What if they allowed PA students to do Allopathic residencies?

[mTOR]

Would that make everyone realize that current medical education MAKES NO SENSE? That it's ridiculously way too long and largely irrelevant to actual practice? That it's a ****ing racket?

Is 1st year truly needed? Is 4th?

Hell, minus the research year requirement (that almost no school does) and the largely unnecessary 4th year, Duke's med school curriculum is ALREADY essentially a low budget version of their PA school curriculum model just with more esoteric basic science garbage you don't need to know (and will likely forget unless you do research in those fields).

brb PA students outshining med students on every rotation @ my school
brb graduating with 2-3x the debt of PA students
brb wait.. where did my 20's go
brb jokes on me

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[HumbleMD]

It'll never happen due to this great lobbying body we have called the AMA. Same reason this talk of doctorate of nursing isn't grounded in reality.

PA is a very good option if all you want to do is practice medicine, or be first assist on a surgery. You make great money with very little investment and opportunity cost.

If you think of yourself as a technician, then yes, you made the wrong choice by going the MD route. I recommend PA school to a number of my older friends.

PAs, however, will never be allowed to do residency - they're trained to do resident level work, and stay there. There's very little career advancement, and you're basically a med tech rather than a team manager as an MD. It's easy to get jealous when you see PAs doing more than chief residents, and certainly more than a rotating med student.

Stick in there - if you love teaching, coordinating care teams, administration and leading the field of medicine, then you haven't made the wrong choice. If you wanted to put in your 40 hours and make bank, then, yes, medicine was a poor choice.

 

[BigRedder]

We live in an era of cookbook medicine. Algorithms and guidelines dominate practice. Sometimes it seems like all this knowledge is useless. Maybe it is. But we provide a service that many people believe to be difficult, complicated, and important. I suspect that many of them appreciate the fact that when we prescribe a medication, we understand why they need it, how it works, and what may go wrong.

What about 1st year is unnecessary? Anatomy and physiology are obviously necessary. Cell and molecular biology are necessary to actually understand both current and future pharmacology. Histology is necessary to understand pathology.

Sure, 4th year is kind of a waste. Only July-October matter for residency, and you can't do anything super meaningful November-January because of interviews. That leaves February-April, with requisite senioritis amid the realization that you have only a few months to be a (somewhat) irresponsible young adult. But think about it. What if they took that away? How much would that suck? You don't even get to enjoy your 20s for a few months!

 

[BigRedder]

It'll never happen due to this great lobbying body we have called the AMA. Same reason this talk of doctorate of nursing isn't grounded in reality.

PA is a very good option if all you want to do is practice medicine, or be first assist on a surgery. You make great money with very little investment and opportunity cost.

If you think of yourself as a technician, then yes, you made the wrong choice by going the MD route. I recommend PA school to a number of my older friends.

PAs, however, will never be allowed to do residency - they're trained to do resident level work, and stay there. There's very little career advancement, and you're basically a med tech rather than a team manager as an MD. It's easy to get jealous when you see PAs doing more than chief residents, and certainly more than a rotating med student.

Stick in there - if you love teaching, coordinating care teams, administration and leading the field of medicine, then you haven't made the wrong choice. If you wanted to put in your 40 hours and make bank, then, yes, medicine was a poor choice.

Also this.

 

[HumbleMD]

We live in an era of cookbook medicine. Algorithms and guidelines dominate practice. Sometimes it seems like all this knowledge is useless. Maybe it is. But we provide a service that many people believe to be difficult, complicated, and important. I suspect that many of them appreciate the fact that when we prescribe a medication, we understand why they need it, how it works, and what may go wrong.

What about 1st year is unnecessary? Anatomy and physiology are obviously necessary. Cell and molecular biology are necessary to actually understand both current and future pharmacology. Histology is necessary to understand pathology.

Sure, 4th year is kind of a waste. Only July-October matter for residency, and you can't do anything super meaningful November-January because of interviews. That leaves February-April, with requisite senioritis amid the realization that you have only a few months to be a (somewhat) irresponsible young adult. But think about it. What if they took that away? How much would that suck? You don't even get to enjoy your 20s for a few months!

The question becomes whether or not you want to be the one writing those cookbooks.

Agreed, 4th year is a waste. But there's no way you could pack electives, residency, etc. into 3rd year. Plus, we need the break before intern year.

 

[hefe]

It would be interested if such 2 year program were tried and outcomes compared to 4, probably would never fly.

One thing as I'm possibly assume 'trad' students is that PA's usually require a bachelors + years worth of healthcare work + year applying/gap to start. Many PA's are actually career changers and/or transition-ers in the current setup.

Very few PA's get into PA school and finish right after undergrad to be 24-25. Though, as an anecdote I know of one. Most PA's by graduation will be beyond or near 30s when they begin practicing.

A PA's role and employ-ability will always be tied to some physician, and so far current physician averages are ~2x salary (though with admittedly some other costs). Some people are OK with this though.

 

[reedman]

i still think the MD degree is meant to be a doctoral degree, where you learn about the science of clinical medicine for the sake of science and knowledge, not to do a particular job. doing the job is what residency is for.

perhaps we should allow a more advanced path for PAs, and require more research for the MD degree? i believe that MD degree should be preserved as a rigorous and science based degree where people are driven by an intrinsic curiosity about biological sciences. at my school there is a difference between the PA education and ours. they take a few classes with us, but the exams are constructed differently. i want MD/DOs to be scientists first, and doctors second.

 

[greatnt249]

i still think the MD degree is meant to be a doctoral degree, where you learn about the science of clinical medicine for the sake of science and knowledge, not to do a particular job. doing the job is what residency is for.

perhaps we should allow a more advanced path for PAs, and require more research for the MD degree? i believe that MD degree should be preserved as a rigorous and science based degree where people are driven by an intrinsic curiosity about biological sciences. at my school there is a difference between the PA education and ours. they take a few classes with us, but the exams are constructed differently. i want MD/DOs to be scientists first, and doctors second.

Uh, no thanks, unless you're willing to subsidize my educational costs and provide a stipend like most graduate programs in this country.

 

[weightyheart]

i still think the MD degree is meant to be a doctoral degree, where you learn about the science of clinical medicine for the sake of science and knowledge

i want MD/DOs to be scientists first, and doctors second.

that's what phds are for
or mds in academic medicine
or md/phds

 

[gravitywave]

Would that make everyone realize that current medical education MAKES NO SENSE? That it's ridiculously way too long and largely irrelevant to actual practice? That it's a ****ing racket?

Is 1st year truly needed? Is 4th?

Hell, minus the research year requirement (that almost no school does) and the largely unnecessary 4th year, Duke's med school curriculum is ALREADY essentially a low budget version of their PA school curriculum model just with more esoteric basic science garbage you don't need to know (and will likely forget unless you do research in those fields).

brb PA students outshining med students on every rotation @ my school
brb graduating with 2-3x the debt of PA students
brb wait.. where did my 20's go
brb jokes on me

i guess i really disagree with this. we have to take the Steps to become doctors, after all - and i don't see any PA program as ever being sufficient preparation for USMLE. unless you're actually at Duke and going to both med and PA classes, I don't see how you can say that there's no daylight between the two. not only is PA material shorter, but what they get is a lot less dense.

I'm not pumped about learning about the proteosome either, but TBH i think you have to walk before you can run. now, the antiquated reliance on lecture as a didactic tool.... that could stand to be changed (and already is changing.)

if PA students are outshining med students on rotations at your school, it's probably because most of them have a lot more clinical experience than the med students do. the med students won't catch up until they're interns.

i still think the MD degree is meant to be a doctoral degree, where you learn about the science of clinical medicine for the sake of science and knowledge, not to do a particular job. doing the job is what residency is for.

perhaps we should allow a more advanced path for PAs, and require more research for the MD degree? i believe that MD degree should be preserved as a rigorous and science based degree where people are driven by an intrinsic curiosity about biological sciences. at my school there is a difference between the PA education and ours. they take a few classes with us, but the exams are constructed differently. i want MD/DOs to be scientists first, and doctors second.

and you would be wrong. the MD degree is a professional doctorate, not a research doctorate. the entire second two years of medical school is supposed to be training you to do clinical medicine. you're supposed to be doing stuff to patients. why do you think most MD schools have no research requirement, and never will. physicians are not scientists, thats what we have the PhDs for!!

 

[johnmendes]

and you would be wrong. the MD degree is a professional doctorate, not a research doctorate. the entire second two years of medical school is supposed to be training you to do clinical medicine. you're supposed to be doing stuff to patients. why do you think most MD schools have no research requirement, and never will. physicians are not scientists, thats what we have the PhDs for!!

Damn, you beat me to writing this...

I find non clinical research to be quite boring, IMHO

 

[dienekes88]

Would that make everyone realize that current medical education MAKES NO SENSE? That it's ridiculously way too long and largely irrelevant to actual practice? That it's a ****ing racket?

Is 1st year truly needed? Is 4th?

Hell, minus the research year requirement (that almost no school does) and the largely unnecessary 4th year, Duke's med school curriculum is ALREADY essentially a low budget version of their PA school curriculum model just with more esoteric basic science garbage you don't need to know (and will likely forget unless you do research in those fields).

brb PA students outshining med students on every rotation @ my school
brb graduating with 2-3x the debt of PA students
brb wait.. where did my 20's go
brb jokes on me

Do they take the same classes on courses that overlap? Just because the title is similar doesn't mean that the course is the same. It very well could be, though.

In what way are the PA students outshining med students? Is it in terms of work ethic or knowledge?

 

[IHeartNerds]

and you would be wrong. the MD degree is a professional doctorate, not a research doctorate. (...) physicians are not scientists, thats what we have the PhDs for!!

Harvey Cushing would be ashamed of you. All physicians should be scientists. We don't have to be as good at it as are PhDs, but we should still strive for excellence.


Most PA programs, at least from my understanding, do not teach a lot of critical thinking on trial design and evidence/science based (or evidence/science-baseless) medicine. This is a huge component of what does, or at least should, separate MDs from the rest of clinical medicine.

 

[gravitywave]

Harvey Cushing would be ashamed of you. All physicians should be scientists. We don't have to be as good at it as are PhDs, but we should still strive for excellence.


Most PA programs, at least from my understanding, do not teach a lot of critical thinking on trial design and evidence/science based (or evidence/science-baseless) medicine. This is a huge component of what does, or at least should, separate MDs from the rest of clinical medicine.

science informs medicine, sure. a medical education will teach you to appreciate the scientific method and to be able to critically evaluate the literature. but we aren't scientists. there's just a lot more to it than that. you do know that clinical medicine is practiced largely out of meta-reviews and databases like UpToDate, don't you? there isn't much time to pore over primary sources in the real world....

I thank Dr. Cushing for his herculean efforts to bring medicine out of the dark ages and into the light, but that battle's already been won.

you're right though that PA programs teach an overview with much broader strokes than MD. they don't get the background we do to be able to parse the scientific literature. lots of how, not as much why.

 

[dienekes88]

science informs medicine, sure. a medical education will teach you to appreciate the scientific method and to be able to critically evaluate the literature. but we aren't scientists. there's just a lot more to it than that. you do know that clinical medicine is practiced largely out of meta-reviews and databases like UpToDate, don't you? there isn't much time to pore over primary sources in the real world....

I thank Dr. Cushing for his herculean efforts to bring medicine out of the dark ages and into the light, but that battle's already been won.

you're right though that PA programs teach an overview with much broader strokes than MD. they don't get the background we do to be able to parse the scientific literature. lots of how, not as much why.

I thought this too. However, most of the very good residents and attendings I've met are able to talk about the primary sources when it comes to the major papers. The best can talk about inclusion/exclusion criteria to those studies and talk about the limitations. The real game-changing papers that set the tone of a discussion don't come around too often. After you know the big papers, skimming other papers and thinking about how they relate to the big ones is a lot easier.

 

[gravitywave]

I thought this too. However, most of the very good residents and attendings I've met are able to talk about the primary sources when it comes to the major papers. The best can talk about inclusion/exclusion criteria to those studies and talk about the limitations. The real game-changing papers that set the tone of a discussion don't come around too often. After you know the big papers, skimming other papers and thinking about how they relate to the big ones is a lot easier.

i don't disagree with anything you've said. the fact remains however that most clinical decisions made on a daily basis are using clinical databases, other pre-masticated research summaries, or plain old physician background knowledge as the reference sources. of course the endocrinologist is familiar with the huge NEJM diabetes study that most people consider to have settled the blood sugar hypothesis. you're no good if you haven't read the game-changers. but no one can keep up with everything that's happening in their field. and there will never be good EBM guidelines for everything that we'll have to make up our minds about. not in our lifetimes, anyway.

i also suspect that your experience is at least partially the result of the academic setting in which you've had it. all i'm saying at the end of the day is that yes, doctors understand science. they have to. practicing medicine is not, however, an scientific endeavour. we don't have that luxury.

 

[weightyheart]

I thought this too. However, most of the very good residents and attendings I've met are able to talk about the primary sources when it comes to the major papers. The best can talk about inclusion/exclusion criteria to those studies and talk about the limitations. The real game-changing papers that set the tone of a discussion don't come around too often. After you know the big papers, skimming other papers and thinking about how they relate to the big ones is a lot easier.

Reading about research that other people have done is not at all like going into the laboratory to do your own research on the subject. As clinicians, we won't have time to 'reinvent the wheel' and do our own research as others here are suggesting; it is however expected that we be updated on relevant research that others have already done.

 

[dienekes88]

i don't disagree with anything you've said. the fact remains however that most clinical decisions made on a daily basis are using clinical databases, other pre-masticated research summaries, or plain old physician background knowledge as the reference sources. of course the endocrinologist is familiar with the huge NEJM diabetes study that most people consider to have settled the blood sugar hypothesis. you're no good if you haven't read the game-changers. but no one can keep up with everything that's happening in their field. and there will never be good EBM guidelines for everything that we'll have to make up our minds about. not in our lifetimes, anyway.

... huge NEJM diabetes study... ACCORD? or ADVANCE. Primary care physicians should know these too. This is a case in which it's really important to know the inclusion/exclusion criteria. ACCORD had patients with significant cardiovascular risk (I think 2 risk factors) or angiographically confirmed CAD and on average had diabetes for ~10 years. Even in pre-digested form, i.e. ADA/AHA/ACCF recs post ACCORD/ADVANCE, say that on account of the major benefits seen from early control following the UKPDS cohort patients should be treated to a target of <7% but that there should be some lee-way given to long term poorly controlled type 2 diabetics.

By the way, I have no intention of going into internal medicine.

Not having pre-digested evidence based guidelines is a good reason to have excellent command of basic physiology/pathophysiology, the major studies in a field, etc. Knowing the basics is even MORE important! That is the importance of going to medical school in my mind.

i also suspect that your experience is at least partially the result of the academic setting in which you've had it. all i'm saying at the end of the day is that yes, doctors understand science. they have to. practicing medicine is not, however, an scientific endeavour. we don't have that luxury.

True.

It's our duty to keep it science/evidence-based, though.

Reading about research that other people have done is not at all like going into the laboratory to do your own research on the subject. As clinicians, we won't have time to 'reinvent the wheel' and do our own research as others here are suggesting; it is however expected that we be updated on relevant research that others have already done.

I may not have read the thread that thoroughly. However, I was under the impression that people were talking about understanding experimental design. From that arises the importance of knowing inclusion and exclusion criteria, being able to read the results section, and evaluating the paper's conclusions.

 

[nitemagi]

You may feel different after being in residency for a few years, and seeing how mid-levels are at management. They're fine with the basics (otitis media in peds, for example), but anything that strays from the common they're often lost. Don't get me wrong, there's plenty of MD's that miss the boat too in all specialties, but it seems less common.

The training is important, even if you don't see it at the moment.

 

[VisionaryTics]

Reading about research that other people have done is not at all like going into the laboratory to do your own research on the subject. As clinicians, we won't have time to 'reinvent the wheel' and do our own research as others here are suggesting; it is however expected that we be updated on relevant research that others have already done.

It is easy to forget that clinical practice needs to advance; I believe physicians have a duty to move medical practice forward, which can't be done by translational PhDs. Like it or not, research (from the basic level on up) is an essential part of medicine. It's easy to pass the buck along, but MDs have a responsibility to their patients that I think requires research based on a solid foundation of basic science.

This is one reason why a lot of subspecialties place such high value on research: when there are so few neurosurgeons/otolaryngologists/radoncs/etc, the few that are out there have a duty to the profession to improve clinical practice through research.

 

[JacobSilge]

Would that make everyone realize that current medical education MAKES NO SENSE? That it's ridiculously way too long and largely irrelevant to actual practice? That it's a ****ing racket?

Is 1st year truly needed?

Maybe it would be possible to shorted biochem or histo (then again, path would make a whole lot less sense), but good luck doing ANYTHING 3rd year without a solid basis in anatomy and physiology. And if you plan to ever treat a patient with cancer (you know, the #2 cause of death in the US) you'll probably want to have some idea how any of the drugs work, which requires some basis in cell biology.

Is 4th?

I'll never understand the complete disdain with which people refer to the utility of 4th year. I've learned a TON this year. And though less stressful than the prior year, it definitely is far from the "vacation" that so many people seem to think it is (well, until the match last month). I mean Sub-i, middle of the night ED shifts, q3 overnights in the unit... it's a good bit of work and I learned a lot from it since I had an opportunity to build on my knowledge base from 3rd year. Even the easy rotations can be educational - just because you are in clinic or a consult service from 8-5 with no weekends doesn't mean you don't learn anything! Having this level of specialized experience seems pretty important, even if you are going into primary care. Not to mention the gaps you can fill in during this year. I will admit that one month of radiology was kind of a joke.

Hell, minus the research year requirement (that almost no school does) and the largely unnecessary 4th year, Duke's med school curriculum is ALREADY essentially a low budget version of their PA school curriculum model just with more esoteric basic science garbage you don't need to know (and will likely forget unless you do research in those fields).

I also did a research year (clinical) and got a lot out of it in terms of taking care of patients. And the PA curriculum has a distinct lack of a 4th year, and very different sounding preclinical coursework. And do the PA and MD students spend the same amount of time at the tertiary university hospital versus outside clinics and community hospitals? I don't know, those curricula are not very specific.

brb PA students outshining med students on every rotation @ my school

At least where I was, the PA students tended to have a lot more healthcare experience coming in so of course they look better when it comes to procedural skills or just being confident with patients. Granted, so did the former EMTs and nurses in our class. The Med students tended to look better when it came to understanding pathophys, using the literature, and formulating an assessment on a patient with multiple comorbidities. And by 4th year I at least felt pretty confident on the procedural side.

brb graduating with 2-3x the debt of PA students

2x. PA school costs the same as med school per year. Not sure where the 3x came from (they went to undergrad too, right?

brb wait.. where did my 20's go

Only you can tell that. Then again, other than some very busy parts of 3rd year I pretty well enjoyed my life during med school. I'm sure most of the "lost time" is during residency, but if PA graduates did residencies, then this would be equal, right?

brb jokes on me

.

 

[mTOR]

You may feel different after being in residency for a few years, and seeing how mid-levels are at management. They're fine with the basics (otitis media in peds, for example), but anything that strays from the common they're often lost. Don't get me wrong, there's plenty of MD's that miss the boat too in all specialties, but it seems less common.

The training is important, even if you don't see it at the moment.

Med school training or RESIDENCY training?


I'd argue, the most VITAL patient care relevant aspect of a physician's fund of knowledge is learned during residency. While I DO think you need SOME basic foundation to start residency, I'm not at all convinced that the 2 extra years in allopathic med school training provides a significant advantage over PA schooling in preparing a competent graduate ready to start internship (e.g., can anyone cogently explain why only having 2 years schooling [a la Duke] + USMLE's would NOT work?). Hell, I'm about to graduate in 2 weeks and while I LOVED this past year to death AND while I learned A LOT MORE about my specialty choice this year, I honestly feel like with all the bullsh*t electives I've taken that overall my medical knowledge has eroded and I'm 2x dumber than I was a year ago

I advocate personal CHOICE in the matter with a concomitant diversity of educational curricula and types of schools. If someone wants to endure 4 years of medical training for god knows what-the-**** (e.g., research, esoteric learning and mental masturbation, a relaxing year of self-exploration and specialty sampling) then fine, let them go do it! I'm happy for you! However, it makes no cost-effective sense to systematically shackle ALL students to this model! This entire process is antiquated and needs to move forward towards personalized learning complete with a diverse array of options and opportunities instead of this wasteful one-size-fits-all model we currently have.

 

[Charles_Carmichael]

Med school training or RESIDENCY training?


I'd argue, the most VITAL patient care relevant aspect of a physician's fund of knowledge is learned during residency. While I DO think you need SOME basic foundation to start residency, I'm not at all convinced that the 2 extra years in allopathic med school training provides a significant advantage over PA schooling in preparing a competent graduate ready to start internship (e.g., can anyone cogently explain why 2 years schooling [a la Duke] + USMLE's would NOT work?).

What evidence/experience do you have to back up that statement? Or are you just speculating? There's currently one PA-to-DO bridge and med school is still 3 years for them and they have to go into primary care. There have been multiple posters on SDN who are PA-turned-medical students who have pointed out the med school education is much more detailed/difficult than PA education. So, what evidence do you have to support anything you've said so far? Because I haven't found anything.

Just curious.

 

[mTOR]

^wtf? Wow, you just wanted to make a post to make a post didn't you? Herp derp. Obvious speculation is obvious. The way I phrased that statement makes it pretty clear that it's from the standpoint of skepticism and intended to highlight absence of proof of the notion that the current educational model (of 2 yr preclinical, 2 yr clinical) is ESSENTIAL to competency. Duke offers a experimental microcosm for this inquiry as they've clearly showed that it is NOT ESSENTIAL -- as they've obviously successfully condensed what takes the vast majority of other schools 3 years into 2 years.

 

[Charles_Carmichael]

^wtf? Wow, you just wanted to make a post to make a post didn't you? Herp derp. Obvious speculation is obvious. The way I phrased that statement makes it pretty clear that it's from the standpoint of skepticism and intended to highlight absence of proof of the notion that the current educational model (of 2 yr preclinical, 2 yr clinical) is ESSENTIAL to competency. Duke offers a experimental microcosm for this inquiry as they've clearly showed that it is NOT ESSENTIAL -- as they've obviously successfully condensed what takes the vast majority of other schools 3 years into 2 years.

Duke condensed 4 years into 3 years. I'm confused as to where you're getting the 2 years from. What you said in your original post comes off as ranting rather than any argument borne out of evidence. So I was curious if you had any evidential basis for claiming that the first and fourth years of med school may not be "truly needed."

As I pointed out, even the current PA-to-physician bridge has 3 years of med school incorporated into the training.

 

[p1acebo]

Duke condensed 4 years into 3 years. I'm confused as to where you're getting the 2 years from. What you said in your original post comes off as ranting rather than any argument borne out of evidence. So I was curious if you had any evidential basis for claiming that the first and fourth years of med school may not be "truly needed."

As I pointed out, even the current PA-to-physician bridge has 3 years of med school incorporated into the training.

Short answer for him, no.

 

[mTOR]

Duke condensed 4 years into 3 years. I'm confused as to where you're getting the 2 years from.

4th year is primarily elective time. Clearly what one does with 4th year depends on the student, but for many students -- it can probably be skipped entirely or in large part.

 

[Charles_Carmichael]

4th year is primarily elective time. Clearly what one does with 4th year depends on the student, but for many students -- it can probably be skipped entirely or in large part.

I can understand that. I disagree with you because, IMO (which may be uninformed currently), elective time is important for med students not applying to primary care.

However, you raised the question of "Is 1st year truly needed?" in your OP. I guess I was more curious about your reasoning behind that, especially since physio (and anatomy to an extent) lays the foundation for everything else. Forgive me for not being clear.

 

[mTOR]

You take physio for the entire year at your medical school?

 

[mTOR]

Oh wait


lulz

 

[Charles_Carmichael]

You take physio for the entire year at your medical school?

At one of the schools I've been accepted to (an MD school), physio lasts the entire year, yes (though I think some of MSK and tissue biology is incorporated into the first semester of physio). And if I end up in the specialty I'm currently interested in (and conducting research in), cell biology/biochemistry/histology also is invaluable.

Again, what evidence do you really have to claim that 1st year may not be needed? According to the Duke website, Duke still covers biochem, cell biology, genetics, anatomy, histo, and physio, which are all generally considered to be 1st year courses in addition to neurobiology, human behavior, microbiology, immunology, pathology, and pharmacology (http://medschool.duke.edu/wysiwyg/images/Duke_Curriculum_Graphic_2006.001.png). They just appear to be covering it at a faster pace and without much of a summer break. Assuming that Duke tends to matriculate highly academic students, this makes sense.

Edit: I'm genuinely curious with my latter paragraph, since I'll be starting med school soon. Not just saying it to tick you off or anything.

 

[mTOR]

^the Duke approach is the main point I'm advocating. I'm not saying the typical coursework associated with 1st year should be wholly dropped, but rather, efforts should be made to merge the more clinically relevant parts into a more cohesive and time efficient framework -- as opposed to the time-consuming linear pre-packaged structuring filled with minutia (taught by Ph.D. lecturers) that most medical schools currently employ. Haha or perhaps there should be two options for a given class if the old structure is to be retained -- one clinically-oriented and the other research-based (for those who absolutely cannot fathom missing out on all that lovely Ph.D. minutia).


As a heads up, 2 years in the future when you begin studying for Step 1, I anticipate you'll begin to look at your first year (assuming you don't end up at Duke) with far greater cynicism and begin to understand why one would question the ultimate utility and time efficiency of that year

 

[ProtossCarrier]

^the Duke approach is the main point I'm advocating. I'm not saying the typical coursework associated with 1st year should be wholly dropped, but rather, efforts should be made to merge the more clinically relevant parts into a more cohesive and time efficient framework -- as opposed to the time-consuming linear pre-packaged structuring filled with minutia (taught by Ph.D. lecturers) that most medical schools currently employ. Haha or perhaps there should be two options for a given class if the old structure is to be retained -- one clinically-oriented and the other research-based (for those who absolutely cannot fathom missing out on all that lovely Ph.D. minutia).


As a heads up, 2 years in the future when you begin studying for Step 1, I anticipate you'll begin to look at your first year (assuming you don't end up at Duke) with far greater cynicism and begin to understand why one would question the ultimate utility and time efficiency of that year

my first year was fine.

 

[p1acebo]

^the Duke approach is the main point I'm advocating. I'm not saying the typical coursework associated with 1st year should be wholly dropped, but rather, efforts should be made to merge the more clinically relevant parts into a more cohesive and time efficient framework -- as opposed to the time-consuming linear pre-packaged structuring filled with minutia (taught by Ph.D. lecturers) that most medical schools currently employ. Haha or perhaps there should be two options for a given class if the old structure is to be retained -- one clinically-oriented and the other research-based (for those who absolutely cannot fathom missing out on all that lovely Ph.D. minutia).


As a heads up, 2 years in the future when you begin studying for Step 1, I anticipate you'll begin to look at your first year (assuming you don't end up at Duke) with far greater cynicism and begin to understand why one would question the ultimate utility and time efficiency of that year

I don't know about your school but the majority of our exam questions in my physio courses have been clinically relevant.

 

[motomed]

OP, this sounds like an issue with you and/or your school more than anything else. if your first year was wothless, that's on your school, not the whole establishment.

also, fwiw, I've personally known two attendings who went to duke and hated it. neither went into academic medicine and both felt like they were less prepared for residency than others coming from schools who did things the old fashioned way. both of them made it very clear to me that in their opinion, if I didn't want to end up in academic medicine, I'd be far better off going to a state school. just because some school is doing it doesn't mean it's a good idea. it serves the school's purpose, it doesn't serve mine.

 

[UAAWolf]

Would that make everyone realize that current medical education MAKES NO SENSE? That it's ridiculously way too long and largely irrelevant to actual practice? That it's a ****ing racket?

Is 1st year truly needed? Is 4th?

Hell, minus the research year requirement (that almost no school does) and the largely unnecessary 4th year, Duke's med school curriculum is ALREADY essentially a low budget version of their PA school curriculum model just with more esoteric basic science garbage you don't need to know (and will likely forget unless you do research in those fields).

brb PA students outshining med students on every rotation @ my school
brb graduating with 2-3x the debt of PA students
brb wait.. where did my 20's go
brb jokes on me

mTOR user name? Leucine/BCAA researcher? Lol. And also you seem like you're from the MISC?

Oh and PA's don't know jack compared to attendings or even residents

 

[ACSurgeon]

Would that make everyone realize that current medical education MAKES NO SENSE? That it's ridiculously way too long and largely irrelevant to actual practice? That it's a ****ing racket?

Is 1st year truly needed? Is 4th?

Hell, minus the research year requirement (that almost no school does) and the largely unnecessary 4th year, Duke's med school curriculum is ALREADY essentially a low budget version of their PA school curriculum model just with more esoteric basic science garbage you don't need to know (and will likely forget unless you do research in those fields).

brb PA students outshining med students on every rotation @ my school
brb graduating with 2-3x the debt of PA students
brb wait.. where did my 20's go
brb jokes on me

PA's don't have the foundation to build on, not more than nurses anyways. Theoretically, an ICU nurse after 20 years of experience should know enough to be an ICU attending. WRONG. Theoretically, said nurse could read medical texts in this time period and ask why things are done the way they are... still no!

You want to make medical education more efficient? That's not a bad idea. Start 1st year in May, do away with the summer between 1st/2nd year, and do away with the waste that is 9 months of 4th year. The 6 months you save by implementing what I suggest will be more than enough for sub-I's and a couple of electives. This will make medical education 3 years instead of 4, and I'd be all for it. You don't eliminate any substance, just wasted free time (that you pay for dearly).

 

[HumbleMD]

PA's don't have the foundation to build on, not more than nurses anyways. Theoretically, an ICU nurse after 20 years of experience should know enough to be an ICU attending. WRONG. Theoretically, said nurse could read medical texts in this time period and ask why things are done the way they are... still no!

You want to make medical education more efficient? That's not a bad idea. Start 1st year in May, do away with the summer between 1st/2nd year, and do away with the waste that is 9 months of 4th year. The 6 months you save by implementing what I suggest will be more than enough for sub-I's and a couple of electives. This will make medical education 3 years instead of 4, and I'd be all for it. You don't eliminate any substance, just wasted free time (that you pay for dearly).

But what do you know about medical education and curricula; you're just a medical student who went through it, rather than the excellent speculation by a number on this thread.

For other posters, a number of other schools are moving things earlier and condensing preclinical curricula. It's going to be a LONG time before anyone considers violating the 4 year mark though. That would be anathema.

 

[VisionaryTics]

But what do you know about medical education and curricula; you're just a medical student who went through it, rather than the excellent speculation by a number on this thread.

For other posters, a number of other schools are moving things earlier and condensing preclinical curricula. It's going to be a LONG time before anyone considers violating the 4 year mark though. That would be anathema.

It's been done before. Apparently, in the 1970s, a few schools experimented with 3-year curricula. I know for a fact that Loyola had an accelerated three-year program, with no summer break and clerkships starting in January of the second year. Apparently, it ended up with a very high burnout rate and lower board scores, so it was discontinued. Food for thought.

 

[HumbleMD]

It's been done before. Apparently, in the 1970s, a few schools experimented with 3-year curricula. I know for a fact that Loyola had an accelerated three-year program, with no summer break and clerkships starting in January of the second year. Apparently, it ended up with a very high burnout rate and lower board scores, so it was discontinued. Food for thought.

Direct in/overlap program are certainly still around now. These programs typically overlap 2 years preclinical with 2 years of undergrad though, and still have 2 years clinical.

Back in my college Alma Matter, the University of Michigan had the Inteflex program which boiled undergrad and med school into 6 years. They cancelled the program after multiple suicides.

 

[BigRedder]

But what do you know about medical education and curricula; you're just a medical student who went through it, rather than the excellent speculation by a number on this thread.

For other posters, a number of other schools are moving things earlier and condensing preclinical curricula. It's going to be a LONG time before anyone considers violating the 4 year mark though. That would be anathema.

There was a proposal at my school to shorten the preclinical years a bit, start them earlier, and shorten summer break, all to start clinical rotations in May like many other schools. The faculty came out in force to defeat it, mostly because there would be a few-year transitional period that would require some clerkships to be shorter by a week. If they won't make a small change to allow students more time for electives before applying to residency, they aren't going to disrupt the entire structure of medical education.

 

[link2swim06]

Can't speak to other schools, but here is my thoughts...I think the first year could easily be condensed....for example, i would be SHOCKED if any resident or attending could recite the citric acids cycle or any other process NOT related to disease or pharmacology. There is so much stuff learned in the first year which has no clinical relevance.

If the enzyme cant be pharmacologically modified or can be altered in disease why the hell do I need to know it?!!? (this is could be said to at least 30% of first year material....and will never show up on usmle either). I think the PhD types get a little over zealous with irrelevant stuff they think is cool.

 

[johnmendes]

In England, medical school is straight out of high school, and they have recently reduced it from 6 to 5 years. I think it is a tendency (and a nice one ahah) to reduce time spent on basic sciences from 3 to 2 years. They still put out great doctors, despite this

 

[StephenMaturin]

Related essay on KevinMD: http://www.kevinmd.com/blog/2011/04/physician-assistant-writes-doctors-america.html

"Medicine needs to see PAs as partners, not medical assistants. Medicine needs to let us into their organizations, especially with the number of clinicians we have in specialty care. Medicine needs to recognize a PA with 10 years experience is able to do many things with more autonomy than a new graduate. Medicine needs to let us evolve, just as any captain of the ship would train his executive officer to one day do what he does. PAs should be allowed to enter residencies, not to automatically become physicians but to increase their knowledge... One-year residencies should be created in primary care that would allow PAs to practice with much more autonomy. Not because “everybody wants to be a doctor” but because professions evolve. This is something I feel you are missing. We have been here since 1965 and have paid our dues."

 

[deleted6669]

There's currently one PA-to-DO bridge and med school is still 3 years for them and they have to go into primary care. .

actually 1/2 the class has to choose primary care. the other 1/2 does not.

 

[dilated]

4th year is primarily elective time. Clearly what one does with 4th year depends on the student, but for many students -- it can probably be skipped entirely or in large part.

So what exactly is your argument? You can drop a lot of schooling without patients immediately exploding when a sub-trained doctor touches them? Yes, that is true. You could put one of the MAs in your local clinic in residency and they probably wouldn't kill anyone for a while.

I have no idea how you get from this to the idea that dropping random segments of education would be totally devoid of consequences, though.

 

[HumbleMD]

There was a proposal at my school to shorten the preclinical years a bit, start them earlier, and shorten summer break, all to start clinical rotations in May like many other schools. The faculty came out in force to defeat it, mostly because there would be a few-year transitional period that would require some clerkships to be shorter by a week. If they won't make a small change to allow students more time for electives before applying to residency, they aren't going to disrupt the entire structure of medical education.

Why, you've just described the "Curriculum 2000" at Penn (silly name, but shows how long we've been doing it):

1.5 years preclinical (with like 5 weeks of summer)
Start 1.0 years clerkship in January of MS2 year
Step 1 in January-March of MS3 year
Electives April 'til the end.
Step 2 when you want, typically July - February of MS4 year

Baylor and UVermont (I think) have already adopted it, and it sounds like many others are as well.

I think it's a good system, but it does make the superfluity of 4th year even that more apparent (I'm managing to squeeze a 2 year masters program into 1 extra year out). It gives you a chance to start electives so you can try out a variety of disciplines before prepping residency apps in August. Personally, I don't know how the rest of the world decides on a specialty in a few briefs months.

Back on other topics. Yes, 4th year is superfluous, but there is no way you could pack residency application into your 3rd year. Clinical learning would suffer.

 

[greatnt249]

Related essay on KevinMD: http://www.kevinmd.com/blog/2011/04/physician-assistant-writes-doctors-america.html

"Medicine needs to see PAs as partners, not medical assistants. Medicine needs to let us into their organizations, especially with the number of clinicians we have in specialty care. Medicine needs to recognize a PA with 10 years experience is able to do many things with more autonomy than a new graduate. Medicine needs to let us evolve, just as any captain of the ship would train his executive officer to one day do what he does. PAs should be allowed to enter residencies, not to automatically become physicians but to increase their knowledge... One-year residencies should be created in primary care that would allow PAs to practice with much more autonomy. Not because “everybody wants to be a doctor” but because professions evolve. This is something I feel you are missing. We have been here since 1965 and have paid our dues."

Apparently I missed the memo on what the "A" in PA now stands for.

 

[HumbleMD]

Apparently I missed the memo on what the "A" in PA now stands for.

It is actually a pretty good read. Dripping with angst, but a good read. If he can't get over being called an "assistant," then either don't be so shallow, or don't go to P.A. school. I find a similarly preposterous argument when Doctorate of Nursing students want to be called Doctor instead of Nurse. Labels only bother people if they let them, but should be used appropriately (ie, if it's in your profession's name...)

If the author wanted to be a doctor, go to friggin' med school. He closed by pointing out that medicine is a team effort, which is an absolute truth, yet spent an entire treatise of an essay writing about how he wants autonomy and doesn't want an MD team leader.

 

[PharmBound2011]

If he can't get over being called an "assistant," then either don't be so shallow, or don't go to P.A. school

...kinda hard to get over when you're not assisting anybody, especially in hospital settings and also settings where a good PA is most of the time interchangeable with an MD (FP, IM perhaps). How about when the PA is the sole medical provider? who is he assisting? That "assistant" is practicing medicine. I understand how labels are only as important as you make them, but there is a reason a doctor is called a doctor and a medical assistant is called a medical assistant. Medical assistants rely on the knowledge base of physicians/PAs to do their jobs. PAs are actually educated in medicine, and 90% of the time diagnose/treat/prescribe for patients without doctors even seeing the patient. Obviously this is a physician-dominated site which sees no advantage giving respect to people that work for them that aren't part of their "clan" but definetely makes sense if there wasn't a conflict of interest here.

Plus, i think the physician associate name is bogus. PAs arent assistants in practice, but associate ehh probably isn't any better... i think i heard clinical associate somewhere, seem to agree with it.