What are some Step1 items that we're absolutely never going to use as MDs?

[Knicks]

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In your opinion, what are some things that may be on boards that we're never going to need?

 

[FutureInternist]

The list is way too long 😀

1. Virus families, coated/uncoated.
2. 95% of embryo

 

[quietude]

In your opinion, what are some things that may be on boards that we're never going to need?

The Gibbs free energy equation. Which WAS on my exam. There should be a rule that if it was covered on the MCAT, putting it on the Step 1 is not allowed.

 

[snowflake83]

kreb's cycle-- actually, most of biochem.

 

[Knicks]

The list is way too long 😀

1. Virus families, coated/uncoated.
2. 95% of embryo

The Gibbs free energy equation. Which WAS on my exam. There should be a rule that if it was covered on the MCAT, putting it on the Step 1 is not allowed.

kreb's cycle-- actually, most of biochem.

So then why test us on that stuff??!! 😡

 

[FutureInternist]

Just think of how much crap you learn in college (Bio I, II, Chem I, II, Orgo I, II, Phy I, II.....) & what % of that actually gets tested on the MCAT.
If they only tested relevant material, it might make it too easy

 

[metallo]

Based on posts I've read on SDN, it seems to me like the NBME is increasing their number of questions that could be relevant for people going into research (many people are surprised by the number of biochem, micro, cell bio, etc. questions on their exams). I guess it makes sense since many of the academic/research-oriented residencies I've looked up seem to require higher Step 1 scores than the clinically-oriented programs. It's just one more way of differentiating one student from another.

 

[McGillGrad]

They are asked because that is what makes the difference b/w a physician and a mid-level. Physicians know medicine from the molecule to the way disease affects society. If we were only tested on what is clinical, then what separates us from PA's and NP's?

 

[FutureInternist]

They are asked because that is what makes the difference b/w a physician and a mid-level. Physicians know medicine from the molecule to the way disease affects society. If we were only tested on what is clinical, then what separates us from PA's and NP's?

1. How many docs remember any of that stuff 5 years out of school??
2. Do we really need to know what the actual chrmosome # that's messed up in a given disease if we're doing anything but peds ??

 

[McGillGrad]

1. How many docs remember any of that stuff 5 years out of school??
2. Do we really need to know what the actual chrmosome # that's messed up in a given disease if we're doing anything but peds ??

#1: You would be surprised what you remember years later. More importantly, it is easier to remember something after a quick search while on the floors than to try to learn about it for the first time.

#2: Yes and no. Not to treat someone (but that's what nurses and PA's and NP's do all day, pattern recognition, plug-and-play). If not the details, what makes you different than them?

 

[FutureInternist]

#1: You would be surprised what you remember years later. More importantly, it is easier to remember something after a quick search while on the floors than to try to learn about it for the first time.

#2: Yes and no. Not to treat someone (but that's what nurses and PA's and NP's do all day, pattern recognition, plug-and-play). If not the details, what makes you different than them?

Other than an ID doc I have yet to meet anyone who remembered what Abx act on 30S vs 50S yet they all prescribe one or the other depending on the standing orders that have been established at that particular hospital & their preference.

Me knowing that CF is a mess up on chrom # 7 has NO bearing on me being able to recognise/treat/refer it .....yet that is something that we need to know...why?????

I guess much like organic II, physics II etc these extra details can serve as "weed-out" so not everyone gets to be a doc.

 

[McGillGrad]

You didn't say what makes you different than a mid-level if all we need to know is pattern recognition.

Other than an ID doc I have yet to meet anyone who remembered what Abx act on 30S vs 50S yet they all prescribe one or the other depending on the standing orders that have been established at that particular hospital & their preference.

Me knowing that CF is a mess up on chrom # 7 has NO bearing on me being able to recognise/treat/refer it .....yet that is something that we need to know...why?????

I guess much like organic II, physics II etc these extra details can serve as "weed-out" so not everyone gets to be a doc.

 

[FutureInternist]

You didn't say what makes you different than a mid-level if all we need to know is pattern recognition.

I would say that docs knowing more than nurses come in handy during unexpected situations like codes, rxns to drugs, unusual illnesses that are not normally seen etc.

For the most part, every chest pain gets the same set of orders as does every abdominal pain in a young female or rectal bleeding in an old guy....there really is nothing much for the doc to do....just check off on the standing orders, wait for the results & admit if needed. Once on the floor, the doc follows the "standard of care protocol" making sure everyone is on a DVT prophylaxis, hospital acquired PNA prophylaxis, PPI for ulcer prophylaxis etc.

 

[McGillGrad]

If this is the truth, then we are going to lose our jobs to DNPs and NPs pretty soon.

I would say that docs knowing more than nurses come in handy during unexpected situations like codes, rxns to drugs, unusual illnesses that are not normally seen etc.

For the most part, every chest pain gets the same set of orders as does every abdominal pain in a young female or rectal bleeding in an old guy....there really is nothing much for the doc to do....just check off on the standing orders, wait for the results & admit if needed. Once on the floor, the doc follows the "standard of care protocol" making sure everyone is on a DVT prophylaxis, hospital acquired PNA prophylaxis, PPI for ulcer prophylaxis etc.

 

[Knicks]

They are asked because that is what makes the difference b/w a physician and a mid-level. Physicians know medicine from the molecule to the way disease affects society. If we were only tested on what is clinical, then what separates us from PA's and NP's?

OK, but if both physicians and mid-levels are NOT going to use those things, it ultimately doesn't matter whether those practically useless factoids "make the difference b/w a physician and a mid-level".

 

[FutureInternist]

If this is the truth, then we are going to lose our jobs to DNPs and NPs pretty soon.

I take it you have not done any rotations yet ?? 😀

 

[McGillGrad]

OK, but if both physicians and mid-levels are NOT going to use those things, it ultimately doesn't matter whether those practically useless factoids "make the difference b/w a physician and a mid-level".

I am speaking from a real-world perspective where mid-levels are assuming the role of Primary Physicians in rural and under-served areas, with the right to independently prescribe medicine, and admit patients.

If our extra years of basic science and clinical training result in the same amount of knowledge, then economic factors will give a DNP your job, for less money and you have nothing to say when they ask you what makes your MD special and worth more a higher salary.

It's your future, and if you decide that your years of education can be replaced with on-the-job training, then be prepared to deal with the consequences.

It won't be a MD in those Walmart clinics, it will be PAs and NPs. Do you really believe that they are as qualified as you to serve patients?

 

[McGillGrad]

I take it you have not done any rotations yet ?? 😀

In the middle of them, actually.

 

[pseudoknot]

I wish the midlevel debates would stay in the anesthesia forum where they belong.

 

[McGillGrad]

I wish the midlevel debates would stay in the anesthesia forum where they belong.

This is not a mid-level debate. This is defining what makes a physician different and why delegation of duties over the years has reduced the scope of practice to a dangerously narrow collection of bureaucratic privileges that are based on legal barriers, not academic barriers (that are much more difficult to overcome for mid-levels).

 

[pseudoknot]

This is not a mid-level debate.

This is defining what makes a physician different and why delegation of duties over the years has reduced the scope of practice to a dangerously narrow collection of bureaucratic privileges that are based on legal barriers, not academic barriers (that are much more difficult to overcome for mid-levels).

I don't understand this sentence at all. Maybe I'm too hung over.

Anyway, the way the midlevel thing got brought into this thread contradicts its premise. If the only thing that separates MDs from NPs and PAs is that we learned and forgot a bunch of clinically irrelevant trivia at some point, then obviously we would all be functionally the same.

I think what you want to be arguing, and what is probably true, is that a lot of the extra knowledge IS clinically relevant. (Maybe not in a 10-minute primary care appointment, but for more complex decision making.)

That doesn't change the fact that there is a lot of waste in medical education. In Melvin Konner's classic Becoming a Doctor he compared it to the federal budget: everyone thinks there is waste in there but no one has the political will to trim it down. Every basic science lecturer thinks they should cram a little more in. It's ridiculous.

 

[scube]

I didn't read all of this tread so this point might be made somewhere already. Its all about exposure. what if a drug hits the market that affects naked DNA viruses only, you have been exposed to it. one very basic example but you should get the point. I am actually glad I've seen it because of the exposure. Am I happy that the recall of these details are used to judge "intelligence" or something of that sort, No. but it is the way it is. If you want to get really upset look at an early version of First Aid. the second edition was like 100 pages of big print.

 

[McGillGrad]

I hear this argument a lot. It started with the SAT/ACT, then I heard it about the MCAT and now I hear it about the USMLE exams...and I'm sure I'll hear it about the board certification exams. The main point I always make is that each piece of info (as useless as it may end up) is a step towards a goal. Even though you may never use calculus/physics again, it helped to shape your mind and your thinking. All prerequisites are designed to create a scaffolding that help shape concepts and connect ideas. Whether you realize it, or not, this is the main purpose.

Maybe I am the wrong person to ask because I am biased (98th in SAT, 31R MCAT, 243/99 Step 1). Generally, I do better than the average peer with less studying....but I am a lazy bastard.

Then again, if I would have spent more time memorizing class notes instead of reading philosophical and historical texts while trying to see the "big picture" of life, I would be at a Canadian medical school not a foreign one.

 

[Knicks]

.......It's your future.......

Huh? Wha..?

"Future"?

How is, "It's your future" augmenting your arguement? The following quote is a good point made by FutureInternist (lol @ irony) that shows that small, never-gonna-be-used-details will not affect our "future" performances as "future" doctors:

......Me knowing that CF is a mess up on chrom # 7 has NO bearing on me being able to recognise/treat/refer it .....yet that is something that we need to know...why?????

But unfortunately, it (Step1) is what it is and if they require us to know tiny details for licensure, then so be it; but that's not going to stop people from pointing out tiny details' potential uselessness.


I guess this sums it up well:

I guess much like organic II, physics II etc these extra details can serve as "weed-out" so not everyone gets to be a doc.

 

[McGillGrad]

Huh? Wha..?

"Future"?

How is, "It's your future" augmenting your arguement? The following quote is a good point made by FutureInternist (lol @ irony) that shows that small, never-gonna-be-used-details will not affect our "future" performances as "future" doctors:

How about this. I scored better than you on step 1 because I know more details. That means I get a more prestigious and more competitive residency which gives me more opportunity in medicine (a.k.a more money and choice).

So that's why tiny details make me a better doctor than you.

 

[FutureInternist]

Congratulations on your sweet step 1 score....however, as I said before, how many of those tiny details are you using during your rotations (although you may remember a lot of them since you're only a year out), or later during your residency.

I do not dispute the fact that the tiny details are a means to an end i.e. like you said, you remembering more of that crap than someone else MAY help in you getting a better residency, which MAY give you better training, which MAY have you become a better doctor BUT the fact remains that you could not recall what the heck FGF-8 does & still be a great doctor.

BTW, more money & more choice does NOT = better docotor

 

[Knicks]

How about this. I scored better than you on step 1 because I know more details. That means I get a more prestigious and more competitive residency which gives me more opportunity in medicine (a.k.a more money and choice).

So that's why tiny details make me a better doctor than you.

Irrelevant "point(s)".

Congratulations on your sweet step 1 score....however, as I said before, how many of those tiny details are you using during your rotations (although you may remember a lot of them since you're only a year out), or later during your residency.

I do not dispute the fact that the tiny details are a means to an end i.e. like you said, you remembering more of that crap than someone else MAY help in you getting a better residency, which MAY give you better training, which MAY have you become a better doctor BUT the fact remains that you could not recall what the heck FGF-8 does & still be a great doctor.

BTW, more money & more choice does NOT = better docotor

Win.

 

[McGillGrad]

Just because you cannot understand a point does not make it irrelevant.

I thank Godzilla in the sky every day that people like you are my competition for residency. It makes things so much easier.

Irrelevant "point(s)".


Win.

 

[Knicks]

Just because you cannot understand a point does not make it irrelevant.

I thank Godzilla in the sky every day that people like you are my competition for residency. It makes things so much easier.

Yes.

 

[Whats_up_doc]

How about this. I scored better than you on step 1 because I know more details. That means I get a more prestigious and more competitive residency which gives me more opportunity in medicine (a.k.a more money and choice).

So that's why tiny details make me a better doctor than you.

🙄

Interesting. I am sure that a few students are interested in making a LOT of money but they don't actually write it in personal statements or shout it in SDN threads. However, there is always an exception. 🙄

I believe that details are important to be teached. I do not believe details should be tested in such important tests as USMLE 1. I believe this tendency responds to medical education philosophy of creating more and more translational researchers (MD/PHd) for X or Y reason. Regardless, I still need to memorize random facts to "prove" to the NBME that I am a good doctor and that I have the necessary skills (meaning Cramming FA capacity) to care for the ill.

Being a good doctor is proportional to each individual perspective's. For some, it may be higher intellectual capacity (falsely measured by knowing more details, applying to a more prestigiou$$$$$$ residency,etc.). For others, it is delivering appropiate care for people who need it, in the most efficient way. Patients will not notice your USMLE score on your forehead, nor will they present in a clinical-vignette scenario but if you make them feel good about themselves after you treat them, you will see that there is more to Medicine than money and that is a patient's life.

We won't tell anyone your real intentions of becoming a doctor. After all, this is an anonymous forum. However, do yourself a favor and never shove it in a patient's face nor to ""mid-levels". You might regret it someday... and that feeling won't be fixed by money. Guaranteed.

 

[Doctor4Life1769]

This is hilarious - but I agree with some of McGill's earlier responses (not his last few - those were just hilarious).

 

[Knicks]

🙄

Interesting. I am sure that a few students are interested in making a lot of money but they don't actually write it in personal statements or shout it in sdn threads. However, there is always an exception. 🙄

I believe that details are important to be teached. I do not believe details should be tested in such important tests as usmle 1. I believe this tendency responds to medical education philosophy of creating more and more translational researchers (md/phd) for x or y reason. Regardless, i still need to memorize random facts to "prove" to the nbme that i am a good doctor and that i have the necessary skills (meaning cramming fa capacity) to care for the ill.

Being a good doctor is proportional to each individual perspective's. For some, it may be higher intellectual capacity (falsely measured by knowing more details, applying to a more prestigiou$$$$$$ residency,etc.). For others, it is delivering appropiate care for people who need it, in the most efficient way. Patients will not notice your usmle score on your forehead, nor will they present in a clinical-vignette scenario but if you make them feel good about themselves after you treat them, you will see that there is more to medicine than money and that is a patient's life.

We won't tell anyone your real intentions of becoming a doctor. After all, this is an anonymous forum. However, do yourself a favor and never shove it in a patient's face nor to ""mid-levels". You might regret it someday... And that feeling won't be fixed by money. Guaranteed.

*clap* *clap* *clap* 👍

 

[McGillGrad]

Reading your horrendously written paragraph (full of grammatical and spelling mistakes) makes me realize that you have no idea that I wrote that as a sarcastic reply. In other words, it wasn't supposed to be taken seriously.

Then again, this thread goes to prove that the average IQ for a physician truly is a 109.

🙄

Interesting. I am sure that a few students are interested in making a LOT of money but they don't actually write it in personal statements or shout it in SDN threads. However, there is always an exception. 🙄

I believe that details are important to be teached. I do not believe details should be tested in such important tests as USMLE 1. I believe this tendency responds to medical education philosophy of creating more and more translational researchers (MD/PHd) for X or Y reason. Regardless, I still need to memorize random facts to "prove" to the NBME that I am a good doctor and that I have the necessary skills (meaning Cramming FA capacity) to care for the ill.

Being a good doctor is proportional to each individual perspective's. For some, it may be higher intellectual capacity (falsely measured by knowing more details, applying to a more prestigiou$$$$$$ residency,etc.). For others, it is delivering appropiate care for people who need it, in the most efficient way. Patients will not notice your USMLE score on your forehead, nor will they present in a clinical-vignette scenario but if you make them feel good about themselves after you treat them, you will see that there is more to Medicine than money and that is a patient's life.

We won't tell anyone your real intentions of becoming a doctor. After all, this is an anonymous forum. However, do yourself a favor and never shove it in a patient's face nor to ""mid-levels". You might regret it someday... and that feeling won't be fixed by money. Guaranteed.

 

[Whats_up_doc]

Reading your horrendously written paragraph (full of grammatical and spelling mistakes) makes me realize that you have no idea that I wrote that as a sarcastic reply. In other words, it wasn't supposed to be taken seriously.

Then again, this thread goes to prove that the average IQ for a physician truly is a 109.

Sarcasm is a place where people refuge when they have no arguments. I know there were some grammar mistakes here and there. If you understood what it meant (the essence), then my job is done here. 👍

 

[Doctor4Life1769]

While it is true that memorizing every little fact in First Aid won't make you any better a doctor than someone who didn't, it will potentially land you a better residency (and one can hope that said residency program has a priority in providing you the best learning experience possible). Med school is not where you become a physician, it's residency. Better training = better doctor. If you want to be a doctor who follows strict protocol, then that in itself may lead to increased patient morbidity and mortality. Do you honestly want a physician who "sees a pattern" and treats you accordingly without looking at you entirely as a separate case? I wouldn't. That can lead to a fatal mistake and potentially patient deaths. I want a physician who can provide the best care possible, and even if it means having that extra knowledge to tie in other aspects of a patient's condition, so be it. If you want to treat by protocol, stick to rural or urban primary care ... too many EM doctors go by protocol and it costs lives. To go strictly by protocol really means we are no different from mid-level healthcare providers. It's like the whole "PhD vs Lab Tech" discussion - a PhD is supposed to have a greater understanding of whatever their research is about ... and yes, there are techs out there who do have a decent understanding but that was on their own (they didn't go through the schooling to gain that) ... and both can do techniques and experiments. I guess for the amount of schooling we go through, I'd hope I learned more than a PA, nursing student, or scrub tech did and be able to use even a little bit of that knowledge towards bettering my future patients' lives.

 

[McGillGrad]

Sarcasm is a place where people refuge when they have no arguments. I know there were some grammar mistakes here and there. If you understood what it meant (the essence), then my job is done here. 👍

You should be indicted for murdering the English language!

And save your sob story about English as a second language. English is my 3rd language.

 

[McGillGrad]

While it is true that memorizing every little fact in First Aid won't make you any better a doctor than someone who didn't, it will potentially land you a better residency (and one can hope that said residency program has a priority in providing you the best learning experience possible). Med school is not where you become a physician, it's residency. Better training = better doctor. If you want to be a doctor who follows strict protocol, then that in itself may lead to increased patient morbidity and mortality. Do you honestly want a physician who "sees a pattern" and treats you accordingly without looking at you entirely as a separate case? I wouldn't. That can lead to a fatal mistake and potentially patient deaths. I want a physician who can provide the best care possible, and even if it means having that extra knowledge to tie in other aspects of a patient's condition, so be it. If you want to treat by protocol, stick to rural or urban primary care ... too many EM doctors go by protocol and it costs lives. To go strictly by protocol really means we are no different from mid-level healthcare providers. It's like the whole "PhD vs Lab Tech" discussion - a PhD is supposed to have a greater understanding of whatever their research is about ... and yes, there are techs out there who do have a decent understanding but that was on their own (they didn't go through the schooling to gain that) ... and both can do techniques and experiments. I guess for the amount of schooling we go through, I'd hope I learned more than a PA, nursing student, or scrub tech did and be able to use even a little bit of that knowledge towards bettering my future patients' lives.

Thank you👍 Excellent summary.

Yet, some people cannot grasp this simple logic.😕

 

[Knicks]

While it is true that memorizing every little fact in First Aid won't make you any better a doctor than someone who didn't, it will potentially land you a better residency

True, but the fact that part of why they're picking you for a program is your ability to memorize and regurgitate facts that are undeniably not going to be used in the clinic seems rather odd.

I want a physician who can provide the best care possible,

Nobody would disagree, but not the point of this thread.

and even if it means having that extra knowledge to tie in other aspects of a patient's condition, so be it.

If we're talking about extra bits of knowledge that will actually be needed and used, then I agree. But this thread is not about that kind of "extra knowledge" that we're tested on Step 1 (which was made quite clear in the thread title, "What are some Step1 items that we're absolutely never going to use as MDs?").

🙂