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

[NigroqueSimillima]

No surprise, the guy is a libertarian strategist.

Who would have thought that mechanical engineering courses were teaching signaling instead of statics all along.

As a practicing engineer of 5 years who graduated from a T10 engineering school, 70-90% of most engineering degrees are useless. I've design systems that are in space right and most of engineering I learned were either on the job, or from Wikipedia, youtube, or stackoverflow. Almost all engineering students without an internship are worthless new hires, and after being a part of our hiring process I consider the bachelors degree to be the biggest ripoff of the modern age.

Engineering school absolutely is mostly signaling, they throw really long, hard, and mostly irrelevant math puzzles at students to see who has the highest IQ and/or work ethic to be worth giving the actual engineering on the job.

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[NigroqueSimillima]

Yes, it should.

Why? Are dentist having problems with their current models? Their students get to practice independently 3 years earlier than any medical students, if anything, more medical specialties should spun into dental like schools. Psych and Derm for starters.

And I don't understand why it's being called "siloing" when dental students taking the same pre clinicals that med students take?

 

[altblue]

As a practicing engineer of 5 years who graduated from a T10 engineering school, 70-90% of most engineering degrees are useless. I've design systems that are in space right and most of engineering I learned were either on the job, or from Wikipedia, youtube, or stackoverflow. Almost all engineering students without an internship are worthless new hires, and after being a part of our hiring process I consider the bachelors degree to be the biggest ripoff of the modern age.

Engineering school absolutely is mostly signaling, they throw really long, hard, and mostly irrelevant math puzzles at students to see who has the highest IQ and/or work ethic to be worth giving the actual engineering on the job.

Part of me wonders if this is also a reason why chemistry and physics are required for med school. You can brute force your way through undergrad-level biology by investing the raw hours if you're not too talented or at least aware of how you learn, but it's much harder to do so for chem/phys

I know chem and phys are helpful for subjects like renal and cardio, but only a small fraction of the UG material is actually useful for med school, and at the end of the day you can rationalize much of the relevant physiology anyway

 

[7331poas]

As a practicing engineer of 5 years who graduated from a T10 engineering school, 70-90% of most engineering degrees are useless. I've design systems that are in space right and most of engineering I learned were either on the job, or from Wikipedia, youtube, or stackoverflow. Almost all engineering students without an internship are worthless new hires, and after being a part of our hiring process I consider the bachelors degree to be the biggest ripoff of the modern age.

Engineering school absolutely is mostly signaling, they throw really long, hard, and mostly irrelevant math puzzles at students to see who has the highest IQ and/or work ethic to be worth giving the actual engineering on the job.

If that is true, they why are you posting on this subforum? Why should anyone care what an engineer thinks about the professions of psychiatry and derm and their training pathways?

And anecdotally, my computer science education did prepare me well for the workforce when I was a programmer once upon a time.

 

[NigroqueSimillima]

If that is true, they why are you posting on this subforum? Why should anyone care what an engineer thinks about the professions of psychiatry and derm and their training pathways?

And anecdotally, my computer science education did prepare me well for the workforce when I was a programmer once upon a time.

My post recommending derm and psych be split out from medicine has nothing to do with my engineering career, so I don't know why you mention it. I think derm and psych should be split out because it's obvious that they(especially the latter) don't use the vast majority of their medical school training, and it's economically inefficient to train someone for 3-4 years longer than necessary. I've heard this for attending in real life and on this forum, but hey, maybe I'm wrong and it's impossible to subscribe psych meds without doing to 3-month surgery rotation.

Ask dental students/dentist if they'd rather have an additional two years of school and a residency. And also I think it's absurd and borderline greedy for certain specialties(like derm) to limit the number of residencies spot to drive up compensation. The idea that the US can only graduate 500 derms each year is BS, and it leads to absurd waiting times, even in large cities. Some claim it's due to lack of government funding(which is weird because orthodontist sponsor their own residencies and they do fine...but w/e), in which case let's cut government out of it, and have all the training necessary to practice independently done in school.

As for the reason I, a simple engineer, dare post in this thread is that:

1) I believe post-secondary education in this country is mostly an absurdly inefficient money-grabbing scam, even in legit degrees like engineering and medicine.
2) I'm considering switching into either dental or medicine.
3) I believe Point 1 exacerbates already present income inequalities and limits access to healthcare.

As for your computer science education, computer science isn't engineering. Programming can be largely self-taught due to the fact that most aspects can be practiced by anyone with a computer. Regardless of how well you feel like your degree prepared you, I'd take someone who's been programming for 4 years with no degree over someone who's just graduated with a degree, assuming they're of equal intelligence.

 

[Captain_Falcon]

Derm doesnt use most of their training?

Insert cancer patients that receives oncologic chemotherapy and develops SCC of the skin.

Insert straight up skin cancer patients on HTN/DM/etc. Meds

Insert psoriasitic arthritis cases where the patient also sees Rheum (for biologic) and Pain specialist (for opioids)

Psych doesn't use most of their training?

How many psych patients have no other comorbidities that need to be accounted for? What about all of those side effects of antipsychotics that can mess with a healthy person, let alone one with other diseases?

Your view of medicine is weird. Obviously a specialist is, specialized. A derm wont be the point person for CAD, and a psych patient wont be the point for type I DM. But these specialists still need training to know how their specific field can both help/hurt patients that need to see multiple physicians

 

[7331poas]

My post recommending derm and psych be split out from medicine has nothing to do with my engineering career, so I don't know why you mention it. I think derm and psych should be split out because it's obvious that they(especially the latter) don't use the vast majority of their medical school training, and it's economically inefficient to train someone for 3-4 years longer than necessary. I've heard this for attending in real life and on this forum, but hey, maybe I'm wrong and it's impossible to subscribe psych meds without doing to 3-month surgery rotation.

Ask dental students/dentist if they'd rather have an additional two years of school and a residency. And also I think it's absurd and borderline greedy for certain specialties(like derm) to limit the number of residencies spot to drive up compensation. The idea that the US can only graduate 500 derms each year is BS, and it leads to absurd waiting times, even in large cities. Some claim it's due to lack of government funding(which is weird because orthodontist sponsor their own residencies and they do fine...but w/e), in which case let's cut government out of it, and have all the training necessary to practice independently done in school.

As for the reason I, a simple engineer, dare post in this thread is that:

1) I believe post-secondary education in this country is mostly an absurdly inefficient money-grabbing scam, even in legit degrees like engineering and medicine.
2) I'm considering switching into either dental or medicine.
3) I believe Point 1 exacerbates already present income inequalities and limits access to healthcare.

As for your computer science education, computer science isn't engineering. Programming can be largely self-taught due to the fact that most aspects can be practiced by anyone with a computer. Regardless of how well you feel like your degree prepared you, I'd take someone who's been programming for 4 years with no degree over someone who's just graduated with a degree, assuming they're of equal intelligence.

What a joke. Derm deals with medical problems. Dermatologists literally preform procedures. The very first question any psychiatrist asks before seeing any patient is "is there a medical cause for this"? How can anyone say that psychiatrists do not need to know about medicine to practice psychiatry?

 

[NigroqueSimillima]

What a joke. Derm deals with medical problems. Dermatologists literally preform procedures. The very first question any psychiatrist asks before seeing any patient is "is there a medical cause for this"? How can anyone say that psychiatrists do not need to know about medicine to practice psychiatry?

Yes, and dentists don't? I never said they "do not need to know about medicine", I said they don't need to go to a 4-year medical school.

Once again, please tell me what a 3 month surgical rotation does for a future psychiatrist.

Derm doesnt use most of their training?

Insert cancer patients that receives oncologic chemotherapy and develops SCC of the skin.

Insert straight up skin cancer patients on HTN/DM/etc. Meds

Insert psoriasitic arthritis cases where the patient also sees Rheum (for biologic) and Pain specialist (for opioids)

Psych doesn't use most of their training?

How many psych patients have no other comorbidities that need to be accounted for? What about all of those side effects of antipsychotics that can mess with a healthy person, let alone one with other diseases?

Your view of medicine is weird. Obviously a specialist is, specialized. A derm wont be the point person for CAD, and a psych patient wont be the point for type I DM. But these specialists still need training to know how their specific field can both help/hurt patients that need to see multiple physicians

Once again read my statement more carefully. I said they don't use most of their medical school training. The dental school model I'm advocating for has essentially the same curriculum for pre-clinical as medical school. The 3 years of residency is where you learn to be a dermatologist/psychiatrist, so what's the downside of doing 1-1/2 of preclinical(most med schools are trending this way), and 3-4 years of clinical mix in with the typical didactics you'd get in residency, and then you graduate as a "doctor of dermatology" with independent practice as soon as you passed the boards, which is 4 years earlier than the current model.

 

[hamstergang]

My post recommending derm and psych be split out from medicine has nothing to do with my engineering career, so I don't know why you mention it. I think derm and psych should be split out because it's obvious that they(especially the latter) don't use the vast majority of their medical school training, and it's economically inefficient to train someone for 3-4 years longer than necessary. I've heard this for attending in real life and on this forum, but hey, maybe I'm wrong and it's impossible to subscribe psych meds without doing to 3-month surgery rotation.

There are certainly many psychiatrists who act like they're not doctors, but that's just bad practice. As a child psychiatrist, in the past 2 days I've had to address the following:
1) monitoring/working up mild neutropenia in a 9 y.o. girl I prescribed Abilify
2) interpreting the QTc in a patient with severe bradycardia stemming from restrictive eating so I know if Zyprexa is safe
3) determining how the medications I prescribe for anxiety interact with the 13 other medications a patient is on for other conditions
4) monitoring for renal and other adverse effects of Lithium

As I've said elsewhere in this thread, no one patient needs all my med school training, but my entire caseload does.

computer science isn't engineering.

My computer science degree came from my college's engineering school.

 

[Captain_Falcon]

Yes, and dentists don't? I never said they "do not need to know about medicine", I said they don't need to go to a 4-year medical school.

Once again, please tell me what a 3 month surgical rotation does for a future psychiatrist.




Once again read my statement more carefully. I said they don't use most of their medical school training. The dentist school model I'm advocating for has essentially the same curriculum for pre-clinical curriculum as medical school, so what exactly is so valuable about the last two years of medical school that a future psychiatrist or dermatologist would be screwed if they went directly to their clinical training for their specialties instead of doing rotations in subjects they have no interest in?

Here is your quote:

My post recommending derm and psych be split out from medicine has nothing to do with my engineering career, so I don't know why you mention it. I think derm and psych should be split out because it's obvious that they(especially the latter) don't use the vast majority of their medical school training, and it's economically inefficient to train someone for 3-4 years longer than necessary. I've heard this for attending in real life and on this forum, but hey, maybe I'm wrong and it's impossible to subscribe psych meds without doing to 3-month surgery rotation.

Ask dental students/dentist if they'd rather have an additional two years of school and a residency. And also I think it's absurd and borderline greedy for certain specialties(like derm) to limit the number of residencies spot to drive up compensation. The idea that the US can only graduate 500 derms each year is BS, and it leads to absurd waiting times, even in large cities. Some claim it's due to lack of government funding(which is weird because orthodontist sponsor their own residencies and they do fine...but w/e), in which case let's cut government out of it, and have all the training necessary to practice independently done in school.

As for the reason I, a simple engineer, dare post in this thread is that:

1) I believe post-secondary education in this country is mostly an absurdly inefficient money-grabbing scam, even in legit degrees like engineering and medicine.
2) I'm considering switching into either dental or medicine.
3) I believe Point 1 exacerbates already present income inequalities and limits access to healthcare.

As for your computer science education, computer science isn't engineering. Programming can be largely self-taught due to the fact that most aspects can be practiced by anyone with a computer. Regardless of how well you feel like your degree prepared you, I'd take someone who's been programming for 4 years with no degree over someone who's just graduated with a degree, assuming they're of equal intelligence.

The bolded does not imply that you want to simply get rid of 4th year rotations for medical students. The problems with your thought process are:
1. you assume people know what they want to do prior to 3rd year, and that any rotation [insert surgery i guess per your thought process] has ZERO value. I'll tackle this specific problem right now --> You don't think a psychiatry-bound MS3/MS4 can gain any value of seeing how patients mental health status is pre-op or post-surgery? That's just silly. There is a reason why even in residencies of most fields have the typical rotations for PGY1/2/3/4 in all areas of medicine.

2. Singling out Derm/Psych as not using the majority of their medical school training implies that all the other fields do extensively use their medical school training. So you are required to elaborate on that.

3. you assume people that want to do Derm are always going to end up in that field (i.e. don't change their interests come end of third year after rotating in PSYCH, or FM, etc.), usually because they self-select out from not being competitive enough.

4. Now you are all over the place in regards to the "borderline greedy" comment. You as a self-described "simple engineer" don't realize how integrated the medical school process, GME, and CME is. Especially when it comes to funding.

5. Post-secondary education as a money-grabbing scam =/= Psych attendings/ Derm attendings don't reap any benefits from [Insert Clerkship Rotation Here].

6. Wanting someone who is programming for 4 years without a degree over someone who has a degree but has no programming does not hold any weight. You cannot have someone practice medicine without a degree.


Ultimately you need to do more research on the topic at hand. There are good threads on why medical school education can be inefficient and a waste of time. You just haven't touched on those reasons.

 

[NigroqueSimillima]

Here is your quote:



The bolded does not imply that you want to simply get rid of 4th year rotations for medical students. The problems with your thought process are:
1. you assume people know what they want to do prior to 3rd year, and that any rotation [insert surgery i guess per your thought process] has ZERO value. I'll tackle this specific problem right now --> You don't think a psychiatry-bound MS3/MS4 can gain any value of seeing how patients mental health status is pre-op or post-surgery? That's just silly. There is a reason why even in residencies of most fields have the typical rotations for PGY1/2/3/4 in all areas of medicine.

2. Singling out Derm/Psych as not using the majority of their medical school training implies that all the other fields do extensively use their medical school training. So you are required to elaborate on that.

3. you assume people that want to do Derm are always going to end up in that field (i.e. don't change their interests come end of third year after rotating in PSYCH, or FM, etc.), usually because they self-select out from not being competitive enough.

4. Now you are all over the place in regards to the "borderline greedy" comment. You as a self-described "simple engineer" don't realize how integrated the medical school process, GME, and CME is. Especially when it comes to funding.

5. Post-secondary education as a money-grabbing scam =/= Psych attendings/ Derm attendings don't reap any benefits from [Insert Clerkship Rotation Here].

6. Wanting someone who is programming for 4 years without a degree over someone who has a degree but has no programming does not hold any weight. You cannot have someone practice medicine without a degree.


Ultimately you need to do more research on the topic at hand. There are good threads on why medical school education can be inefficient and a waste of time. You just haven't touched on those reasons.

1. Regarding "not knowing what you want to do" you can make the same argument for dental school/optometry/podiatry, or pretty much anything. Is there a problem with people dropping out of dental school en mass?

2. I'm not saying the rotations have zero value, I'm saying their value isn't worth their cost. If a psychiatrist-in-training needs to see patients pre or post-op, then psychiatry school can provide them with that opportunity.

3. Yes, I think some fields make more sense to split from medical school than others. I think dentistry being part of medical school would make way more sense than psychiatry.

4. I don't get your point about my assumption on derm. What I did say was that they're way more people that want to become derms and are capable of becoming derms than are being trained to become derms, and that this is mainly because of a shortage of residency spots. I can't believe any would argue this seriously.

5. Not reaping any benefit != worth 2 years and 100k in tuition. Nor does it mean that an M.D/D.O school is the only place for them to gain that benefit.

6. What are you even talking about? I never implied that my desire to hire programmers with experience had anything to do with medicine, it's a complete non-sequitur responding to another poster.

You wrote a lot of words but I haven't seen anything addressing the main point: Why can dentists separate from medical and psychiatrists can't?

 

[NigroqueSimillima]

There are certainly many psychiatrists who act like they're not doctors, but that's just bad practice. As a child psychiatrist, in the past 2 days I've had to address the following:
1) monitoring/working up mild neutropenia in a 9 y.o. girl I prescribed Abilify
2) interpreting the QTc in a patient with severe bradycardia stemming from restrictive eating so I know if Zyprexa is safe
3) determining how the medications I prescribe for anxiety interact with the 13 other medications a patient is on for other conditions
4) monitoring for renal and other adverse effects of Lithium

As I've said elsewhere in this thread, no one patient needs all my med school training, but my entire caseload does.


My computer science degree came from my college's engineering school.

Could you do those things on day one of your residency?

EDIT: Different schools split group their CS department differently, in any case, computer engineering is very different from computer science.

 

[hamstergang]

Could you do those things on day one of your residency?

I don't think I was ready on day 1 of residency to prescribe anything to anyone. Med school gave me the knowledge and way of thinking that I learned to put into practice in residency. I am better at all those things now than 9 years ago when I started residency.

 

[NigroqueSimillima]

I don't think I was ready on day 1 of residency to prescribe anything to anyone. Med school gave me the knowledge and way of thinking that I learned to put into practice in residency. I am better at all those things now than 9 years ago when I started residency.

Then why couldn't psychiatry school do the same thing? I'm not arguing for no medical training, I'm arguing for most specialized training that lets students practice much more quickly while still learning the material they need to do their job effectively. And I haven't heard one convincing argument as to why that couldn't be done.

 

[hamstergang]

Then why couldn't psychiatry school do the same thing? I'm not arguing for no medical training, I'm arguing for most specialized training that lets students practice much more quickly while still learning the material they need to do their job effectively. And I haven't heard one convincing argument as to why that couldn't be done.

If you copied all of medical school and labeled it "Psychiatry School," then sure that would work. But how is that any different really?

I don't know what you could really cut from med school specifically for me as a psychiatrist that you couldn't just cut for everyone. I also liked being able to see the various specialties before having to settle on one. I didn't pick psychiatry until the end of my 3rd year.

 

[NigroqueSimillima]

If you copied all of medical school and labeled it "Psychiatry School," then sure that would work. But how is that any different really?

I don't know what you could really cut from med school specifically for me as a psychiatrist that you couldn't just cut for everyone. I also liked being able to see the various specialties before having to settle on one. I didn't pick psychiatry until the end of my 3rd year.

Why on earth would you need all of medical school? There's not one doctor that needs all of medical school and you know it(see how well the average attending 15 years out of med school would do on the STEP exams if they had to take them with no studying). Take the first two years and go directly to clinical training and be done 3 years earlier. And I'm sure there are somethings that could be cut from medical school entirely but that's a different story. But if you want a specific example, tell me why a psychiatrist needs to be able to answer question 23, 29, 30, or 31: https://www.usmle.org/pdfs/step-1/samples_step1.pdf

And that's great that you needed more time to pick psychiatry, but I don't see why that means everyone else needs to spend 2-4 years more extra in schooling, accumulating debt. By your logic dentistry should be part of medicine because there might be potential dentists in medical school that are missing out.

 

[hamstergang]

Why on earth would you need all of medical school? There's not one doctor that needs all of medical school

Sure, there's probably no one fact that everyone needs to know, but we learn a lot of things to build up to the next level of understanding of what's going on in the body. You could separate out every single residency and make it its own shorter school/training, but that would reduce each of our global understandings of medicine. I gave examples of more than 4 other body systems I needed knowledge of in just the past 2 days. If I didn't do all of med school I would have had to provide less good care to these patients. I'd refer the first girl to a hematologist, and after they finally got to that visit the hematologist could evaluate the neutropenia but her understanding of what Abilify is doing would be less since she attended hematology school. How could either of us have a real discussion of the risks and benefits of the situation?

I've been a practicing child psychiatrist for 4 years and I know I provide better care for having gone through med school than if I missed any block or rotation. You're listed here as a premed. The arrogance is astonishing.

Also, I imagine dentistry would be part of medicine if not for history. I don't know enough about it to know if that's good or bad. I don't post opinions on things I don't actually know.

 

[7331poas]

Why on earth would you need all of medical school? There's not one doctor that needs all of medical school and you know it(see how well the average attending 15 years out of med school would do on the STEP exams if they had to take them with no studying). Take the first two years and go directly to clinical training and be done 3 years earlier. And I'm sure there are somethings that could be cut from medical school entirely but that's a different story. But if you want a specific example, tell me why a psychiatrist needs to be able to answer question 23, 29, 30, or 31: https://www.usmle.org/pdfs/step-1/samples_step1.pdf

And that's great that you needed more time to pick psychiatry, but I don't see why that means everyone else needs to spend 2-4 years more extra in schooling, accumulating debt. By your logic dentistry should be part of medicine because there might be potential dentists in medical school that are missing out.

premeds telling attendings what is true and what is not. Gotta love sdn

 

[efle]

premeds telling attendings what is true and what is not. Gotta love sdn

If an attending told you 2+2=5, would they be right?

 

[Captain_Falcon]

If an attending told you 2+2=5, would they be right?

You're right in that appeal to authority would be in play here. However, in this scenario a fact is easily explained to show the attending is wrong. The poster arguing about x y and z above has provided few worthy arguments and reasoning

 

[VA Hopeful Dr]

If an attending told you 2+2=5, would they be right?

Not a fair comparison in the slightest. You've got someone saying that we shouldn't have general medical education and just have separate schools for every specialty because most specialties doesn't use a large part of that general medical knowledge.

You then have a fairly specialized attending pointing out that yes, he/she does use a large amount of that general medical knowledge on a regular basis.

 

[penpenclown]

After half a decade on this site if another premed told me 2+2=4 I'd second guess it.

 

[VA Hopeful Dr]

Why on earth would you need all of medical school? There's not one doctor that needs all of medical school and you know it(see how well the average attending 15 years out of med school would do on the STEP exams if they had to take them with no studying). Take the first two years and go directly to clinical training and be done 3 years earlier. And I'm sure there are somethings that could be cut from medical school entirely but that's a different story. But if you want a specific example, tell me why a psychiatrist needs to be able to answer question 23, 29, 30, or 31: https://www.usmle.org/pdfs/step-1/samples_step1.pdf

And that's great that you needed more time to pick psychiatry, but I don't see why that means everyone else needs to spend 2-4 years more extra in schooling, accumulating debt. By your logic dentistry should be part of medicine because there might be potential dentists in medical school that are missing out.

Its interesting in that this pandemic has actually shown that a general medical education is useful.

You're right in that if I had to take Step 1 tomorrow it wouldn't be pretty. But, much of the pre-clinical stuff comes back pretty quickly at need. For example, lots of the research coming out about COVID is based (naturally) in immunology which as an FP I don't really use much on a regular basis especially the more lab-based stuff like vaccine trials. But, when I read the articles much of that 2nd year immunology comes back so I don't have to go re-read an immunology textbook to understand what's going on.

As for picking a specialty, most people don't know what they want to do when starting medical school. Right before Match Day, I changed specialties.

" In fact, nearly 75% of students change their specialty preferences during medical school, according to the AAMC’s 2017 Report on Residents. "

Things like dentistry and optometry are slightly easier. Are you OK with spending your entire career on the teeth and associated structures? OK, dentistry will work for you. Same with eyes and optometry. I might also argue that both of those fields could do with a little more general education given how many dentists have to ask me how long before a root canal they need to stop the patient's plavix or how many optometrists send me notes that the patient, who I prescribe insulin for, might have diabetes based on the eye exam. But that's a whole other thing.

But medicine has much much greater breadth to it so I'm not sure having "General surgery school" and "Ob/GYN school" and "pediatrician school" and <insert 12+ other specialty schools here> wouldn't cause more problems than it would solve.

 

[Ho0v-man]

I think the best part of certain specialty school is that I’d never have to listen to people talk about ortho in preclinical.

other than that, it’s a pretty dumb idea.

 

[efle]

Not a fair comparison in the slightest. You've got someone saying that we shouldn't have general medical education and just have separate schools for every specialty because most specialties doesn't use a large part of that general medical knowledge.

You then have a fairly specialized attending pointing out that yes, he/she does use a large amount of that general medical knowledge on a regular basis.

The attending has never experienced the proposed alternatives. Imagine an alternate reality where Dentists and Podiatrists get an MD - I'm sure they'd say it's a necessity too, having never lived in our world and seen that specialized schooling works.

 

[VA Hopeful Dr]

The attending has never experienced the proposed alternatives. Imagine an alternate reality where Dentists and Podiatrists get an MD - I'm sure they'd say it's a necessity too, having never lived in our world and seen that specialized schooling works.

Right, but that wasn't the issue under discussion. You're going after a broad point when the point I'm talking about was a fairly specific one.

The issue was the poster who wants specialty-specific schools claiming that most doctors don't use most of what they learn in a general medical education and then a fairly sub-specialized attending saying otherwise. That is literally all I'm going after with this.

 

[Alkaidius]

Regarding the previous discussion, I know for a fact I would not have gotten into med school straight out of high school...I was an immature little brat, with severe anxiety, under his parents’ thumb, that didn’t know how to study, and had no knowledge of how the world works. I know quite a few people like this. Alternatively, I have a couple of friends who are extremely intelligent that were considering medical school that I guarantee would have gotten in and quit because they realized they hated science (and dealing with people lol) and went into alternative fields.

There would be a lot of wasted resources on those that have no idea what they want to do, or worse, those that wind up hating their jobs and being crappy doctors. I can practically guarantee the last point will be huge as we already have thousands of people who spent YEARS of their life devoted to the pursuit of medicine currently regretting their decision and only pressing on because of the debt.

Other countries skip college, sure, but over there you can quit medical school with virtually no repercussions vs. ~$50k here after just one year (good luck making medical school education free in this country). I’ve shadowed in a couple of European hospitals and while, yes, we can’t prove that the upper quality of doctors is any different from here, the bad doctors that I’ve seen there...just wow, I would argue the lowest quality doctors here are higher quality on the sheer fact that our requirements are so substantial (this opinion is, of course, subjective and built on evidence from just a couple of places). The couple of doctors that I’ve spoken to about the differences in systems actually wished theirs was a bit more similar to ours (grass is always greener effect).

Difficulty getting in due to financials also isn’t inherently a medical school problem...this is across a lot of fields and wouldn’t be an issue if there wasn’t such a huge class discrepancy in the first place. Not only would changing the current system be ridonculously hard, but it doesn’t even qualify as a bandaid for the bigger issue at large.

 

[efle]

The issue was the poster who wants specialty-specific schools claiming that most doctors don't use most of what they learn in a general medical education and then a fairly sub-specialized attending saying otherwise. That is literally all I'm going after with this.

Again, a Podiatrist with an MD would say the same thing. Equally specific.

 

[VA Hopeful Dr]

Again, a Podiatrist with an MD would say the same thing. Equally specific.

Would they? You know this for a fact?

Edit: Turns out there are some MD/DPMs out there. Maybe we can find out why they went back for the MD (seems that most were DPMs that went back to med school which isn't a surprise).

Double edit: looks like a fair number gave up the podiatrist part after med school (one I found practices as a family doctor, another as an internist). I found 2 still doing both (I'm sure there's more but I got bored after page 4 of Google):

About the Doctor - Dr. Graziano

There are about 17,000 podiatrists in the United States, according to the Department of Labor, and Dr. Thomas Graziano is one of only six who hold both a Doctor of Podiatric Medicine (D.P.M.) and a Doctor of Medicine (M.D.) degree. Thomas A. Graziano, M.D., D.P.M “I went back to school to obtain...

drtgraziano.com

jeffross

BCM

www.bcm.edu

Not sure of the actual motivations, but both specifically say they went back to med school to increase his general medical knowledge.

Super small N, I know, but its the best I can manage for a fairly small population.

 

[Tangerine123]

Starting from reforming the tuition system as a whole in the US... That would help a lot..

I'm not sure what the people advocating for shortening the length of everything and skipping stuff are thinking.

The goal of Medical School isn't to rush you to residency. You have to create well rounded physicians.

If anything, I think the whole Undergrad section should be eliminated and medical school should be offered like in other countries (6+ years as an undergrad, including intern year).

I went into Genetics and Psych. At the time, given the option I would have "skipped" everything surgical. That would have been a really dumb decision.

 

[hamstergang]

Again, a Podiatrist with an MD would say the same thing. Equally specific.

Maybe podiatrists are providing care at a level below what it could be if they were integrated in medical school. Do any of us know if that's true or not?

 

[efle]

Would they? You know this for a fact?

Edit: Turns out there are some MD/DPMs out there. Maybe we can find out why they went back for the MD (seems that most were DPMs that went back to med school which isn't a surprise).

Double edit: looks like a fair number gave up the podiatrist part after med school (one I found practices as a family doctor, another as an internist). I found 2 still doing both (I'm sure there's more but I got bored after page 4 of Google):

About the Doctor - Dr. Graziano

There are about 17,000 podiatrists in the United States, according to the Department of Labor, and Dr. Thomas Graziano is one of only six who hold both a Doctor of Podiatric Medicine (D.P.M.) and a Doctor of Medicine (M.D.) degree. Thomas A. Graziano, M.D., D.P.M “I went back to school to obtain...

drtgraziano.com

jeffross

BCM

www.bcm.edu

Not sure of the actual motivations, but both specifically say they went back to med school to increase his general medical knowledge.

Super small N, I know, but its the best I can manage for a fairly small population.

Well I'd bet a lot of money they didn't go back for the MD to get more generally knowledgeable about how to best treat feet. The central fact here is that we have specialist schools that work well in dental, pod, I'd probably also include pharma in the discussion, and being dismissive of that potentially working for additional fields like psych is totally unfounded.

 

[efle]

Maybe podiatrists are providing care at a level below what it could be if they were integrated in medical school. Do any of us know if that's true or not?

The system has never been, and shouldn't be, designed to maximize ability from training. Any attending will admit they kept learning a great deal out in practice. If this was our yardstick we'd have IM residencies spanning 10+ years so we can be sure we're really giving the best care.

 

[VA Hopeful Dr]

Well I'd bet a lot of money they didn't go back for the MD to get more generally knowledgeable about how to best treat feet. The central fact here is that we have specialist schools that work well in dental, pod, I'd probably also include pharma in the discussion, and being dismissive of that potentially working for additional fields like psych is totally unfounded.

I don't think anyone is saying it couldn't work. Its more that a) its not necessary as our training as it stands now produces good doctors, b) it might very well produce an inferior product compared to the existing training, c) it would pigeon hole a not insignificant number of students into a specialty they might end up not liking and d) it might end up looking almost the same as medical school is now anyway so you're not getting much benefit from a radical overhaul of medical education.

 

[hamstergang]

The system has never been, and shouldn't be, designed to maximize ability from training.

Sure, but I didn't say that we need to absolutely maximize ability or care. I just feel that what we have now is sufficient, and if I had cut out chunks of medical school I feel I'd be inadequate as a psychiatrist. If you want to change what we currently have, can you show that that's still good enough and worthwhile?

If an attending told you 2+2=5, would they be right?

An appeal to authority is not inappropriate when talking about the subject in which the authority is an authority. I mean, I have a pre-med and a med student telling me what I need to know to do the job (attending psychiatrist) I've been doing for years. Should your opinions really count anywhere nearly as much as mine on this topic?

 

[efle]

Sure, but I didn't say that we need to absolutely maximize ability or care. I just feel that what we have now is sufficient, and if I had cut out chunks of medical school I feel I'd be inadequate as a psychiatrist. If you want to change what we currently have, can you show that that's still good enough and worthwhile?


An appeal to authority is not inappropriate when talking about the subject in which the authority is an authority. I mean, I have a pre-med and a med student telling me what I need to know to do the job (attending psychiatrist) I've been doing for years. Should your opinions really count anywhere nearly as much as mine on this topic?

When neither of us have experienced the hypothetical alternative to a US MD program, neither of us can comment on the relative quality, correct. Just like a DPM couldn't comment on the overlap (or lack thereof) with a US MD any more than we could comment on the content of a DPM.

Riddle me this, if good general medical knowledge is a backbone of psych training and practice, why is the usual amount of time in your several years of training just a few months front loaded in an intern year? Why not make Psych a fellowship after IM since you need to know all that just as much as the cards and heme/onc etc do?

 

[Taddy Mason]

Why not make Psych a fellowship after IM since you need to know all that just as much as the cards and heme/onc etc do?

No one said or implied that. You're being petty solely for the sake of being argumentative.

 

[efle]

No one said or implied that. You're being petty solely for the sake of being argumentative.

/shrug idk I think it follows from the assumption that the more thorough and broad a psych's medicine background, the better their psych care becomes.

Arguing for the sake of it is my whole thing here, though

 

[Tangerine123]

/shrug idk I think it follows from the assumption that the more thorough and broad a psych's medicine background, the better their psych care becomes.

Arguing for the sake of it is my whole thing here, though

Because the foundations are set in Medical School. The knowledge that you (in theory) have of the other medicals fields should be enough.

At the end of medical school you should be confortable in any setting (Outpatient/Inpatient/ER/OR/ICU/Adults/Kids/Medical/Surgical/Lab etc) while supervised.

Residency just expands on a specific field, however, you should still have an idea of what you're doing when interacting with other fields and settings.

 

[VA Hopeful Dr]

When neither of us have experienced the hypothetical alternative to a US MD program, neither of us can comment on the relative quality, correct. Just like a DPM couldn't comment on the overlap (or lack thereof) with a US MD any more than we could comment on the content of a DPM.

Riddle me this, if good general medical knowledge is a backbone of psych training and practice, why is the usual amount of time in your several years of training just a few months front loaded in an intern year? Why not make Psych a fellowship after IM since you need to know all that just as much as the cards and heme/onc etc do?

Because that's one of the purposes of medical school - to give everyone a decent foundation of general medical knowledge.

 

[efle]

Because the foundations are set in Medical School. The knowledge that you (in theory) have of the other medicals fields should be enough.

At the end of medical school you should be confortable in any setting (Outpatient/Inpatient/ER/OR/ICU/Adults/Kids/Medical/Surgical/Lab etc) while supervised.

Residency just expands on a specific field, however, you should still have an idea of what you're doing when interacting with other fields and settings.

Huh, an interesting take, the usual opinion from everyone I've asked IRL was that they learned all the knowledge and skills of their job in their specialist residency or fellowship. Like, less than 12 hours ago had three different rads residents at a big name program telling me how useless their entire prelim year was and that everyone starts off at 0% for PGY2. Heard similar in the past from derm and several surgical specialties regarding all the USMLE content they had to master at the time so they'd match.

 

[efle]

Because that's one of the purposes of medical school - to give everyone a decent foundation of general medical knowledge.

Dang, it's a good thing you dont need that to safely operate in the mouth or feet then, or advise the docs about the drugs they order

 

[Taddy Mason]

Arguing for the sake of it is my whole thing here, though

Which is why I venture into allo/pre-allo land maybe once a year.

 

[Tangerine123]

Yes, and dentists don't? I never said they "do not need to know about medicine", I said they don't need to go to a 4-year medical school.

Once again, please tell me what a 3 month surgical rotation does for a future psychiatrist.




Once again read my statement more carefully. I said they don't use most of their medical school training. The dental school model I'm advocating for has essentially the same curriculum for pre-clinical as medical school. The 3 years of residency is where you learn to be a dermatologist/psychiatrist, so what's the downside of doing 1-1/2 of preclinical(most med schools are trending this way), and 3-4 years of clinical mix in with the typical didactics you'd get in residency, and then you graduate as a "doctor of dermatology" with independent practice as soon as you passed the boards, which is 4 years earlier than the current model.

Yes, and dentists don't? I never said they "do not need to know about medicine", I said they don't need to go to a 4-year medical school.

Once again, please tell me what a 3 month surgical rotation does for a future psychiatrist.




Once again read my statement more carefully. I said they don't use most of their medical school training. The dental school model I'm advocating for has essentially the same curriculum for pre-clinical as medical school. The 3 years of residency is where you learn to be a dermatologist/psychiatrist, so what's the downside of doing 1-1/2 of preclinical(most med schools are trending this way), and 3-4 years of clinical mix in with the typical didactics you'd get in residency, and then you graduate as a "doctor of dermatology" with independent practice as soon as you passed the boards, which is 4 years earlier than the current model.

I did 5 months surgery back in Medical School. I rhen did Genetics and now in a combined PhD/Residency in Psych

We use deep brain stimulation at my hospital (surgical), I've had to suture patients and care for wounds (surgical), A patient tried to commit suicide while admited, had to use my ATLS knowledge while ER docs got there (surgical), I've had a elderly patient fall + hip fracture (surgical)

Also, you forgot a whole branch of the field called COnsultation-Liason Psychiatry....

No, we aren't supposed to be able to solve every surgical issue. But we have to understand what is happening and what you should initially do.

If you srart using that logic then you break every specialty appart. Why does ortho need to learn cards? Etc

 

[efle]

Why does ortho need to learn cards? Etc

I mean. Yes. Orthopod school can still teach basics about other areas of medicine like they do in dental. But most ortho attendings would be lucky to Pass a modern USMLE form if they had to take it tomorrow. Huge amounts of excessive study-then-forget for many specialists not just psych.

 

[VA Hopeful Dr]

Dang, it's a good thing you dont need that to safely operate in the mouth or feet then, or advise the docs about the drugs they order

What on earth are you talking about mouth and feet for, we were talking about psychiatry?

 

[VA Hopeful Dr]

I mean. Yes. Orthopod school can still teach basics about other areas of medicine like they do in dental. But most ortho attendings would be lucky to Pass a modern USMLE form if they had to take it tomorrow. Huge amounts of excessive study-then-forget for many specialists not just psych.

We have that, its called medical school.

The problem is many of our fields are very broad. Ortho training covers the entire body (since the MSK system is everywhere). I suspect orthopedic school (as @hamstergang suggested) wouldn't look that different from medical school + residency. It might be a touch shorter, but I suspect not by a huge amount. Unless you went even further, instead of ortho school its "knee ortho school" and "shoulder ortho school". That could probably be done like podiatry school but that seems pretty wasteful.

 

[efle]

What on earth are you talking about mouth and feet for, we were talking about psychiatry?

Oh, I thought psych was just being used as an example. I feel this way about many specialties, like psych or derm or ortho or plastics, could get by with similarly focused schooling to dental or DPM or pharma.

Specialties that changed from fellowships to integrated would be an interesting perspective too. Wonder how many old school plastic surgeons would insist their gensurg residency was all completely necessary despite that dying out now, for example.

 

[efle]

We have that, its called medical school.

The problem is many of our fields are very broad. Ortho training covers the entire body (since the MSK system is everywhere). I suspect orthopedic school (as @hamstergang suggested) wouldn't look that different from medical school + residency. It might be a touch shorter, but I suspect not by a huge amount. Unless you went even further, instead of ortho school its "knee ortho school" and "shoulder ortho school". That could probably be done like podiatry school but that seems pretty wasteful.

Very fair point, if I'm not mistaken dental and pod are still 4 years. More about tailoring what you study than doing it all faster.

 

[Tangerine123]

I Had a Cholecystectomy 14 hours ago and will hopefuly get discharged tomorrow.

This was after I went to the ER knowing what my diagnosis was beforehand because of clinical findings. Literally told the ER residents that I had a positive Murphy sign and I suggested labs and USG. I'm sure they were more than capable to getting to the diagnosis on their own, but that is something I would have never been able to do if this "Psychiatry School" were a thing instead of being normal medical training.

As I said before, you aren't supposed to know everything of every field. Just have an idea of what's happening, be able to identify key facts and events and know when to refer and what to do first before the experts come.