It sounds from what they wrote that there is a real drop off in basic science knowledge by the time residency comes around
The current medical education system doesn't train physicians to be life longer learners well and isn't interactive or self-directed enough in my opinion. Sure there is a drop off in basic sciences learned from Step 1 to Step 3. I knew Step 2 would cover some basic sciences so I re-studied some stuff like pharm which paid off big time during clinicals, I guess those questions were just to see how bad the drop off is. The bigger problem is that physicians lose their edge when out of training and patient mortality increases about 1 percent for each year out of training. I believe it, my grandmother was being seen by an FP who made a really wrong comment about warfarin saying that you can't have a stroke when you are on it, . . . really.
I don't think that by having fewer Step examinations that this will make medical students study basic sciences more or somehow retain the info. You only retain what you learn and use. I still remember studying for Step 1 and it sure solidifies your knowledge when you sit down and try to condense what you know. Now students won't be pushed to solidify their knowledge base at the end of basic sciences. I think that third year students will do OK on some Step 1 material, but might not be as good as people finishing their second year or may just be the same.
I really took to heart re-learning basic sciences during third year, everybody at some point or another on a renal elective says, "Wow, I wish I could go back and do nephrology again" because seeing patients helps you remember better. If you don't have a grasp of RTA physiology you basically have a sort of knowledge base that is flimsy.
In the end the first two years of medical school need to be totally overhauled. The system doesn't let students learn at their own pace which often is faster than what a lot of lecturers do. I would:
1. Use a computer based compulsory quizes which must be completed, but not graded which ask students questions from anatomy or pharm or anything randomly during the entire two years. The problem with gross anatomy, and perhaps all courses, is that they are very intense and then nothing after you finish them, it is sort of like you have had it and that's it.
2. Cut lecture time in half. Really. Death by powerpoints is ridiculous and some topics which are interesting and important don't get enough time. I think I got one or two lectures on CHF in med school, which were very intense, but after they are done that is it. And perhaps a year ago I got the pharmacology lectures on drugs for CHF . . . it doesn't make sense in a way to learn pharmacology before pathophysiology. I know that some schools are trying to become more integrated and have a systems based approach, but even that would fail as once you finished with cardio you would be done with it.
The educational experience should approach so fit in seamlessly with how physicians keep up to date, which most of us means reading a couple articles a year on CHF or other topics. What I would for each topic would be to have a primer for a couple of weeks and then refreshers through out the two years.
For example, for cardiology I would teach a two week introduction that involved gross anatomy, pharmacology, and some basic pathophysiology AND give students some material to read for the next cardio class in a year. At the second cardio class I would then do a two week class with a quick review of cardio anatomy, pharmacology, advanced pathophysiology and a review quiz. And then half a year later do a two week course on advanced cardio II with cardio anatomy in relation to surgeries/CAD/clinical procedures which could involved a quick return to the gross lab, do a review of pharmacology, arrythmias, and then advanced adult and pediatric EKG/cardiology and then have a self-learning quiz. Total time would be about 6-8 weeks split over two years, and maybe even something during third or fourth year, but it would be much better retained that six weeks in second year that you would forget. Do this with every course and students would live with their cardio knowledge rather trying to remember what happened a year or a year and a half ago . . . it would only be 4 ot 6 months ago.
This is how my schedule would look like from begining of year 1 to the end of year 2:
Block 1 - 2 weeks cardiovascular
Block 2 - 2 weeks infectious disease
Block 3 - 2 weeks pulmonary
Block 4 - 2 weeks renal
Block 5 - 2 weeks hem/onc.
Block 6 - 2 weeks Gen Pharm.
Block 7 - 2 weeks Biochem Basic
Block 8 - 2 weeks Histo Basic
Block 9 - 2 weeks GI
Block 10 - 2 weeks cardiovascular 2 advanced
Block 11 - 2 weeks infectious disease 2 advanced
etc . . . I missed a lot of courses, but you get the general idea, sort of building on what you learned and switching topics quickly enough that old stuff is retained. I would use short 40 minute computer based multimedia quizes each week, where a certain number would be dropped, but something to evaluate your progress. The biochem faculty would have to do lectures on a rotating basis instead of for a single block each year but with computer technology and multimedia this could enhace learning and retention.
I re-invented how I studied after two years of basic sciences and got 250+ (you don't want to know how much it would make you cry) on CK and I am lesiurely reading through Lange Pharm now, yes it is "Step 1 material" but I realized I have to rotate what I am learning and review or I forget stuff. I wish I was in charge of the first two years, my curriculum would rock! People would ask students, "What are you studying now, pharmacology?" And under my curriculum the answer would be, "Well, we study a lot of stuff I finished a pharm quiz and we are doing Biochem now, but we switch so frequently it feels like we are studying everything!"
Of course not everybody would be in gross lab for example at the same time as people would rotate through via short schedule stints BUT you could look at a kidney again in gross lab after passing a basic renal exam on anatomy and physiology . . . very cool I actually get to appreciate what I am seeing much more.
I would do a similar thing for third and fourth year, have students do a mini-medicine clerkship that is only one month, and rotate in something else, and then come back to medicine for the second month perhaps half a year later, their evaluation file could be updated with more recent clinical evals so students could comeback and do even more spectacularly if they didn't shine on their first "mini clerkship".
