any meaning exposure to each choice. They still manage without too much trouble.

 

[evilbooyaa]

I just divided them into categories as a quick example, as i stated that doesn't have to be the actual way it is divided, it is just the concept I am trying to point out.

Yet the issue here is not your distinctions, but rather the fact there are distinctions at all. IM residents have to know anatomy for when they place lines and basic psych issues (literally every doctor in the US should know the signs of depression at least, if not recognizing a schizophrenic/manic patient, IMO).

Yeah, the timeline for residency interviews and such would have to be reworked also. As far as not being sure what you want to do... yeah it is not ideal, but that is how it is in all professions, and yet they still have to pick a career stream before their education, not after. In engineering for example, you have to choose whether you want to do mechanical, aerospace, civil, electrical, etc. before you enrol, without having any meaning exposure to each choice. They still manage without too much trouble.

Thing is, there is significant variation and flexibility in what you can do with an engineering degree, more than would be possible with the fields of medicine.

One thing I would consider is having a "surgical pathway" and a "non-surgical pathway". I'm not sure where Anesthesia would fit, but pretty much everyone else that goes into an OR > 50% of the time (not including Derm --> MOHS, Rad-Onc, Radiology) would be in the 'surgical pathway'. That being said, I don't know what you would change from a curriculum perspective. Non-surgeons still have to know gross anatomy. Surgeons still have to know physiology and pharm, as they will be prescribing a decently wide class of drugs regularly.

 

[notbobtrustme]

I don't want medical education watered down, I want it made efficient.

For example, we spent an insane amount of time learning all the minute details of nerves/arteries in the hand when in real life, few people will need that level of detail save for hand surgeons. Instead, we should have been taught the overall theme. We don't need to know all 12 branches of the ulnar nerve, but knowing where and what it innervates is important.

Half of Step 1 is knowing stupid, random trivia that few doctors will ever use in their practice. For example, what chromosome is the gene located that is mutated for tuberous sclerosis. This has no implications for the clinic. What DR alleles are associated with myasthenia gravis? Again, no clinical importance. Knowing that these diseases have a genetic component is important. For example, your attending may be impressed that you know HLA-DR3 and 4 are associated with Diabetes, but how does this influence patient care? It really doesn't except that having a 1st degree family member with DM2 is significant.

We learn too many facts and too few concepts. I never once came across contact-dependent growth inhibition in medical school, but knowing it from my previous studies have made cancer growth/metastasis so much more easy to understand. We never delved into how blocking a tube results in infection in our classes and if it weren't for Pathoma, this concept would have never been made clear by our professors. Instead, we would have brute force memorized all the different conditions in which blocked tubes get infected.

I think part of the reason this is the case is that preclinical classes are actually pretty ****ing easy once you strain away the extraneous bull****. The true killer is knowing all this worthless junk along with the important stuff and that's how classes can be stratified. That's also why class grade is a poor indicator of how someone performs in the clinic because sitting 8 hours a day memorizing stupid bull**** has no real bearing on how one takes cares of patients in the clinics.

 

[deleted500612]

Lol no psych or micro for surgery, but lots of micro for pathologists

Must be a M1

Yes I'm MS1, so yeah the list is probably not the greatest. As I stated, the list is just meant to demonstrate the concept. It's the general idea I wanted to discuss, not my specific example.

But I will entertain you... please explain why you need extensive knowledge of schizophrenia, alzheimer's disease, or any other neurological disorder for that matter, to complete a hip replacement or an appendectomy? Please, do enlighten me on this.

And oh the irony in criticizing me for not emphasizing micro in surgery and then in the same sentence stating that micro is not important in pathology... must be a pre-med.

 

[deleted500612]

Yet the issue here is not your distinctions, but rather the fact there are distinctions at all. IM residents have to know anatomy for when they place lines and basic psych issues (literally every doctor in the US should know the signs of depression at least, if not recognizing a schizophrenic/manic patient, IMO).



Thing is, there is significant variation and flexibility in what you can do with an engineering degree, more than would be possible with the fields of medicine.

One thing I would consider is having a "surgical pathway" and a "non-surgical pathway". I'm not sure where Anesthesia would fit, but pretty much everyone else that goes into an OR > 50% of the time (not including Derm --> MOHS, Rad-Onc, Radiology) would be in the 'surgical pathway'. That being said, I don't know what you would change from a curriculum perspective. Non-surgeons still have to know gross anatomy. Surgeons still have to know physiology and pharm, as they will be prescribing a decently wide class of drugs regularly.

I wasnt trying to say no anatomy, or no psych... just much less of it! They would still learn key things that would actually be useful in IM. I don't think its true to say that a pulmonologist needs to know extensive gross anatomy or psychological disorders by any stretch of the imagination.

We could be pedantic and say that EVERYTHING is important to know, but in reality it really isn't. A lot of docs are going to forget 90%+ of their gross anatomy, because they will literally never use it once they begin practicing. Sure we could keep teaching psychologists extensive gross anatomy to prepare for that 1 in a million chance they will need to use it for some freakish unforeseeable case, or we could teach even more detailed and extensive knowledge about things they will use on a daily basis, like sociology and psychology. These subjects are barely even brushed upon in medical school and yet are very integral and relevant to the profession. Instead we are teaching psychiatrists extensive detail of the vasculature and innervation of the lower limb.

 

[CherryRedDracul]

I wasnt trying to say no anatomy, or no psych... just much less of it! They would still learn key things that would actually be useful in IM. I don't think its true to say that a nephrologist needs to know extensive gross anatomy or psychological disorders by any stretch of the imagination.

A lot of docs are going to forget 90%+ of their gross anatomy, because they will literally never use it once they begin practicing. Sure we could keep teaching psychologists extensive gross anatomy to prepare for that 1 in a million chance they will need to use it for some freakish unforeseeable case, or we could teach even more detailed and extensive knowledge about things they will use on a daily basis, like sociology and psychology. These subjects are barely even brushed upon in medical school and yet are very integral and relevant to the profession. Instead we are teaching psychiatrists extensive detail of the vasculature and innervation of the lower limb.

I thought your name looked familiar. You're on the Misc, aren't you?

 

[Arkangeloid]

Well, I'm all for as little learning as possible, but I think some problems could arise out of such a system. What happens when a student comes in wanting to do Psychiatry, and falls in love with Surgery? He won't be able to transfer to that pathway. Ditto for the other way around.

 

[croak]

I'm sure many of you have noticed how much irrelevant material is taught in medical school compared to what you will actually need to know as a practicing physician. A lot of time is wasted studying material you will never look at or think about again, depending on which specialty you go into. Given the added fact that medicine is getting so advanced, and branching out into so many specialties and sub-specialties that it doesn't really make sense any more to have one med school degree to cover everything. I mean, we've had separate schooling for teeth docs for ages now... By streamlining medical education in other specialties as well we could reduce the amount of time spent in medical school to 3 years and/or reduce post-grad years, reduce the amount of student debt, while increasing the knowledge and expertise of students specific to their specialty. Here's one example:

Split medical school entry into separate streams based on general field. Example:

Primary care stream (prerequisite for GP, EM)
- curriculum similar to current curriculum, little bit of everything

Medicine stream (prerequisite for IM and most IM subspecialties, anesthesiology, etc.)
- Much less time spent learning detailed gross anatomy, histology, psych
- Strong focus on detailed physiology, pathophysiology, pharm

Surgery & Imaging stream (prerequisite for surgical specialties and rads)
- Only learn relevant physiology, pharm, and very little psych or micro.
- Strong focus on anatomy, pathoanatomy, imaging modalities.

Pathology stream (prerequisite for pathology, dermatology, immunology, microbiology/ID, rad onc)
- Much less time spent on gross anatomy, psych
- Strong focus on histology, microbiology, immunophysiology, pathophysiology.

Neurological medicine stream (includes psych, neurology)
- Strong regional focus on neuroanatomy, neurophysiology, brain imaging, neuropharmacology and psychology, etc.

Now I'm not saying it should be broken down exactly like this, it's just a general example of the idea. I think it would allow doctors to waste less time in school learning irrelevant material, graduate with less debt, and be even better at what they do. Only negative I can think of would be that you'd have to decide on your general area of specialization much sooner... but lets be frank here, in virtually every other profession in existence you have to decide on what you want to do as a career before you go to school for it, not after.

 

[deleted500612]

Well, I'm all for as little learning as possible, but I think some problems could arise out of such a system. What happens when a student comes in wanting to do Psychiatry, and falls in love with Surgery? He won't be able to transfer to that pathway. Ditto for the other way around.

Yeah, you are right. I guess it depends on how much you value that freedom of being able to swap to a wider range of specialties later on, vs having 1 year less of school and 50k less debt haha.

I could just as easily say what happens when a student comes in doing dentistry and falls in love with derm? He won't be able to transfer to that pathway. Ditto for the other way around. You don't see people complaining about that, because that's the way it is and has always been and people are used to it. Eventually people would get used to having separate surgery and medicine schools too I think.

 

[croak]

I graduated medical school (MD), decades ago (>3), and if you believe you're studying irrelevant material in medical school you don't belong there. Learn as much as you can while you're there not a few years down the road. You don't know what you don't know. Everything you learn in medical school may at some point over your career be useful. There are no shortcuts, and you might start out doing one thing, and in a few years be doing something else altogether. You mature, your interests change, and if you're driven by making bank you've chosen the wrong career. Your original post strikes me as that of a remarkably lazy, unimaginative child. You've managed to get accepted to medical school and are already looking to cut corners. There are plenty of para-medical fields that would happily take your tuition, and you can go out into the world knowing all you've decided you should, and do just swell. If you're not "into" learning mechanisms of action, interrelationships of organ systems, pathologies, etc., you're not suited for the profession. Maybe there's a spot for you at one of the ancillary service provider schools. You're post echoes of one of my children's—spoiled, unwilling to commit, and rebellious—Your in med school now, grow up, buckle down, and earn your degree. I'm not going to dicker with you.

 

[SouthernSurgeon]

The NYU program is interesting as it eliminates the residency interview process entirely. Wonder how many people they take each year for that program, and if there's any competition within that (incase they all want to go into Derm/Ortho or something).

My understanding of the program is that the applicant has to be accepted by a specific residency program director - I.e. You apply and specify dermatology -- your app goes to the derm PD for final approval. So there would be no internal competition in the program since everyone is already slotted into a residency spot. I also imagine that the bar to get accepted in the three year track is much higher if you're trying to do something like derm or plastics.

I don't know a ton about the program. Would be interested to hear what their mechanism is for dealing with someone who changes their mind partway through med school.

 

[evilbooyaa]

But I will entertain you... please explain why you need extensive knowledge of schizophrenia, alzheimer's disease, or any other neurological disorder for that matter, to complete a hip replacement or an appendectomy? Please, do enlighten me on this.

Because routinely, at least for hip replacements, you will be doing it on elder patients who may have mild dementia/alzheimer's that you will have to deal with. You don't have to remember all of psych (and no one will), but just having heard of it before may be somewhat useful.

And oh the irony in criticizing me for not mentioning micro in surgery and then in the same sentence stating that micro is not important in pathology... must be a pre-med.

Knowledge of micro isn't that important for a practicing pathologist. Pathologists look at the histopath of biopsies, sections, tumors, etc. They're not doing gram stains on samples looking for bacteria.

Also, I believe Wordead is a MS4, if I'm not mistaken.

I wasnt trying to say no anatomy, or no psych... just much less of it! They would still learn key things that would actually be useful in IM. I don't think its true to say that a pulmonologist needs to know extensive gross anatomy or psychological disorders by any stretch of the imagination.

Damnit. I had something more typed out, but I will condense it to say that every sub-specialty of IM should know the anatomy of the organ they deal with (Pulm = lungs, Cards = heart/vasculature, etc.)

or we could teach even more detailed and extensive knowledge about things they will use on a daily basis, like sociology and psychology. These subjects are barely even brushed upon in medical school and yet are very integral and relevant to the profession. Instead we are teaching psychiatrists extensive detail of the vasculature and innervation of the lower limb.

We had more than enough psychiatry (and psychology to some extent) in medical school. The thing about your last point is that with this system, you are eliminating the ability for people to switch what they want to pursue even earlier. There were innumerable in my class that were gung-ho on being surgeons, did their MS3 rotation in surgery, and realized they didn't want to do surgery at all. I know you said your distinctions are not final, but in your scenario all those people would be relegated to rads.

I think you underestimate how many people either 1) don't know what they want to do coming into medical school or 2) know what they are leaning towards, but change their mind once they hit MS3.

 

[evilbooyaa]

My understanding of the program is that the applicant has to be accepted by a specific residency program director - I.e. You apply and specify dermatology -- your app goes to the derm PD for final approval. So there would be no internal competition in the program since everyone is already slotted into a residency spot. I also imagine that the bar to get accepted in the three year track is much higher if you're trying to do something like derm or plastics.

I don't know a ton about the program. Would be interested to hear what their mechanism is for dealing with someone who changes their mind partway through med school.

That'd be interesting. You have to be accepted by a specific residency prior to starting medical school? Or once you're a 3rd year?

If the former, are GPA/MCAT going to determine who gets into derm vs IM?

If the latter, is a 250 Step 1 with all honors + AOA (who would match somewhere if they applied nationally) going to lose out to the 260 Step 1 with all honors + AOA for the one derm spot available, and thus have to do something else?

 

[SouthernSurgeon]

That'd be interesting. You have to be accepted by a specific residency prior to starting medical school? Or once you're a 3rd year?

If the former, are GPA/MCAT going to determine who gets into derm vs IM?

If the latter, is a 250 Step 1 with all honors + AOA (who would match somewhere if they applied nationally) going to lose out to the 260 Step 1 with all honors + AOA for the one derm spot available, and thus have to do something else?

Conditional on acceptance into the 3 year MD program is acceptance into the affiliated residency program, so yeah - GPA/MCAT/interview. I'm not sure what the motivation is for a PD (other than top down institutional pressure) - I'd think my predictive ability to know whether a premed will end up being a good resident would be extremely low.

 

[evilbooyaa]

Conditional on acceptance into the 3 year MD program is acceptance into the affiliated residency program, so yeah - GPA/MCAT/interview. I'm not sure what the motivation is for a PD (other than top down institutional pressure) - I'd think my predictive ability to know whether a premed will end up being a good resident would be extremely low.

Exactly. I guess it's kind of like BS/MD programs, just one level up. Obviously different b/c you're locking into a specific field of medicine (rather than 'locking' into medicine in general). Maybe if you decide to opt out, you have to transition back to the 4 year curriculum? That must make admission to the 3 year crazy competitive.

 

[deleted500612]

Because routinely, at least for hip replacements, you will be doing it on elder patients who may have mild dementia/alzheimer's that you will have to deal with. You don't have to remember all of psych (and no one will), but just having heard of it before may be somewhat useful.

Agree, "having heard of it" and having a gist of what it is is pretty basic level though and does not necessitate detailed psych knowledge.

Knowledge of micro isn't that important for a practicing pathologist. Pathologists look at the histopath of biopsies, sections, tumors, etc. They're not doing gram stains on samples looking for bacteria.

Sigh... are you disagreeing with me just because I'm MS1 now? Countless pathological conditions are caused or exacerbated by microbes. A huge portion of what some clinical pathologists do is related to microbiology. There are a lot of schools that have a division of microbiology within the pathology department, because they are so interrelated... I mean, you do realize that there is an entire subspecialty of pathology called "clinical microbiology" right?

Damnit. I had something more typed out, but I will condense it to say that every sub-specialty of IM should know the anatomy of the organ they deal with (Pulm = lungs, Cards = heart/vasculature, etc.)

100% agree on this one.

We had more than enough psychiatry (and psychology to some extent) in medical school. The thing about your last point is that with this system, you are eliminating the ability for people to switch what they want to pursue even earlier. There were innumerable in my class that were gung-ho on being surgeons, did their MS3 rotation in surgery, and realized they didn't want to do surgery at all. I know you said your distinctions are not final, but in your scenario all those people would be relegated to rads.

Yeah this is what everyone seems to be saying so far as the major complaint of such a system. And the amount of actual psychology and sociology taught in med school (aka social aspects, not science) is abysmal. In my opinion that sort of knowledge is much more relevant and useful than lower limb anatomy for a psychiatrist. Now I do realize that as the current system stands, lower limb anatomy is probably more important than psychology/sociology for most other specialties, and thus it will never be replaced. But since psychiatrists have to go through the same stream as everyone else, they are stuck with the lower limb anatomy. What I'm trying to say is that the curriculum is not optimized for any one specialty, because it is meant to accommodate all specialties. If med school entry was streamlined into different general categories then the material would be a lot more relevant and specifically tailored for each specialty, if that makes sense. The idea is definitely not to "water it down" as one of the above posters mentioned, but rather to maximize the percentage of learned material that you will use on a regular basis in your specialty of practice.

 

[evilbooyaa]

Sigh... are you disagreeing with me just because I'm MS1 now? Countless pathological conditions are caused or exacerbated by microbes. A huge portion of what some clinical pathologists do is related to microbiology. There are a lot of schools that have a division of microbiology within the pathology department, because they are so interrelated... I mean, you do realize that there is an entire subspecialty of pathology called "clinical microbiology" right?

Not disagreeing with you just because you're a MS1. I have no interest in path and thus haven't examined the field in-depth, so perhaps they do rarely do special microbiology tests. I guess I'm speaking from my own experience.

What I'm trying to say is that the curriculum is not optimized for any one specialty, because it is meant to accommodate all specialties. If med school entry was streamlined into different general categories then the material would be a lot more relevant and specifically tailored for each specialty, if that makes sense.

I still don't think there should be a huge difference. There is still residency (and possibly fellowship) that will re-teach (or ideally, refresh) all the relevant anatomy, physiology, etc. that is required to be practicing physician in the field.

My personal opinion is that everyone should have learned, at least at one point, the human body in its entirety. Depending on how NYU's 3-year curriculum progresses, there may be some changes in the future.

Sidefx, what is your opinion about 1st and 2nd year (I believe) students in dentistry schools routinely having the same subjects as pre-clinical medical students? Clearly that should be absolutely unnecessary (and dentists should only learn about the mouth + any side effects of anesthetics), right? Just trying to gauge how consistent you'll be.

 

[DermViser]

Pathology stream (prerequisite for pathology, dermatology, immunology, microbiology/ID, rad onc)
- Much less time spent on gross anatomy, psych
- Strong focus on histology, microbiology, immunophysiology, pathophysiology.

Let's see for Derm: Yeah, I agree with your list. Bc it's not like Dermatologists and Procedural Derm/Mohs surgeons don't have to know nerve innervation, esp. in the face, how deep we're doing incisions and which layer we're in, etc. that would be covered in Gross Anatomy.

It's also not like we ever get Psych patients whose derm conditions result from their mental condition (delusions of parasitosis, trichotillomania, OCD) or patients whose skin conditions contribute to their psych conditions, or whose psychiatric drugs contribute to their skin findings.


🙄

 

[boogaloo]

This is a typical MS1/MS2 post, and no, I'm not on my high horse.

I graduated medical school (MD), decades ago (>3), and if you believe you're studying irrelevant material in medical school you don't belong there. Learn as much as you can while you're there not a few years down the road. You don't know what you don't know. Everything you learn in medical school may at some point over your career be useful. There are no shortcuts, and you might start out doing one thing, and in a few years be doing something else altogether. You mature, your interests change, and if you're driven by making bank you've chosen the wrong career. Your original post strikes me as that of a remarkably lazy, unimaginative child. You've managed to get accepted to medical school and are already looking to cut corners. There are plenty of para-medical fields that would happily take your tuition, and you can go out into the world knowing all you've decided you should, and do just swell. If you're not "into" learning mechanisms of action, interrelationships of organ systems, pathologies, etc., you're not suited for the profession. Maybe there's a spot for you at one of the ancillary service provider schools. You're post echoes of one of my children's—spoiled, unwilling to commit, and rebellious—Your in med school now, grow up, buckle down, and earn your degree. I'm not going to dicker with you.

I agree wholeheartedly with this post. I've noticed this sort of mentality in my class and in the classes below mine. Why do first and second year medical students always moan and groan about learning "useless" information when they don't have the slightest clue as to what is relevant or irrelevant to the practice of medicine? I'm a third year medical student, and I still don't know what all is relevant to my specialty of choice--and I don't care at this point. All I know is that I want to learn as much as possible so that I am much less of an incompetent ***hole who doesn't know what he's doing after graduating and starting residency. I don't think it's a bad thing to require that all doctors have some basic knowledge of all aspects of medicine when they graduate. Frankly, I think this half-proposal of a half-idea is stupid.

Now I'm not saying it should be broken down exactly like this, it's just a general example of the idea. I think it would allow doctors to waste less time in school learning irrelevant material, graduate with less debt, and be even better at what they do. Only negative I can think of would be that you'd have to decide on your general area of specialization much sooner... but lets be frank here, in virtually every other profession in existence you have to decide on what you want to do as a career before you go to school for it, not after.

I think this idea would churn out tech monkeys instead of competent doctors. I think it will cost a lot more money in the long run with all of the consults you'll need to make because you never truly learned gross anatomy or any psych, depending on what you focused on during "training." You'd graduate with less debt and with less medical knowledge. You'd get a lot of people dropping out because they thought they wanted to do surgery, but now they want a family and a reasonable schedule. Good job, buddy. Great idea.

 

[deleted500612]

Sidefx, what is your opinion about 1st and 2nd year (I believe) students in dentistry schools routinely having the same subjects as pre-clinical medical students? Clearly that should be absolutely unnecessary (and dentists should only learn about the mouth + any side effects of anesthetics), right? Just trying to gauge how consistent you'll be.

Just glanced over a couple curriculum outlines for dentistry, and while they do include a couple basic medical science classes almost all of the classes are related to head and neck anatomy, oral diseases, and clinical procedures. I completely agree that a basic understanding of the body is important no matter what specialty someone is in, and so I see no problem with having some general med classes. This is why I did not recommend eliminating any subjects entirely and emphasized rather focusing on only the relevant material in a subject that is not entirely integral to a specialty.

 

[deleted500612]

Let's see for Derm: Yeah, I agree with your list. Bc it's not like Dermatologists and Procedural Derm/Mohs surgeons don't have to know nerve innervation, esp. in the face, how deep we're doing incisions and which layer we're in, etc. that would be covered in Gross Anatomy.

It's also not like we ever get Psych patients whose derm conditions result from their mental condition (delusions of parasitosis, trichotillomania, OCD) or patients whose skin conditions contribute to their psych conditions, or whose psychiatric drugs contribute to their skin findings.


🙄

So lets see, another person who ignores the entire point of the thread to nitpick one comment that was specifically stated as not being necessarily accurate but purely meant to exemplify a concept. You should also take note of how I did not recommend not learning anatomy or psych as a derm but rather limiting it to areas that are relevant to derm.

 

[mcloaf]

I graduated medical school (MD), decades ago (>3), and if you believe you're studying irrelevant material in medical school you don't belong there. Learn as much as you can while you're there not a few years down the road. You don't know what you don't know. Everything you learn in medical school may at some point over your career be useful. There are no shortcuts, and you might start out doing one thing, and in a few years be doing something else altogether. You mature, your interests change, and if you're driven by making bank you've chosen the wrong career. Your original post strikes me as that of a remarkably lazy, unimaginative child. You've managed to get accepted to medical school and are already looking to cut corners. There are plenty of para-medical fields that would happily take your tuition, and you can go out into the world knowing all you've decided you should, and do just swell. If you're not "into" learning mechanisms of action, interrelationships of organ systems, pathologies, etc., you're not suited for the profession. Maybe there's a spot for you at one of the ancillary service provider schools. You're post echoes of one of my children's—spoiled, unwilling to commit, and rebellious—Your in med school now, grow up, buckle down, and earn your degree. I'm not going to dicker with you.

QFT. Some of my most motivating moments this year (M1) have been when we have full time clinical faculty work with us and we'll end up talking about some factoid or process that I'd studied and thought "well this is some bull **** I can't wait to forget when I actually practice medicine" only to have the doc know way more about the topic than even what I had been studying.

 

[deleted500612]

I think this idea would churn out tech monkeys instead of competent doctors. I think it will cost a lot more money in the long run with all of the consults you'll need to make because you never truly learned gross anatomy or any psych, depending on what you focused on during "training." You'd graduate with less debt and with less medical knowledge. You'd get a lot of people dropping out because they thought they wanted to do surgery, but now they want a family and a reasonable schedule. Good job, buddy. Great idea.

Appreciate your opinion, it's pretty obvious that most people seem to be opposed to such an idea. I disagree that you would have less medical knowledge, you would actually have more medical knowledge relevant to your specialty. Never considered the fact that there would likely be more money wasted on consults though, which is also a very good point.

 

[ToldYouSo]

I graduated medical school (MD), decades ago (>3),

I could tell by your rant. Whenever I see the term "dinosaur" brought up on SDN; those of the old guard who reject change and are dismissive of any attempts to improve the current model, this is what I think of. Sorry, but there are shortcuts and there are ways that education can be streamlined and refined while increasing the quality. Several schools already have accelerated pathways. So unless you believe that the 4 year model that we have now (and which one, PBL? Lecture based?) is optimal and can't be improved in anyway, you have no right to call someone who is just throwing out ideas "spoiled".

 

[boogaloo]

Appreciate your opinion, it's pretty obvious that most people seem to be opposed to such an idea. I disagree that you would have less medical knowledge, you would actually have more medical knowledge relevant to your specialty. Never considered the fact that there would likely be more money wasted on consults though, which is also a very good point.

I think in time you will see that a lot of what you think you didn't need to know will come up time and time again and be relevant to what you're learning in third year. Imagine how this would be magnified during residency and once you get out. This is what's dangerous about your proposal. I don't know that any doctor would agree to learning less about the basic sciences to focus on their specialty. Also, you're leaving out a significant percentage of medical students who didn't know what they were going to do until they finished third year (e.g., me). Lots of other issues.

I could tell by your rant. Whenever I see the term "dinosaur" brought up on SDN; those of the old guard who reject change and are dismissive of any attempts to improve the current model, this is what I think of. Sorry, but there are shortcuts and there are ways that education can be streamlined and refined while increasing the quality. Several schools already have accelerated pathways. So unless you believe that the 4 year model that we have now (and which one, PBL? Lecture based?) is optimal and can't be improved in anyway, you have no right to call someone who is just throwing out ideas "spoiled".

Pre-med status confirmed.

 

[evilbooyaa]

I could tell by your rant. Whenever I see the term "dinosaur" brought up on SDN; those of the old guard who reject change and are dismissive of any attempts to improve the current model, this is what I think of. Sorry, but there are shortcuts and there are ways that education can be streamlined and refined while increasing the quality. Several schools already have accelerated pathways. So unless you believe that the 4 year model that we have now (and which one, PBL? Lecture based?) is optimal and can't be improved in anyway, you have no right to call someone who is just throwing out ideas "spoiled".

Want shortcuts? Go NP or PA.
3-year MD is very rare. 1.5 years of pre-clinical is significantly more common, but it's still a total of 4 years MD.

I don't think there is enough fluff in the medical curriculum to 'streamline' it significantly if we're going to let students not know what they want to do in medicine prior to the beginning of MS4.

To people who want to streamline it - what are your suggestions? Would you suggest that a future derm resident shouldn't have to learn about the physiology or anatomy of every internal organ system in the body? What about for his intern year prior to starting his derm residency? Or should we get rid of that position entirely?

Should a dermatologist not be able to answer a question about treatment for a URI (for example) since, "hey sorry mom, I never learned about that. I just focused on nothing but skin stuff for 4 straight years".

Do I remember all of the glycogen storage diseases from MS1? Hell no. Would I recognize the name if I saw it, or at least know to go look it up if I had a patient with symptoms of McArdle's or something? Hell yes.

I agree with boogaloo that what you guys think is fluff or not relevant right now isn't correct. You guys aren't really in a position to suggest changes. I felt very similar to OP when I was a pre-clinical student (more along the lines of "ugh, why do we have to learn about the pentose phosphate pathway, it's so boring"), but looking back, I'm glad I did learn it, even if I remember almost none of it off the top of my head at this point.

 

[SouthernSurgeon]

I graduated medical school (MD), decades ago (>3), and if you believe you're studying irrelevant material in medical school you don't belong there. Learn as much as you can while you're there not a few years down the road. You don't know what you don't know. Everything you learn in medical school may at some point over your career be useful. There are no shortcuts, and you might start out doing one thing, and in a few years be doing something else altogether. You mature, your interests change, and if you're driven by making bank you've chosen the wrong career. Your original post strikes me as that of a remarkably lazy, unimaginative child. You've managed to get accepted to medical school and are already looking to cut corners. There are plenty of para-medical fields that would happily take your tuition, and you can go out into the world knowing all you've decided you should, and do just swell. If you're not "into" learning mechanisms of action, interrelationships of organ systems, pathologies, etc., you're not suited for the profession. Maybe there's a spot for you at one of the ancillary service provider schools. You're post echoes of one of my children's—spoiled, unwilling to commit, and rebellious—Your in med school now, grow up, buckle down, and earn your degree. I'm not going to dicker with you.

Quoted because that was an awesome smack down.

Now, I will say, it is exceptionally foolish to just say the status quo of medical education right now is acceptable. There are a lot of ways education has to improve moving forward. But "streamlining" the process and turning us into technicians who are forced into one manufacturing line or another is not what I'd hope for.

Some of the glaringly obvious issues that need to be addressed:
1) fix the absolute joke that fourth year has become for the majority of students. Content wise I actually think you could fit all of med school in three years, since the average student only spends 2-3 months of 4th year doing any real work. But due to the application and interview process I think you need the actual time of fourth year (ie moving interviews up into the third year as it exists now would be a disaster). My off the top of my head suggestions:
-all schools give December and January off for interviews. Residency programs agree to conduct 100% of interviews during those two months
-add more tailored specialty specific rotations after the interview season ( a la the popular surgery boot camps) - these should not be indentured servitude sub-Is or sucking up auditions, but rather focused, thoughtful electives that balance didactic and experiential components
-increase the number of required clinical months

2) move fully into the 21st century technology wise. Most schools (and this is really all the education system not medicine) are so woefully behind at integrating technology into education. Even when they have something up ontheweb, 9/10 times it is just a video of someone giving a PowerPoint presentation, or the slides themselves. Online con tent can be so much more dynamic.

3) bring back real clinical responsibilities for med students on the wards. Their inability to do much of anything (even write a note) and the lowered expectations that come with this are a real problem

 

[deleted500612]

I graduated medical school (MD), decades ago (>3), and if you believe you're studying irrelevant material in medical school you don't belong there. Learn as much as you can while you're there not a few years down the road. You don't know what you don't know. Everything you learn in medical school may at some point over your career be useful. There are no shortcuts, and you might start out doing one thing, and in a few years be doing something else altogether. You mature, your interests change, and if you're driven by making bank you've chosen the wrong career. Your original post strikes me as that of a remarkably lazy, unimaginative child. You've managed to get accepted to medical school and are already looking to cut corners. There are plenty of para-medical fields that would happily take your tuition, and you can go out into the world knowing all you've decided you should, and do just swell. If you're not "into" learning mechanisms of action, interrelationships of organ systems, pathologies, etc., you're not suited for the profession. Maybe there's a spot for you at one of the ancillary service provider schools. You're post echoes of one of my children's—spoiled, unwilling to commit, and rebellious—Your in med school now, grow up, buckle down, and earn your degree. I'm not going to dicker with you.

I wasn't even going to bother with your post until I saw that you actually went back and edited it to turn it into a personal attack.

"remarkably lazy unimaginative child"? lol ok. Brainstorming ideas to learn more about your profession in less time is "lazy" and "unimaginative". You are as absolutely delusional and pretentious as they come. I bet companies would love to have masterminds like you in charge of improving efficiency and productivity. I don't think I have ever seen anybody on these boards so offended at even the idea of discussing change. Disagreeing with my idea is fine, and that's one thing. But to get so ferociously irritated at the mere thought of changing med school curriculum, and insisting that it is already perfect and everyone should just shut up and do it without ever questioning anything only shows how narrow-minded and stuck in your ways you truly are.

I knowingly and gladly signed up for 4 years of med school in a traditional curriculum, but somehow the fact that I brought up a discussion of improving education for future generations means that I am trying to cut corners for myself? Honestly, you are going off on such a tangent that I don't think you even know what you're arguing about any more.

And once again, NOWHERE did I say im not into learning mechanisms of action or interrelationships of organ systems, that sort of thing is the main reason I am in medicine. And truth be told I don't care half as much about income or prestige as you do, I can guarantee you that much. Maybe if I was more of a self-righteous and malignant personality like yourself I'd "deserve" to be in medicine more.

 

[notbobtrustme]

I graduated medical school (MD), decades ago (>3), and if you believe you're studying irrelevant material in medical school you don't belong there. Learn as much as you can while you're there not a few years down the road. You don't know what you don't know. Everything you learn in medical school may at some point over your career be useful. There are no shortcuts, and you might start out doing one thing, and in a few years be doing something else altogether. You mature, your interests change, and if you're driven by making bank you've chosen the wrong career. Your original post strikes me as that of a remarkably lazy, unimaginative child. You've managed to get accepted to medical school and are already looking to cut corners. There are plenty of para-medical fields that would happily take your tuition, and you can go out into the world knowing all you've decided you should, and do just swell. If you're not "into" learning mechanisms of action, interrelationships of organ systems, pathologies, etc., you're not suited for the profession. Maybe there's a spot for you at one of the ancillary service provider schools. You're post echoes of one of my children's—spoiled, unwilling to commit, and rebellious—Your in med school now, grow up, buckle down, and earn your degree. I'm not going to dicker with you.

No, certainly not everything we learn in medical school is important. For example, where is the VHL gene located? What DR loci are associated with myastenia gravis? DM? Ankylosing spondilitis? Rheumatoid arthritis? What IL is involved in acute inflammation? How many subunits make up the insulin receptor? What intracellular pathway does GH utilize? GHRH? How many turns of the F1 ATPase do you need to make an ATP? What part of the DNA-dependent RNA polymerase does amantin cleave? What are the dibasic amino acids? What cells secrete secretion? What color are the granules in small cell lung cancer? What does focal segmental glomercusclerosis look like under the electron microscope? What type of receptor is the gastrin receptor? What granules are in basophils? What are cell surface markers for Natural Killer T cells? Where are the basophilic inclusions in reticulocytes? What type of biochemistry does Vitamin B12 perform? Is the glomerular membrane positively or negatively charged? What is the cleavage site for factors V and VIII? What amino acids are in the active site of caspases? What bands move in muscle fibers? What bands stay stationary? What is the function of phospholamben? What color are the crystals of uric acid under polarized light? What is the function of neurophysins? What vitamins are involved in the production of serotonin? What gene is defective in Fredreich's ataxia? What type of cells line the distal convoluted tube? What is the function of the repressor protein in the lac operon?

All essentially junk information but extremely high yield information for Step 1. Knowing these facts does very little for patient care but it will stratify the bottom of the class from the top of the class. Moreover, the volume of knowledge learned in the last 30 years is enormous. We have more antibiotics, more bugs, more drugs, more pathology, more genetics, more physiology, more everything because science marches on. 40 years ago, retroviruses were a curious thing with practically no implications for human health. Now, retroviruses are major human pathogens and form a bedrock for molecular genetics.

 

[deleted500612]

No, certainly not everything we learn in medical school is important. For example, where is the VHL gene located? What DR loci are associated with myastenia gravis? DM? Ankylosing spondilitis? Rheumatoid arthritis? What IL is involved in acute inflammation? How many subunits make up the insulin receptor? What intracellular pathway does GH utilize? GHRH? How many turns of the F1 ATPase do you need to make an ATP? What part of the DNA-dependent RNA polymerase does amantin cleave? What are the dibasic amino acids? What cells secrete secretion? What color are the granules in small cell lung cancer? What does focal segmental glomercusclerosis look like under the electron microscope? What type of receptor is the gastrin receptor? What granules are in basophils? What are cell surface markers for Natural Killer T cells? Where are the basophilic inclusions in reticulocytes? What type of biochemistry does Vitamin B12 perform? Is the glomerular membrane positively or negatively charged? What is the cleavage site for factors V and VIII? What amino acids are in the active site of caspases? What bands move in muscle fibers? What bands stay stationary? What is the function of phospholamben? What color are the crystals of uric acid under polarized light? What is the function of neurophysins? What vitamins are involved in the production of serotonin? What gene is defective in Fredreich's ataxia? What type of cells line the distal convoluted tube? What is the function of the repressor protein in the lac operon?

All essentially junk information but extremely high yield information for Step 1. Knowing these facts does very little for patient care but it will stratify the bottom of the class from the top of the class. Moreover, the volume of knowledge learned in the last 30 years is enormous. We have more antibiotics, more bugs, more drugs, more pathology, more genetics, more physiology, more everything because science marches on. 40 years ago, retroviruses were a curious thing with practically no implications for human health. Now, retroviruses are major human pathogens and form a bedrock for molecular genetics.

You're clearly just trying to be lazy and cut corners. Shut up and memorize it you ungrateful swine 🙄

 

[DermViser]

So lets see, another person who ignores the entire point of the thread to nitpick one comment that was specifically stated as not being necessarily accurate but purely meant to exemplify a concept. You should also take note of how I did not recommend not learning anatomy or psych as a derm but rather limiting it to areas that are relevant to derm.

You do know that dermatology does procedures all over the body right? You do know that derm isn't just limited to certain psych conditions, right?

 

[DermViser]

Quoted because that was an awesome smack down.

Now, I will say, it is exceptionally foolish to just say the status quo of medical education right now is acceptable. There are a lot of ways education has to improve moving forward. But "streamlining" the process and turning us into technicians who are forced into one manufacturing line or another is not what I'd hope for.

Some of the glaringly obvious issues that need to be addressed:
1) fix the absolute joke that fourth year has become for the majority of students. Content wise I actually think you could fit all of med school in three years, since the average student only spends 2-3 months of 4th year doing any real work. But due to the application and interview process I think you need the actual time of fourth year (ie moving interviews up into the third year as it exists now would be a disaster). My off the top of my head suggestions:
-all schools give December and January off for interviews. Residency programs agree to conduct 100% of interviews during those two months
-add more tailored specialty specific rotations after the interview season ( a la the popular surgery boot camps) - these should not be indentured servitude sub-Is or sucking up auditions, but rather focused, thoughtful electives that balance didactic and experiential components
-increase the number of required clinical months

2) move fully into the 21st century technology wise. Most schools (and this is really all the education system not medicine) are so woefully behind at integrating technology into education. Even when they have something up ontheweb, 9/10 times it is just a video of someone giving a PowerPoint presentation, or the slides themselves. Online con tent can be so much more dynamic.

3) bring back real clinical responsibilities for med students on the wards. Their inability to do much of anything (even write a note) and the lowered expectations that come with this are a real problem

Those who are going for specialties that are not IM, General Surgery, OB-Gyn, Psych, and Peds, need the 4th year in order to match.

 

[Anastomoses]

OP was an interesting idea and brought up for discussion/contemplation; why does it always have to get nasty in here?

Anyway, I like what we learn. I know sometimes it's a little much and a lot will be forgotten but I have faith that plenty of things will be further built upon in the future. I've witnessed exactly what McLoaf mentioned - being really uneasy first year with what's actually relevant, only to see in a proper clinic that a buttload of it is not only relevant but needs even more details/clinical experience to become a full-fledged understanding of the topic.

 

[Wordead]

Yes I'm MS1, so yeah the list is probably not the greatest. As I stated, the list is just meant to demonstrate the concept. It's the general idea I wanted to discuss, not my specific example.

But I will entertain you... please explain why you need extensive knowledge of schizophrenia, alzheimer's disease, or any other neurological disorder for that matter, to complete a hip replacement or an appendectomy? Please, do enlighten me on this.

And oh the irony in criticizing me for not emphasizing micro in surgery and then in the same sentence stating that micro is not important in pathology... must be a pre-med.

I understood the underlying concept, I just thought it was a funny mistake.

And yes, as a surgeon you need to know psych because a big part of surgery is knowing when to not operate. And altered mental status is common enough that you should understand it well if it happens post op, or know if the patient is contraindicated for surgery preop. And if youre doing anything cosmetic, well, 50% of your patient base has some personality or other psych disorder.

The overall point is that you cannot appreciate what you will or will not need. Though I agree medical education could be streamlined, DEFINITELY not in the way you are describing.

 

[deleted500612]

You do know that dermatology does procedures all over the body right? You do know that derm isn't just limited to certain psych conditions, right?

Skin covers the whole body? Holy sh|t, that must be something they dont teach until MS2 🙄 You are being illogically belligerent just for the sake of it. This tangential argument still isn't the point of the thread, but since apparently every detail learned in anatomy is absolutely paramount in derm, please explain the utility of memorizing the crista terminalis, fossa ovalis, thebesian tube, ligamentum venosum, sulcus chiasmatis, umbo and what week the ostium secundum forms during fetal development as a dermatologist. During which dermatological procedure will this knowledge be useful? Please inform me. I bet the number of dermatologists who forgets at least one those factoids approaches 100% because they are literally completely and utterly useless to know about as a dermatologist and chances are you will never utter a single one of those words in your entire practicing career. I bet you don't remember the origin, insertion and innervation of obliquus capitis inferior Dermviser. So by your own logic you are saying that makes you an inferior dermatologist to someone who had bothered to memorized it, because every minute detail of gross anatomy is extremely paramount and useful to your profession according to you. But yeah by all means, keep up the pedantic argument for no logical reason other than trying to prove how little the MS1 knows about derm compared to you. Sometimes I swear that the only reason some people post on these boards is to belittle med students who aren't as far along as them in the process rather than contribute anything even remotely useful to a discussion. It's ok, go on and tell us more about how much you know and how important and hard dermatology is, I know it's your favourite topic.

 

[deleted500612]

I understood the underlying concept, I just thought it was a funny mistake.

And yes, as a surgeon you need to know psych because a big part of surgery is knowing when to not operate. And altered mental status is common enough that you should understand it well if it happens post op, or know if the patient is contraindicated for surgery preop. And if youre doing anything cosmetic, well, 50% of your patient base has some personality or other psych disorder.

Most doctors doing fee for service cosmetic procedures couldn't care less what psych disorder you are afflicted by as long as you hand them a cheque.

The overall point is that you cannot appreciate what you will or will not need. Though I agree medical education could be streamlined, DEFINITELY not in the way you are describing.

So what would you suggest for streamlining medical education then?

 

[DermViser]

Skin covers the whole body? Holy sh|t, that must be something they dont teach until MS2 🙄 You are being illogically belligerent just for the sake of it. This tangential argument still isn't the point of the thread, but since apparently every detail learned in anatomy is absolutely paramount in derm, please explain the utility of memorizing the crista terminalis, fossa ovalis, thebesian tube, ligamentum venosum, sulcus chiasmatis, umbo and what week the ostium secundum forms during fetal development as a dermatologist. During which dermatological procedure will this knowledge be useful? Please inform me. I bet the number of dermatologists who forgets at least one those factoids approaches 100% because they are literally completely and utterly useless to know about as a dermatologist and chances are you will never utter a single one of those words in your entire practicing career. I bet you don't remember the origin, insertion and innervation of obliquus capitis inferior Dermviser. So by your own logic you are saying that makes you an inferior dermatologist to someone who had bothered to memorized it, because every minute detail of gross anatomy is extremely paramount and useful to your profession according to you. But yeah by all means, keep up the pedantic argument for no logical reason other than trying to prove how little the MS1 knows about derm compared to you. Sometimes I swear that the only reason some people post on these boards is to belittle med students who aren't as far along as them in the process rather than contribute anything even remotely useful to a discussion. It's ok, go on and tell us more about how much you know and how important and hard dermatology is, I know it's your favourite topic.

You do know that one of the risks of Mohs surgery is nerve damage right? You really think the Derm shouldn't give a ****, if a specific muscle is suddenly paralyzed bc the skin CA that was removed, might have surrounded a nerve which was damaged in the incision process? Who cares if I know the nerve, I'll just refer it to a neurologist?

 

[deleted500612]

You do know that one of the risks of Mohs surgery is nerve damage right? You really think the Derm shouldn't give a ****, if a specific muscle is suddenly paralyzed bc the skin CA that was removed, might have surrounded a nerve which was damaged in the incision process? Who cares if I know the nerve, I'll just refer it to a neurologist?

lol... completely ignores entire comment, reverts immediately to strawman argument. Good grief.

 

[DermViser]

lol... completely ignores entire comment, reverts immediately to strawman argument. Good grief.

I bolded part of the comment, genius.

 

[deleted500612]

I bolded part of the comment, genius.

Yep and ignored the rest of the comment, genius. As far as what you bolded, yeah it might be relevant in the off chance you're doing a procedure in that area but I bet not a single derm has that information memorized off the top of their head. You would simply look it up in the remote circumstance that you'd ever need to. But I do like how you deliberately ignored the other list of structures that will never, ever be used in derm, yet you illogically insist that memorizing your entire anatomy atlas is an important part of derm just to be belligerent and condescending.

 

[DermViser]

Yep and ignored the rest of the comment, genius. As far as what you bolded, yeah it might be relevant in the off chance you're doing a procedure in that area but I bet not a single derm has that information memorized off the top of their head. You would simply look it up in the remote circumstance that you'd ever need to. But I do like how you deliberately ignored the other list of structures that will never, ever be used in derm, yet you illogically insist that memorizing your entire anatomy atlas is an important part of derm just to be belligerent and condescending.

Yes, let's all learn with the backup excuse that you can always look things up. Good grief. By the way, embryology is not equivalent to gross anatomy.

 

[deleted500612]

Yes, let's all learn with the backup excuse that you can always look things up. Good grief. By the way, embryology is not equivalent to gross anatomy.

So you're saying you have innervations, blood supplies, origins and insertions memorized for every muscle? No, you don't, and neither does any other derm. Get over yourself. And yet again you are ignoring the fact that there are plenty of anatomical structures that you will never use in derm, yet you still continue to insist that memorizing your anatomy textbook cover to cover is crucial to being a good dermatologist for the sole purpose of being condescending and arrogant.

Look I get it, derm is such an advanced and difficult specialty that you literally need to know everything about everything. Tell me more about how a mastery in quantum physics will help you perfect your surgical technique and lead to better patient outcomes.

 

[Wordead]

Most doctors doing fee for service cosmetic procedures couldn't care less what psych disorder you are afflicted by as long as you hand them a cheque.



So what would you suggest for streamlining medical education then?

Wildly untrue. It is important to tease out your cosmetics patients psych status because there are patients you will never get a satisfactory result for and will result in your reputation getting trashed, sued, etc. Which is very bad in a field that is mostly word of mouth. You tell those patients I can't help you and move on.

I don't have a plan for improving medical education. I just know that yours is a bad one.

 

[SouthernSurgeon]

Yep and ignored the rest of the comment,

Well to his credit... The rest of the comment was approaching Billy
Madison levels of tangential and nonsensical thinking...

 

[deleted500612]

Well to his credit... The rest of the comment was approaching Billy
Madison levels of tangential and nonsensical thinking...

Actually the part of the post preceding that was much more relevant to the point than the part he responded to. The part he actually quoted and responded to was where it started to get tangential... he chose it simply because it was the only thing he could find to nitpick and misinterpret to fit his agenda of showing everyone how impressive his scope of practice is as a dermatologist. Trying to convince people that he needed to know advanced osseus anatomy of the inner skull and every minute visceral structure to exemplify his ridiculous assertion that memorizing an anatomy text book cover to cover is an integral part of being a dermatologist would have appeared too troll-like even for him, thus he just ignored it since it would have shown his logic to be clearly fallacious and over-extended.