What would you change about the way medical education is practiced?

[theepodiatrist]

I'm particularly interested what people would change about the number of training years, the subjects\modules studied in med school, the creation of new specialties, and whether you think certain specialties should go down the path of dentistry and be separate from general medicine like some people say psychiatry should.

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[theepodiatrist]

A couple of interesting factlets....in my home country, Romania, diabetes is a specialty on its own for some reason rather than a subspecialty. There's also a legal\criminal medicine specialty.

 

[COMMANDER CLOWN]

Replace undergrad with the current first two years of medical school. The MCAT is now a test on that preclinical information (essentially Step 1 now). People who score high get accepted to medical school, which now consists solely of clinical work. Undergrad is a complete waste of time and money for people who want to go into medicine and only exists because of outdated traditions and expectations.

 

[OnePunchBiopsy]

More clinical knowledge and healthcare-based lecturers starting M1 year.

As a resident, I probably use about 10% of what I learned during the first two basic science years, which was taught mostly by PhD’s who rarely stepped foot in a hospital.

 

[7331poas]

Replace undergrad with the current first two years of medical school. The MCAT is now a test on that preclinical information (essentially Step 1 now). People who score high get accepted to medical school, which now consists solely of clinical work. Undergrad is a complete waste of time and money for people who want to go into medicine and only exists because of outdated traditions and expectations.

I agree, but then again I would never have gotten accepted to med school out of high school.

My proposal: make medical school 3 years across the board and extend residency training across the board by 1 year. Lessens loan burden and increases years where I get a salary.

 

[jdp207]

Scrap the MCAT and just replace it with Step1. Preclinical years of medical school could work like the CFA exam. Let private companies handle the pre-clinical stuff since they already do and do it way better then medical schools do. This would save all of us at least $100,000 and stop medical schools from all poorly reinventing the wheel with their bad pre-clinical curriculums and shift their focus and resources entirely onto the clinical curriculum. There is also clearly plenty that could be cut from 4th year.

 

[efle]

Preclinicals to 1 year, and move emphasis more towards clinically relevant knowledge like shelf exam content
Clinical years all sub-I's in how you function/what you do. Compared to being treated as an intern, being a clerk is the epitome of low-yield
No more prelims/TYs, because of the above line

 

[Splenda88]

No defacto bachelor degree requirement.

3-yr of prereqs and 3-yr of med school and 2-6 yr residency.

 

[7331poas]

No defacto bachelor degree requirement.

3-yr of prereqs and 3-yr of med school and 2-6 yr resdisency.

2 year residency huh...

 

[Splenda88]

2 year residency huh...

IM/FM... There are some 2-yr FM programs in Canada. 25+ yrs ago, a lot of physicians were practicing with only 1 yr of internship.

 

[Sky138]

Increase residency pay

 

[VA Hopeful Dr]

Cut tuition to 2007ish levels.

Add special liability protections for physicians that train students (hopefully that would reverse the trend of students shadowing on rotations).

Require EMRs to support medical student documentation for the same reason.

Mandatory lectures only with a very good reason, should be pretty rare.

 

[mehc012]

Let students do more...M4 was a waste of time with me busting my hump like the intern, but not receiving the pages to stay up to date on them, and not decreasing the workload because I couldn't enter orders. TBH, most of intern orders are "convert what team says into EMR order". I was just as capable of that last year, and maybe if I'd been doing it, I would have actually learned something and could do more at this point.

 

[VA Hopeful Dr]

Let students do more...M4 was a waste of time with me busting my hump like the intern, but not receiving the pages to stay up to date on them, and not decreasing the workload because I couldn't enter orders. TBH, most of intern orders are "convert what team says into EMR order". I was just as capable of that last year, and maybe if I'd been doing it, I would have actually learned something and could do more at this point.

The VA used to be good about student orders that would get routed to the intern to edit/cosign. No reason every EMR couldn't do that.

The pages one should be a fairly easy fix with how much technology has improved in recent years but I can't claim enough expertise to say how to accomplish that exactly.

 

[hamstergang]

Have people be able to drop the rotation they are least interested in. Medical school has very little to do with some medical specialities, such as Psych.

I think people should be careful about how far to take this idea. Any specialty, really, could be taught effectively on its own and in less time, but I think a strength of medical education is how broad and integrated it is. The human body is, after all, one unit, and our treatments don't contain their effects to our specialties.

As a psychiatrist, most of my patients don't require my full medical school training (and I'd bet that's true for nearly every specialty), but it's certainly being put to good use over my caseload. I have patients with medical comorbidities, taking other medications, or reporting potential adverse effects from my meds which I need to understand and potentially work up. I have to coordinate with other specialists or read literature that involves other organs, and it helps to have a common language and some experience/understanding of each other's field.

This isn't to say there isn't room for optimization, but I think people need to be mindful of taking the siloing too far.

 

[Ho0v-man]

Prereqs only. No bachelors degree requirement.

3 year curriculum. 1.5 year preclinical followed by a boot camp of sorts that lasts a couple months to get students thinking clinically. I’d prefer this over the piecemealing of clinically relevant stuff we do throughout the first two years that heavily disincentivizes learning clinical skills over basic science minutiae. I think this would work really well because you’d have people showing up to clinical rotations day one knowing how to present, do any kind of physical exam, and having done tons of simulations on basic skills like line placements, LPs, chest tubes, different suturing techniques, etc. No stupid classes during this time that force you to prioritize memorizing a PowerPoint over learning actual clinical skills. Instead, everyone does uworld and the school makes you take practice tests for step 2. Everyone walks out of this course ready for boards and ready for rotations.

I think rotations should just be universally pass/fail. The current model incentivizes doing the easiest stuff so you look less stupid. That’s no way to learn. Most students just try to find the attending that gives everyone honors and rewards them for not seeking honest feedback about how to become a better clinician. Also, it rewards focusing on uworld over actually learning from doctors. I think rotations should be more about finding out what you want to do with your life instead of just trying to get honors.

Graduate after third year. If you want to do more rotations/auditions, that’s cool. But you don’t need to pay tuition for that.

Tuition should be lower.

 

[deleted1005514]

Replace undergrad with the current first two years of medical school. The MCAT is now a test on that preclinical information (essentially Step 1 now). People who score high get accepted to medical school, which now consists solely of clinical work. Undergrad is a complete waste of time and money for people who want to go into medicine and only exists because of outdated traditions and expectations.

I think this would put non-trads at a severe disadvantage, and how many 18 year olds really know they want to do medicine for the rest of their lives?

 

[theepodiatrist]

I think people should be careful about how far to take this idea. Any specialty, really, could be taught effectively on its own and in less time, but I think a strength of medical education is how broad and integrated it is. The human body is, after all, one unit, and our treatments don't contain their effects to our specialties.

As a psychiatrist, most of my patients don't require my full medical school training (and I'd bet that's true for nearly every specialty), but it's certainly being put to good use over my caseload. I have patients with medical comorbidities, taking other medications, or reporting potential adverse effects from my meds which I need to understand and potentially work up. I have to coordinate with other specialists or read literature that involves other organs, and it helps to have a common language and some experience/understanding of each other's field.

This isn't to say there isn't room for optimization, but I think people need to be mindful of taking the siloing too far.

I completely agree...but I guess that begs the question: should dentistry be integrated into medicine too then? (A rather big question, I know)

 

[Oedipa Maas]

Replace undergrad with the current first two years of medical school. The MCAT is now a test on that preclinical information (essentially Step 1 now). People who score high get accepted to medical school, which now consists solely of clinical work. Undergrad is a complete waste of time and money for people who want to go into medicine and only exists because of outdated traditions and expectations.

Isn’t this pretty much how nursing school operates?

Have people be able to drop the rotation they are least interested in. Medical school has very little to do with some medical specialities, such as Psych.

I don’t love this idea. I think if I were to have been given the option, I probably would have given up surgery because of the dreadful hours. I learned so much in the OR and about common surgical procedures and regarding difficult conversations. I’m glad I did it and I think my education would have been lacking if I just removed the specialty I was least likely to go into. I would also say that many people are surprised by what they like and don’t like and culling a specialty based on a low level of actual knowledge of the specialty might mean that some people would miss out on finding a perfect fit.

 

[VA Hopeful Dr]

I completely agree...but I guess that begs the question: should dentistry be integrated into medicine too then? (A rather big question, I know)

Honestly a handful of lectures that address common dental problems and what we need to do while the patient waits to see a dentist wouldn't be a bad idea

 

[VA Hopeful Dr]

Prereqs only. No bachelors degree requirement.

3 year curriculum. 1.5 year preclinical followed by a boot camp of sorts that lasts a couple months to get students thinking clinically. I’d prefer this over the piecemealing of clinically relevant stuff we do throughout the first two years that heavily disincentivizes learning clinical skills over basic science minutiae. I think this would work really well because you’d have people showing up to clinical rotations day one knowing how to present, do any kind of physical exam, and having done tons of simulations on basic skills like line placements, LPs, chest tubes, different suturing techniques, etc. No stupid classes during this time that force you to prioritize memorizing a PowerPoint over learning actual clinical skills. Instead, everyone does uworld and the school makes you take practice tests for step 2. Everyone walks out of this course ready for boards and ready for rotations.

I think rotations should just be universally pass/fail. The current model incentivizes doing the easiest stuff so you look less stupid. That’s no way to learn. Most students just try to find the attending that gives everyone honors and rewards them for not seeking honest feedback about how to become a better clinician. Also, it rewards focusing on uworld over actually learning from doctors. I think rotations should be more about finding out what you want to do with your life instead of just trying to get honors.

Graduate after third year. If you want to do more rotations/auditions, that’s cool. But you don’t need to pay tuition for that.

Tuition should be lower.

I actually like these ideas. Wouldn't mind seeing somewhere pilot this to see how it goes, but definite potential here to improve clinical rotations.

 

[ciestar]

All i can say for my school is that i feel like i learned very little when it comes to MSK and derm. Also think about how derm is generally taught...

 

[LunaOri]

I would like to see some of the basic courses shifted back to college and not repeated in medical school. Biochem, statistics, psychology, a few others....
I would keep the core rotations in surgery, medicine, peds, Ob. I would add a rotation in outpatient primary care (with option to choose peds, family med, geriatrics) because most docs do not end up practicing in a hospital setting. I don't think psych and neurology should be mandatory; instead, let students choose from the whole menu of specialties, so they can be exposed to more possibilities: hospital medicine, emergency medicine, pathology, radiology, anesthesiology, ophthalmology, surgical subspecialties, med subspecialties, peds subspecialties....

 

[Splenda88]

I would like to see some of the basic courses shifted back to college and not repeated in medical school. Biochem, statistics, psychology, a few others....
I would keep the core rotations in surgery, medicine, peds, Ob. I would add a rotation in outpatient primary care (with option to choose peds, family med, geriatrics) because most docs do not end up practicing in a hospital setting. I don't think psych and neurology should be mandatory; instead, let students choose from the whole menu of specialties, so they can be exposed to more possibilities: hospital medicine, emergency medicine, pathology, radiology, anesthesiology, ophthalmology, surgical subspecialties, med subspecialties, peds subspecialties....

That is actually a good idea. Neurology is not mandatory. My school did not have a neuro rotation at all when I was an MS1, but by the time I made it to MS3, we had 2 wks neuro incorporated in our 12-wk IM rotation.

 

[VA Hopeful Dr]

I would like to see some of the basic courses shifted back to college and not repeated in medical school. Biochem, statistics, psychology, a few others....
I would keep the core rotations in surgery, medicine, peds, Ob. I would add a rotation in outpatient primary care (with option to choose peds, family med, geriatrics) because most docs do not end up practicing in a hospital setting. I don't think psych and neurology should be mandatory; instead, let students choose from the whole menu of specialties, so they can be exposed to more possibilities: hospital medicine, emergency medicine, pathology, radiology, anesthesiology, ophthalmology, surgical subspecialties, med subspecialties, peds subspecialties....

How terrible were your rotations?

My FM rotation had outpatient both with residents and PP groups.

IM was nothing but hospital medicine with an ICU option.

Peds rotated around all the subspecialties including shifts in the peds ED.

Had rotations specifically in medicine and surgical subspecialties.

The only things on the list we weren't required to do were path and radiology.

 

[Ho0v-man]

How terrible were your rotations?

My FM rotation had outpatient both with residents and PP groups.

IM was nothing but hospital medicine with an ICU option.

Peds rotated around all the subspecialties including shifts in the peds ED.

Had rotations specifically in medicine and surgical subspecialties.

The only things on the list we weren't required to do were path and radiology.

In third year?

 

[VA Hopeful Dr]

In third year?

All of that except the IM and surgical subspecialties, yes.

And in 3rd year we did spend time on vascular and trauma surgery so we got some subspecialty time. Plus 2, 2 week electives. I picked up radiology and EM on those if I remember correctly.

Honest to goodness, despite going to the lesser of the 2 med schools (at the time) in my state the more time I spend here the more I realize I actually got a pretty top notch education.

 

[7331poas]

I would like to see some of the basic courses shifted back to college and not repeated in medical school. Biochem, statistics, psychology, a few others....
I would keep the core rotations in surgery, medicine, peds, Ob. I would add a rotation in outpatient primary care (with option to choose peds, family med, geriatrics) because most docs do not end up practicing in a hospital setting. I don't think psych and neurology should be mandatory; instead, let students choose from the whole menu of specialties, so they can be exposed to more possibilities: hospital medicine, emergency medicine, pathology, radiology, anesthesiology, ophthalmology, surgical subspecialties, med subspecialties, peds subspecialties....

all of these are normal things in a clerkship year. idk what you had on your rotations.

 

[theepodiatrist]

Honestly a handful of lectures that address common dental problems and what we need to do while the patient waits to see a dentist wouldn't be a bad idea

I wasn't talking about adding a couple of dentistry lectures for the benefit of med students. I was talking about making dentistry a medical specialty since, as we both agreed, the human body is one unit and treatments affect more than just the target area....and therefore dentists should posses ALL the knowledge that a doctor does (which they don't quite do atm).

 

[Ho0v-man]

All of that except the IM and surgical subspecialties, yes.

And in 3rd year we did spend time on vascular and trauma surgery so we got some subspecialty time. Plus 2, 2 week electives. I picked up radiology and EM on those if I remember correctly.

Honest to goodness, despite going to the lesser of the 2 med schools (at the time) in my state the more time I spend here the more I realize I actually got a pretty top notch education.

It makes a lot more sense to me now why you advocate for not changing med schools curricula whenever these talks come up. I hate surgery, but it would have been cool to see so many subspecialties. Same with medicine and peds.

 

[ciestar]

In third year?

I experienced almost all of those things during my third year

anesthesia, gen surg, vascular, trauma, plastics, peds ENT, peds urology, peds ortho, heme/onc

 

[VA Hopeful Dr]

It makes a lot more sense to me now why you advocate for not changing med schools curricula whenever these talks come up. I hate surgery, but it would have been cool to see so many subspecialties. Same with medicine and peds.

It probably doesn't help that I honestly enjoyed every rotation I did. Not an uncommon thing among family doctors as it turns out.

I do understand the anger so many of y'all have about everything now as well. I'd be pretty angry if I was paying 50k+/year to have bad rotations.

 

[Ho0v-man]

It probably doesn't help that I honestly enjoyed every rotation I did. Not an uncommon thing among family doctors as it turns out.

I do understand the anger so many of y'all have about everything now as well. I'd be pretty angry if I was paying 50k+/year to have bad rotations.

No third year sub specialty exposure at my school. There’s a little mandatory subspecialty exposure in 4th year, but you pick and choose it to an extent. I think if we were all paying half what we are now for better exposure there’d be less complaints.

 

[LunaOri]

I went to med school back in the dark ages. We had to do 12 weeks of medicine, 12 of surgery, 6 of ob, 6 of peds, 6 of psych, 6 of family med, 6 of neuro, 4 med subI, 4 surg subI. The rest of 4th year was electives. We had very little exposure to subspecialties, and almost no exposure to hospital-based specialties. And for some reason, nearly all of it was hospital-based. You younguns don’t know how good you have it!

 

[LunaOri]

I also would eliminate accelerated programs and make all applicants take at least one gap year after college to work or volunteer. There’s a world of difference in maturity that comes with work and life experience!

 

[7331poas]

I also would eliminate accelerated programs and make all applicants take at least one gap year after college to work or volunteer. There’s a world of difference in maturity that comes with work and life experience!

Perhaps, but is that maturity worth 500 thousand dollars worth of lost income, investment growth, 1 year off your career, etc?

 

[ciestar]

Perhaps, but is that maturity worth 500 thousand dollars worth of lost income, investment growth, 1 year off your career, etc?

Yes

 

[Goro]

I also would eliminate accelerated programs and make all applicants take at least one gap year after college to work or volunteer. There’s a world of difference in maturity that comes with work and life experience!

You beat me to it!! But I would require a year's employment as a pre req, and dump Physics

 

[Neopolymath]

You beat me to it!! But I would require a year's employment as a pre req, and dump Physics

Physics is more useful than ochem for sure.

 

[<L>]

Have people be able to drop the rotation they are least interested in. Medical school has very little to do with some medical specialities, such as Psych.

lol no.

 

[Bacchus]

IM/FM... There are some 2-yr FM programs in Canada. 25+ yrs ago, a lot of physicians were practicing with only 1 yr of internship.

Humbly I have to disagree with a 2 year FM residency. The difference between myself at the end of PGY2 and PGY3 was shocking. You need the three years.

 

[Splenda88]

Humbly I have to disagree with a 2 year FM residency. The difference between myself at the end of PGY2 and PGY3 was shocking. You need the three years.

I guess it's only about "you"...

 

[Bacchus]

I guess it's only about "you"...

No, it's about recognizing that anyone with only two years of training is not adequately able to take care of the vast expanse that is family medicine. But since it's not nice to talk about others, I referenced myself.

 

[Splenda88]

No, it's about recognizing that anyone with only two years of training is not adequately able to take care of the vast expanse that is family medicine. But since it's not nice to talk about others, I referenced myself.

That is just your opinion.

I am all ears if you have any study that back up your statement...

 

[Bacchus]

That is just your opinion.

I am all ears if you have any study that back up your statement...

Considering there is no major 2 year programs in IM or FM, rather hard to generate a study or provide one. 3 vs 4 years on the other hand have shown anecdotally numerous more IP and OP encounters, more experiences, greater elective exposure. We know with time comes experience and with experience outcomes trend better.

 

[Splenda88]

Considering there is no major 2 year programs in IM or FM, rather hard to generate a study or provide one. 3 vs 4 years on the other hand have shown anecdotally numerous more IP and OP encounters, more experiences, greater elective exposure. We know with time comes experience and with experience outcomes trend better.

I agree that time comes experience. But it's not like doctors will stop learning after PGY2. I guess Canadian FM docs are unprepared after their 2 yr training. I actually know one who is practicing in NY and doing well.

I don't think any of my PGY3 colleagues will have any issues practicing medicine now (inpatient or outpatient)... My program is not the best program in the US. Not even top 100.

 

[Bacchus]

I agree that time comes experience. But it's not like doctors will stop learning after PGY2. I guess Canadian FM docs are unprepared after their 2 yr training. I actually know one who is practicing in NY and doing well.

I don't think any of my PGY3 colleagues will have any issues practicing medicine now (inpatient or outpatient)... My program is not the best program in the US. Not even top 100.

The greatest thing you learn in residency is recognizing what you don't know.

 

[Splenda88]

The greatest thing you learn in residency is recognizing what you don't know.

I guess these Canadians with 2-yr FM training don't know what they don't know.


This is from my GME president (an IM doc)... 'I believe FM/IM residents would have learned a lot more in their first year out practicing medicine than what they learn in their last year of residency.' You don't usually hear things like that from people in academia

 

[Bacchus]

I guess these Canadians with 2-yr FM training don't know what they don't know.


This is from my GME president (an IM doc)... 'I believe FM/IM residents would have learned a lot more in their first year out practicing medicine than what they learn in their last year of residency.' You don't usually hear things like that from people in academia

Neither of our opinions are going to change. There’s no reason to continue the back and forth. Good luck in residency and don’t discount your third year.

 

[Splenda88]

Neither of our opinions are going to change. There’s no reason to continue the back and forth. Good luck in residency and don’t discount your third year.

How was your first year of attending-hood compared to your last year of residency?

It's amazing that a system that allows moonlighting and then turn around claiming one is not prepared to practice on their own... When will we stop drinking academia kool-aid?