Whats the point of undergrad?

[hamstergang]

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The correct answer, as a few have pointed out, is that undergrad is required and med school is 4 years long because they are. It wasn't designed this way, but instead it developed this way. There's too much momentum to expect this to change any time soon.

That said, the made up reasons others gave are things I'm appreciative of having gone through. For example, I like that I had more time to explore other subjects in more depth. I gained skills and knowledge from other fields that absolutely help me today as an attending. So while the process may seem overly stretched out, you can't change it quickly but you can derive some of the benefits it offers to somewhat offset the price.

 

[VA Hopeful Dr]

None of those arguments make sense in the first place. No other career requires you to spend 4 years of expensive college learning about something just to gain admission, and a lot of those jobs are just as critical if not more than a physician.

Yeah, it's a good thing law school doesn't require an undergrad degree. Or business school. Or divinity school. I'm glad we're the only ones who have to "suffer" through undergrad.

 

[IslandStyle808]

It was in the ER, and while it was mostly other docs noticing the mistakes and mentioning it, I was picking up on some of them as well. For example, I think any competent 4th year would know that Kayexelate isn't first line treatment for someone with chest pain, an arrhythmia, and potassium of 7.5. Pretty sure that doc isn't going to be around much longer based on some conversations I heard.

I was also referring to FMG residents though. Over the course of 2 weeks I taught 2 FMGs and an IMG how to perform a DRE and watched them miss things on films that should have been obvious to a pre-med (multiple rib fractures, femoral neck fx, etc). It wasn't unconscious bias, it was incredible obvious things that they were missing. I'm not saying that there aren't U.S. residents that suck or that I'm a particularly stellar M4 (I'm not), but as I said, anecdotally I've found the FMGs and IMGs I've worked with have gaping holes in their education that are basic for most US students.

Looking at this whole scenario, it looks more like a problem with their clinical education and not so much the "breath" of their education. We have one of best medical education system in the world. So while it may seem like it is a diversity of experiences that make better medical student, its far more so because our education is better.

 

[W19]

Looking at this whole scenario, it looks more like a problem with their clinical education and not so much the "breath" of their education. We probably have one of best medical education system in the world. So while it may seem like it is a diversity of experiences that make better medical student, it maybe more so because our education is better.

That might be true, but I am not sure how you arrive with that conclusion...

 

[IslandStyle808]

That might be true, but I am not sure how you arrive with that conclusion...

I was speaking to a doctor who did his medical school in India and then did his residency in the US. He said the medical education here was far better than the one he received in medical school in India. I cannot really speak for every country in the world,but considering a lot of people from other countries actually fly to the US for treatment I would think our doctors are that well trained. The care here is definitely not affordable, so that is definitely not the reason why travel so far...

 

[sliceofbread136]

Yeah, it's a good thing law school doesn't require an undergrad degree. Or business school. Or divinity school. I'm glad we're the only ones who have to "suffer" through undergrad.

Those don't have residencies though, they kind of are the residency

 

[VA Hopeful Dr]

Those don't have residencies though, they kind of are the residency

My cousin doing a chaplain fellowship might disagree...

But most of them do a good bit of on the job training. During that time they don't often make more than most residents and often work similar hours. Where's @Law2Doc when you need him.

 

[Moose A Moose]

OP: Once upon a time, people were able to study in undergrad for direct entry into a stable career... without grad school!

Mind blown? Mind blown.


Sent from my iPhone using SDN mobile

 

[deleted407021]

Feels like a first world problem 🙄

 

[Domperidone]

Tomatoes, to-mah-toes regarding europe/uk/australia/nz (every Western country except Canada/the US) and their medical pathways.
No wait..I've done that wrong. apples to oranges.
Or I give up. I have night brain right now.

The back and forth observations made earlier are both 'true'.
I know it seems dichotomous.

This seems absurd that an m3-m4 is picking out mistakes from doctors who have completed residencies. I am unsure of how you can say that the FMGs were making more mistakes compared to their US counterparts either. They have completed residencies and licensing exams as any other doctor would have.

This peer reviewed journal article says the exact opposite of what you are claiming. You sure it wasnt unconscious bias coloring your view of their practice.

Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study | The BMJ

Here is another study for surgeons which indicates no difference.
Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology. - PubMed - NCBI

It was in the ER, and while it was mostly other docs noticing the mistakes and mentioning it, I was picking up on some of them as well. For example, I think any competent 4th year would know that Kayexelate isn't first line treatment for someone with chest pain, an arrhythmia, and potassium of 7.5. Pretty sure that doc isn't going to be around much longer based on some conversations I heard.

I was also referring to FMG residents though. Over the course of 2 weeks I taught 2 FMGs and an IMG how to perform a DRE and watched them miss things on films that should have been obvious to a pre-med (multiple rib fractures, femoral neck fx, etc). It wasn't unconscious bias, it was incredible obvious things that they were missing. I'm not saying that there aren't U.S. residents that suck or that I'm a particularly stellar M4 (I'm not), but as I said, anecdotally I've found the FMGs and IMGs I've worked with have gaping holes in their education that are basic for most US students.



The maturity issue has nothing to do with the educational system and everything to do with those students experiencing life without their parents. As you said, plenty of kids are "still drinking mommy's booby milk at age 18", and having those kids go straight to a med school curriculum is a terrible idea. I agree that a lot of it is bureaucratic and that we could make significant changes to the system to cut down on time and expenses, but having 18 year olds go straight into a medical school curriculum is not one of them. If you think it is, just look at the attrition rates of the 6-year programs that already exist in the U.S. (over 20%) compared the attrition rates of normal 4 year programs (just over 2%).

With the articles about FMG performances earlier - I can't find anywhere in the articles about FMG residents. So I'm assuming the articles linked are referring to fully qualified physicians. Which is forgetting that residency is much longer or extended (for a reason) in Europe, Australia, NZ. Either that, or I didn't look hard enough.

the intern year or the foundation years x 2 in the UK (and other Western countries not in the continent of North America) is comprised of rotations in surgery, medicine, emergency. And you don't get into a particular specialty directly after medical school either. you're just "intern". if you look at it this way. the number of years comes out as the same. sure, 6 years of medical school directly after high school. But then you have 1-2 years of rotations without actually being dedicated to any particular field.

As there's no equivalent to the UK "intern or foundation years' in the US. so, unsurprisingly, the exposure and competency is different for American students (v.s. their counterparts in other Western countries that follow the old UK or European models). responsibilities are also different.

That's just the tip of the iceberg of differences.
For instance, FM is 5 years long. everything else that isn't FM is up to twice as long in training/residency years. It's also be more or less alluded to in other comments in this thread. The trade off is better lifestyle and hours (very relatively speaking or generally speaking) during residency itself. It is not ideal for finishing 'everything' if you're in a rush.

Regardless, sure, high school direct entry might be attractive to premeds bitter about undergrad being a waste of time.
But i mean, it's not like short cuts are actually being made in the other Western countries that follow that model.
Everyone roughly comes out the same age as attendings. Which is old. 😛

 

[sliceofbread136]

My cousin doing a chaplain fellowship might disagree...

But most of them do a good bit of on the job training. During that time they don't often make more than most residents and often work similar hours. Where's @Law2Doc when you need him.

Is that training required by law to practice? Are they doing that on the job training into their 30s? I'm going to guess no.

 

[Ad2b]

I work in an very geriatric centered part of the country (take your pic: AZ, FL, TX). There is a good reason to have no one under 22 or 23 start med school.

What many/most of you might not know is that you have to build your practice, just like a business unless you do academic med and then you still have to build a research portfolio, apply for grants, and build a curriculum to teach your course to med students.

In private practice, you have to build that. Based on RVUs and closed charts and accurate coding and all of that is essential to keep your patient population who rather come and go at will or come in and stay for awhile if CMS is any part of that equation. Oh, and none of that is taught to you during the u-grad portion of your med school years (MS 1 - 4). You get to learn that in residency, I hope... or OJT when you officially are on your own.

There is no one to help molly-coddle you through the quality metrics either. JCAHO won't care that you didn't get the time to grow up, they'll care if you left a sponge on the inside of your patient or a scalpel blade (yes, it's happened) and they certainly won't care that you are only 2x. AND if you don't build your practice, and chart/code/RVU build, you get fired.

Yes, you. That one with the fancy initials behind your name, you get fired.

At 29, you better be able to handle the gal with a BMI of 42 with COPD, A1C issues, renal failure and smoke on her breathe while farting and gasping for air with her not yet clean teeth. And you better get her chart right for the coding folks and make sure you can cover the RVU and earn your salary.

I seriously doubt many younger than that can do all of that, and care for someone's health. Why? Observations of the 35 yr olds that can't handle it and get fired. And then whine...

 

[Peach Newport]

It's actually part of the whole healthcare industrial complex conspiracy.

When you need to go to college in addition to med school, you need to take out more student loans... and waste more of your life.

Then as a medical student you have more scary debt hanging over your head.

As a result, you tailor your medical career to desperately earning as much as possible, and you become terrified of the looming threat of socialized medicine and Medicare for all.

Then as a doctor, you vehemently oppose single payer healthcare and vote republican.

This makes the insurance companies, hospital administrators, Ted Cruz, and captains of healthcare industry very happy. They use their influence to maintain the status quo.

So you see, by becoming a doctor, you're being used by the 1%. You're just a tool for them, man.

The only way to escape to freedom is to not apply to any competitive residencies in 2020. Especially Academic Jewish Dermatology.that's where they really get you. I'll take that hit so you all can be free.

 

[Ad2b]

It's actually part of the whole healthcare industrial complex conspiracy.

 

[Peach Newport]

Stay woke!

 

[Ad2b]

Requiring a bachelors degree, MCAT, etc helps filter out both people who don't really want to do this and people who can't handle hard work.

yeah, had a doc the other day (2 yrs out of residency) complain that she was working 38 hours this week and seeing 10 patients a day. A WHOPPING 10 patients!!!! (she's 30; med school at 21, finished residency at 28)

 

[FourniersGreenGang]

What ever the people talk about above , developing maturity etc is hogwash. There are plenty of immature medical students who will make incompetent doctors. Children in foreign countries arent babied like our American students to be taught they are special snowflakes and still drink mommy's booby milk at age 18.
I side with the people saying its a bureaucratic development, and honestly if maturity is an issue it makes more sense to drag out residencies longer rather than a ununiform undergrad system where everyone is subject to the schools difficulty level. ( A student studying at UC Berkeley who gets into med school will probably be more resilient and mature than a student studying at some small private college in a random 1 horse town)

You've clearly never met anyone who studied undergrad at UC Berkeley 😛

 

[VolibearMain]

You've clearly never met anyone who studied undergrad at UC Berkeley 😛

Most of my friends did and they are all landing successful positions because they are mature obviously. Stanford, UCLA, UCSF, etc don't take in comic book charachters
The one's who went thru engineering are also employed at pretty sweet places like google, apple, etc.
Meanwhile my ex girlfriend majored in psych got a 4.0 doesnt know a thing about the brain, and got like a 22 on her MCAT after studying for it, (and she went to a random college)

 

[FourniersGreenGang]

Most of my friends did and they are all landing successful positions because they are mature obviously. Stanford, UCLA, UCSF, etc don't take in comic book charachters
The one's who went thru engineering are also employed at pretty sweet places like google, apple, etc.
Meanwhile my ex girlfriend majored in psych got a 4.0 doesnt know a thing about the brain, and got like a 22 on her MCAT after studying for it, (and she went to a random college)

Anecdotally, but, it's a joke bb. Take a Valium.

 

[VA Hopeful Dr]

Is that training required by law to practice? Are they doing that on the job training into their 30s? I'm going to guess no.

Funny, I had a full license after intern year and was finished with residency at 29 (and was not the youngest person in my residency class).

 

[Raryn]

Undergrad is required because of the historical happenstance of how medical education developed in the United States. Among many other recommendations, the Flexner Report in 1910 put forth the requirement of prerequisites to medical school (chemistry, biology, whatever else). It was adopted universally in this country. Before then, there were dozens of medical schools that did not require undergraduate education. Most schools actual "requirement" these days is a set of prerequisites based on the original recommendations as well as 90 semester credit hours of education. That said though, as time went on, these prerequisites morphed into a de facto requirement to have a bachelors degree (so ~120 semester credit hours). Why? Well, many people were finishing the degrees. They had a step up in the application process, because adcoms looked favorably on that. So they got accepted. People saw that, more applicants finished their degrees, etc.

You could easily come up with a system that does away with the current state of affairs and gets you a more streamlined education system. But literally zero of the stakeholders have any reason to do so. Think about it from the med schools perspective. Would you rather have to deal with 18 year olds or 22 year olds? Most people would rather outsource the first few years of seasoning. Hell, med schools more and more are accepting "nontrads", with something like half of people taking gap year(s). The trend is going the exact opposite direction of where the people in this thread would want (and I personally think it's dumb to routinely go for gap years if you know you want to do med school, but what do I know?).

I enjoyed undergrad. I had a good time, expanded my horizons. Had a full scholarship and left with no debt. It made me a better person. Can't really say it made me a better doctor, but there's more to life than knowing how to titrate insulin.

The system in the US isn't THAT outside the norm (1-2 total years on top of even the faster systems in the world) and I think I got a good overall education. Anecdotes about FMGs who don't want to do rectal exams aside, so do most people everywhere else. There's more than one way to skin a cat.

 

[W19]

Funny, I had a full license after intern year and was finished with residency at 29 (and was not the youngest person in my residency class).

Why did you get a full license after intern year? Did you have the opportunity to moonlight?

If I got into residency next year, it might be something that I will do even if there won't be no opportunity for moonlighting...

You finished residency at 29 and your student loan probably wasn't > 150k, and interest back then was in the 3%... Now most students will graduate with 300k+ student loan with an interest ~8%. That's probably why some of us want sanity to be restored in this process...

 

[VA Hopeful Dr]

Why did you get a full license after intern year? Did you have the opportunity to moonlight?

If I got into residency next year, it might be something that I will do even if there won't be no opportunity for moonlighting...

You finished residency at 29 and your student loan probably wasn't > 150k, and interest back then was in the 3%... Now most students will graduate with 300k+ student loan with an interest ~8%. That's probably why some of us want sanity to be restored in this process...

South Carolina. I got my license in December of 2nd year (started the application in August - ****ing FCVS). Started moonlighting in May of second year. Moonlit heavily in 3rd year - probably made an extra 24k that year.

I encourage everyone who can to get their full license as soon as they can - renewing is way easier than applying, and once you are licensed in 1 state its easier to do in others.

My wife finished residency at 30 with 180k at 6.4% so I get the debt problem (we started school the year after the raised rates from 3%). I finished with no debt, but only because my father died 2 months before I started school and my mother used part of his life insurance to pay for my schooling so I guess I was lucky... maybe?

But look, its like I have to keep saying - the problem isn't the educational requirements, the problem is the cost. If college and med school weren't so insanely expensive, the extra 1-2 years wouldn't be that big of a deal. I graduated college in 2005, tuition was 18k my last year. At my alma mater it is currently 42k. I'm not sure why the price had to go up 2.5X in just over a decade, but I did notice that the scholarship I had which was full tuition in 2005 now is only 70% of tuition. Meaning if I went to college now I couldn't afford to go there anymore. That's not OK and that should be the focus, not on shortening education but making it affordable again.

 

[W19]

@VA Hopeful Dr I am not rehashing the discussion about shortening med school curriculum since the BS/BA degree has become a de facto requirement as @Raryn pointed that out already. However, no one will convince me that the 4-year curriculum of med school itself could not be shorten to 3-year with some modification... Again the 18 + 18 months would be a good one. I am done with this thing. Whatever!

I just wanted to the reason behind applying for a license after intern year, and you gave me an excellent reason to do it--easier to renew later on than applying for the first time.

 

[VA Hopeful Dr]

@VA Hopeful Dr I am not rehashing the discussion about shortening med school curriculum since the BS/BA degree has become a de facto requirement as @Raryn pointed that out already. However, no one will convince me that the 4-year curriculum of med school itself could not be shorten to 3-year with some modification... Again the 18 + 18 months would be a good one. I am done with this thing. Whatever!

I just wanted to the reason behind applying for a license after intern year, and you gave me an excellent reason to do it--easier to renew later on than applying for the first time.

I'd prefer the 4 years to be more efficient so you learn more, but as things stand now I think you're correct. But you're also right, not the place to rehash it.

I also think moonlighting is a great reason to get a full license as well. Earn extra money AND start getting a feel for what its like working without as much of a safety net.

 

[VolibearMain]

South Carolina. I got my license in December of 2nd year (started the application in August - ****ing FCVS). Started moonlighting in May of second year. Moonlit heavily in 3rd year - probably made an extra 24k that year.

I encourage everyone who can to get their full license as soon as they can - renewing is way easier than applying, and once you are licensed in 1 state its easier to do in others.

My wife finished residency at 30 with 180k at 6.4% so I get the debt problem (we started school the year after the raised rates from 3%). I finished with no debt, but only because my father died 2 months before I started school and my mother used part of his life insurance to pay for my schooling so I guess I was lucky... maybe?

But look, its like I have to keep saying - the problem isn't the educational requirements, the problem is the cost. If college and med school weren't so insanely expensive, the extra 1-2 years wouldn't be that big of a deal. I graduated college in 2005, tuition was 18k my last year. At my alma mater it is currently 42k. I'm not sure why the price had to go up 2.5X in just over a decade, but I did notice that the scholarship I had which was full tuition in 2005 now is only 70% of tuition. Meaning if I went to college now I couldn't afford to go there anymore. That's not OK and that should be the focus, not on shortening education but making it affordable again.

You can try to make it affordable again but the issue for undergraduate education still stands that its a lot of useless crap that no one needs or pays attention to. "A liberal arts education creates a well rounded person," no because most of us just threw the liberal arts classes in the back of the trunk focused on ochem physics etc (which are almost equally useless to our medical careers), and still ended up getting A's in those classes by cramming the night before/winging projects.
This is just my opinion but the medical system of finding well rounded people based on academics is off in the wrong position (adding the psych/sociology) section to see who is more socially adept????? People just memorize the 100 pages of notes on random principles someone posted on reddit and go in and ace that section. Undergrad really can be shaved down to a two year program. Additionally most undergrad degrees just don't prepare students for the actual fields they want to go into either.

Anyway anecodtally, this is getting harder now, I have an uncle who is 39 now. Born and raised in the states, his parents sent him off to India for a 5 year mbbs (MD) degree. He came home did his radiology residency and IR fellowship in some random town in ohio. He now sits at the head of the GWU IR radiology department and was done with residency etc by the time he was about 29 years old (pulling 300-500 k annually) so as a family guy, his life was set to go and comfortable
For students who want to go into internal medicine, family, ped, etc, where its only a three year residency, it would be pretty sweet to be done with school around 24, done with residency by 27 and pulling 150-200 k /year.

Moral of the story: Never forget the opportunity cost
PS. No way am I endorsing foreign schools in today's day and age

 

[VA Hopeful Dr]

You can try to make it affordable again but the issue for undergraduate education still stands that its a lot of useless crap that no one needs or pays attention to. "A liberal arts education creates a well rounded person," no because most of us just threw the liberal arts classes in the back of the trunk focused on ochem physics etc (which are almost equally useless to our medical careers), and still ended up getting A's in those classes by cramming the night before/winging projects.
This is just my opinion but the medical system of finding well rounded people based on academics is off in the wrong position (adding the psych/sociology) section to see who is more socially adept????? People just memorize the 100 pages of notes on random principles someone posted on reddit and go in and ace that section. Undergrad really can be shaved down to a two year program. Additionally most undergrad degrees just don't prepare students for the actual fields they want to go into either.

Anyway anecodtally, this is getting harder now, I have an uncle who is 39 now. Born and raised in the states, his parents sent him off to India for a 5 year mbbs (MD) degree. He came home did his radiology residency and IR fellowship in some random town in ohio. He now sits at the head of the GWU IR radiology department and was done with residency etc by the time he was about 29 years old (pulling 300-500 k annually) so as a family guy, his life was set to go and comfortable
For students who want to go into internal medicine, family, ped, etc, where its only a three year residency, it would be pretty sweet to be done with school around 24, done with residency by 27 and pulling 150-200 k /year.

Moral of the story: Never forget the opportunity cost
PS. No way am I endorsing foreign schools in today's day and age

That's your problem. If you go into undergrad not wanting to learn, then guess what: you won't learn anything.

If, on the other hand, you go into undergrad wanting to learn, there is a lot of value to be had. Am I likely to use what I learned in elective P-Chem 3, of course not. But I enjoyed it so it was worth it.

 

[NotYou20]

Meh. The biggest benefit is that people's grades when they're fourteen doesn't determine their capability to be a doctor. Seeing as I wouldn't have gotten in out of high school I'll take the chance to prove myself as an adult

 

[VolibearMain]

That's your problem. If you go into undergrad not wanting to learn, then guess what: you won't learn anything.

If, on the other hand, you go into undergrad wanting to learn, there is a lot of value to be had. Am I likely to use what I learned in elective P-Chem 3, of course not. But I enjoyed it so it was worth it.

There will always be plenty of time later in life to "learn" useless facts- that have no pertinence to your career.

 

[VolibearMain]

Meh. The biggest benefit is that people's grades when they're fourteen doesn't determine their capability to be a doctor. Seeing as I wouldn't have gotten in out of high school I'll take the chance to prove myself as an adult

This can work in the opposite directly depending on how you are raised, many students ace thru high school and college (if you go to a difficult school/major) can screw your GPA over . It is much easier for someone to perform well in highschool and get in, than drag their education (just to get into medical school) until they are 25 (the average age). Our generation has a nasty habit of procrastination and repentance later in life.

 

[VA Hopeful Dr]

There will always be plenty of time later in life to "learn" useless facts- that have no pertinence to your career.

Yeah it sure is easier to learn new subjects when you have a job +/- family compared to when your only job is to learn. Good thinking.

 

[VolibearMain]

Yeah it sure is easier to learn new subjects when you have a job +/- family compared to when your only job is to learn. Good thinking.

That wasn't what I meant, the subjects are useless, if you are learning useless material, you gain no benefit from it.
You can learn plenty just from your free time watching a history show or visiting a museum or location- and these are all easy things you can do later in life.
Watching a ted talk, the stuff you learn in your humanities classes will not retain, thu out your journey of med school, but the ted talk may
When you are younger your ability to retain knowledge is much better than when youre 25+

You still haven't given a good reason why you would actually need to know any of this stuff. And as people have indicated with studies, medical education outside of the US - which starts after high school produces more competent doctors and the system of spending more time training as a resident outperforms the amount of useless material we have to learn as undergraduates.
Frankly the only reason why so many foreign doctors want to immigrate to the US is the salary opportunity which is a whole different basis.
Unless you can give me a solid reason why I should learn about some guy's philosophy of life who lived 1000's of years ago, this discussion is over.

 

[PlutoBoy]

I think our medical education system needs to be revamped. The wasted time and resources go beyond college.

As it stands now, it will soon be impossible or it is already impossible to be confident, competent, and able to provide the most advanced and up to date medical care in more than one limited field. We need to create tracks from medical school itself. A surgical track vs. a medical track vs. imaging/pathology track, etc.

There is a lot of waste right now. Do you really need four years of college plus four years of medical school plus three years of internal medicine residency plus two years of A&I if all you want to do is treat allergies? We can be more efficient. I don't remember much biochemistry or embryology. I don't think I would be a better doctor if I did.

In most of Western Europe, people do what here would be an IM sub specialty straight out of medical school. Want to be a rheumatologist? Complete medical school (six years) and four years of rheumatology. Their outcomes suggest that their training is not inferior to ours.

The main reason why this won't change is that there are too many interests at play. College/MCAT/USMLE/Board prep/Shelf exams/Boards... it's a big industry.

 

[VA Hopeful Dr]

That wasn't what I meant, the subjects are useless, if you are learning useless material, you gain no benefit from it.
You can learn plenty just from your free time watching a history show or visiting a museum or location- and these are all easy things you can do later in life.
Watching a ted talk, the stuff you learn in your humanities classes will not retain, thu out your journey of med school, but the ted talk may
When you are younger your ability to retain knowledge is much better than when youre 25+

You still haven't given a good reason why you would actually need to know any of this stuff. And as people have indicated with studies, medical education outside of the US - which starts after high school produces more competent doctors and the system of spending more time training as a resident outperforms the amount of useless material we have to learn as undergraduates.
Frankly the only reason why so many foreign doctors want to immigrate to the US is the salary opportunity which is a whole different basis.
Unless you can give me a solid reason why I should learn about some guy's philosophy of life who lived 1000's of years ago, this discussion is over.

Prove this statement.

 

[VolibearMain]

Prove this statement.

So in all your extensive years of training and undergraduate experience they never taught you how to use the search function?
Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study | The BMJ
Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology. - PubMed - NCBI

Besides the point, if foreign graduates are spending more years training in residencies and less on useless crap - in undergrad and even basic sciences of MS I, they will be the more prepared physician for their field. End of story.

 

[VolibearMain]

I think our medical education system needs to be revamped. The wasted time and resources go beyond college.

As it stands now, it will soon be impossible or it is already impossible to be confident, competent, and able to provide the most advanced and up to date medical care in more than one limited field. We need to create tracks from medical school itself. A surgical track vs. a medical track vs. imaging/pathology track, etc.

There is a lot of waste right now. Do you really need four years of college plus four years of medical school plus three years of internal medicine residency plus two years of A&I if all you want to do is treat allergies? We can be more efficient. I don't remember much biochemistry or embryology. I don't think I would be a better doctor if I did.

In most of Western Europe, people do what here would be an IM sub specialty straight out of medical school. Want to be a rheumatologist? Complete medical school (six years) and four years of rheumatology. Their outcomes suggest that their training is not inferior to ours.

The main reason why this won't change is that there are too many interests at play. College/MCAT/USMLE/Board prep/Shelf exams/Boards... it's a big industry.

I think it also has some financial incentive. Medical schools are always hoping to get that one genius who makes their school shine bright with research publications, discoveries , etc. They dont just want a doctor, they want a god tier visionary. And its hard to judge this from someone coming straight out of high school. Which is fine, just sucks for us. We have to deal with it.

 

[PlutoBoy]

So in all your extensive years of training and undergraduate experience they never taught you how to use the search function?
Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study | The BMJ
Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology. - PubMed - NCBI

Besides the point, if foreign graduates are spending more years training in residencies and less on useless crap - in undergrad and even basic sciences of MS I, they will be the more prepared physician for their field. End of story.

To me this means that residency training is what makes competent physicians (both cohorts are US residency trained).

 

[VA Hopeful Dr]

So in all your extensive years of training and undergraduate experience they never taught you how to use the search function?
Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study | The BMJ
Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology. - PubMed - NCBI

Besides the point, if foreign graduates are spending more years training in residencies and less on useless crap - in undergrad and even basic sciences of MS I, they will be the more prepared physician for their field. End of story.

So that second article says that outcomes are the same, which is not what you claimed. Maybe you should have used your time in undergrad on basic reading comprehension.

"CONCLUSION:
Despite considerable differences in educational background, surgical training characteristics, and practice patterns, IMG and USMG-surgeons deliver equivalent surgical care to the patients whom they treat."

The first article was addressed earlier in the thread. I suggest you go back and read what was written. Since I doubt you'll do that, I'll let this link do the talking: Re: Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study | The BMJ

Your second article absolutely disputes your main point, and the first wasn't designed particularly well nor has it been verified by any repeat studies.

 

[VolibearMain]

So that second article says that outcomes are the same, which is not what you claimed. Maybe you should have used your time in undergrad on basic reading comprehension.

"CONCLUSION:
Despite considerable differences in educational background, surgical training characteristics, and practice patterns, IMG and USMG-surgeons deliver equivalent surgical care to the patients whom they treat."

The first article was addressed earlier in the thread. I suggest you go back and read what was written. Since I doubt you'll do that, I'll let this link do the talking: Re: Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study | The BMJ

Your second article absolutely disputes your main point, and the first wasn't designed particularly well nor has it been verified by any repeat studies.

The first article clearly indicates they are better.
The second article indicates they are the same in surgery, wait, what was that? The same? And they had to waste less time on useless crap ( I feel like I am repeating myself and you aren't getting the point, just trying to prove yourself about undergrad being necessary and digress from the original topic that undergrad is not really needed). Stop nitpicking tiny words here and there and accept the fact there is no point to an extensive variable undergrad in hundreds of topics covered in various majors at different colleges of variable caliber. When the result is the same if not better for the foreign graduates
So based on the second article, in a simple analogy, if you had to walk across the Sahara desert to get to a lake with drinking water and if the guy who lives right next to the lake has to walk 2 feet, and get the SAME drinking water, who has it better? What is the purpose of that walk across the Sahara. Nothing

 

[VA Hopeful Dr]

I think our medical education system needs to be revamped. The wasted time and resources go beyond college.

As it stands now, it will soon be impossible or it is already impossible to be confident, competent, and able to provide the most advanced and up to date medical care in more than one limited field. We need to create tracks from medical school itself. A surgical track vs. a medical track vs. imaging/pathology track, etc.

There is a lot of waste right now. Do you really need four years of college plus four years of medical school plus three years of internal medicine residency plus two years of A&I if all you want to do is treat allergies? We can be more efficient. I don't remember much biochemistry or embryology. I don't think I would be a better doctor if I did.

In most of Western Europe, people do what here would be an IM sub specialty straight out of medical school. Want to be a rheumatologist? Complete medical school (six years) and four years of rheumatology. Their outcomes suggest that their training is not inferior to ours.

The main reason why this won't change is that there are too many interests at play. College/MCAT/USMLE/Board prep/Shelf exams/Boards... it's a big industry.

Incorrect. In the UK you have to do 2 Foundation years before the 4 years of rheumatology training. Well look, its the same 6 years as it is here!

Interestingly in Germany, it is just 6 years (at the end you get your license) but the average age of people entering med school is 21.4. That's about a year younger than here but the schooling is longer. Specialty training for them is 5-6 years depending on the field. So to be anything other than a GP takes 11-12 years post high-school (and their high schools for academics last 8 years and students start between ages 10-13, so they might not even be eligible to start medical school until age 21 anyway). When everything is taken into considering, the time differences are pretty small all things considered.

 

[VA Hopeful Dr]

The first article clearly indicates they are better.
The second article indicates they are the same in surgery, wait, what was that? The same? And they had to waste less time on useless crap ( I feel like I am repeating myself and you aren't getting the point, just trying to prove yourself about undergrad being necessary and digress from the original topic that undergrad is not really needed). Stop nitpicking tiny words here and there and accept the fact there is no point to an extensive variable undergrad in hundreds of topics covered in various majors at different colleges of variable caliber. When the result is the same if not better for the foreign graduates
So based on the second article, in a simple analogy, if you had to walk across the Sahara desert to get to a lake with drinking water and if the guy who lives right next to the lake has to walk 2 feet, and get the SAME drinking water, who has it better? What is the purpose of that walk across the Sahara. Nothing

There is absolutely a point, you just seem to be missing it.

 

[VolibearMain]

Incorrect. In the UK you have to do 2 Foundation years before the 4 years of rheumatology training. Well look, its the same 6 years as it is here!

Interestingly in Germany, it is just 6 years (at the end you get your license) but the average age of people entering med school is 21.4. That's about a year younger than here but the schooling is longer. Specialty training for them is 5-6 years depending on the field. So to be anything other than a GP takes 11-12 years post high-school (and their high schools for academics last 8 years and students start between ages 10-13, so they might not even be eligible to start medical school until age 21 anyway). When everything is taken into considering, the time differences are pretty small all things considered.

The cohort of foreign physicians were "largely from India, Republic of Ireland, and Pakistan, and in the US, largely from India, the Philippines, and Pakistan". We aren't talking about Germans here. The Indian grad graduates high school at 17-18 and is out in medical school by 18. Finishes by 23, and is doing his residency training (in the us according to that study). Ireland is pretty much the same program.
The average age to start medical school in the states is not 22, it's 25.
And specialty training, AGAIN, is relevant to them learning about being a clinician and not some crap, AGAIN, about some philosopher, which is irrelevant stuff we learn in undergrad (and pay $$$) while the foreign trainees make ($$$) in their training.

There is absolutely a point, you just seem to be missing it.

The point is, undergrad is useless, Can be shortened down to 1 or 2 years.
Youre upset a foreign grad is eating your lunch at a younger age.
You still haven't proved a single reason why undergrad is needed, are now digressing onto foreign training times vs american (Which as a whole still proves out to be the same if not better financially and objectively)
Welcome to my ignore list, you were just wrecked by a student. T

 

[PlutoBoy]

Incorrect. In the UK you have to do 2 Foundation years before the 4 years of rheumatology training. Well look, its the same 6 years as it is here!

Interestingly in Germany, it is just 6 years (at the end you get your license) but the average age of people entering med school is 21.4. That's about a year younger than here but the schooling is longer. Specialty training for them is 5-6 years depending on the field. So to be anything other than a GP takes 11-12 years post high-school (and their high schools for academics last 8 years and students start between ages 10-13, so they might not even be eligible to start medical school until age 21 anyway). When everything is taken into considering, the time differences are pretty small all things considered.

I guess that is true for the UK. Becoming an independent GP takes 11 years if I understand correctly:

Usually six years of medical school
Two years of FP
Three years to become a GP

As compared to:

Four years of college
Four years of medical school
Three years of IM/FP

Things are different in Germany and Spain, IIRC.

Big difference is that you are not $200,000 in debt 😛

EDIT: I see you already looked up the German system. Here is an interesting link for those interested:

http://ic.daad.de/imperia/md/content/informationszentren/icdamaskus/facharztausbildung_engl.pdf

 

[VA Hopeful Dr]

The cohort of foreign physicians were "largely from India, Republic of Ireland, and Pakistan, and in the US, largely from India, the Philippines, and Pakistan". We aren't talking about Germans here. The Indian grad graduates high school at 17-18 and is out in medical school by 18. Finishes by 23, and is doing his residency training (in the us according to that study). Ireland is pretty much the same program.
The average age to start medical school in the states is not 22, it's 25.
And specialty training, AGAIN, is relevant to them learning about being a clinician and not some crap, AGAIN, about some philosopher, which is irrelevant stuff we learn in undergrad (and pay $$$) while the foreign trainees make ($$$) in their training.



The point is, undergrad is useless, Can be shortened down to 1 or 2 years.
Youre upset a foreign grad is eating your lunch at a younger age.
You still haven't proved a single reason why undergrad is needed, youre butthurt about it, and are now digressing onto foreign training times vs american (Which as a whole still proves out to be the same if not better financially and objectively)
Welcome to my ignore list, you were just wrecked by a student. Time to revisit your undergrad skills (which are useless)

Wow, I sense some serious anger in this posting. Well done. If I'm the one who got "wrecked", why are you putting me on ignore? That's not the usual response to winning an argument.

The point about foreign training was a response to a difference poster complaining about the amount of time we train to produce a rheumatologist after med school. I was pointing out that in our closest allied country (The UK) they take the same amount of time. I threw in the Germany part because their system is one that's often held up as an example for how the US should structure things (and because I thought it was interesting).

I'm not upset about anything - I'm an attending physician, with a family, no undergrad debt (scholarships) and no med school debt (questionable good fortune). It'll take more than some random on a message board to get my temper up. I've yet to have a foreign trained physician take a job I wanted nor did I lose a residency slot to one, so I'm not sure why I'd be upset about them being physicians here - I wonder if you're projecting your own feelings onto me.

As for undergrad, its important because of how our whole education system is, sadly, lacking. Our high school graduates are rarely prepared for medical education (hence the high drop out rates in the 6-year programs we do have). Most don't know how to self-study or really do any independent learning which is a large part of, if not the majority of, medical education. Heck, pharmacy school (the main health profession 6-year program) has an 11% drop out rate. 4 year medical schools after undergrad in this country have a 4% drop out rate, or almost 1/3rd the drop out rate. And yet the only difference is 4 years of undergrad instead of 2. Nah, there's no way undergrad could be important in preparing people for a more rigorous course of study than they're used to, you're right and I'm obviously wrong.

 

[NotYou20]

This can work in the opposite directly depending on how you are raised, many students ace thru high school and college (if you go to a difficult school/major) can screw your GPA over . It is much easier for someone to perform well in highschool and get in, than drag their education (just to get into medical school) until they are 25 (the average age). Our generation has a nasty habit of procrastination and repentance later in life.

I'm aware. Performance ages 18-22 should matter way more than performance 14-18. I'm not interested in the easier path, I'd rather go for the one that makes sense.

Highly doubt not caring about high school is a generational thing. Mostly because it's easy af for those who are academically inclined, and for those who aren't, well that should be obvious enough

 

[VA Hopeful Dr]

I guess that is true for the UK. Becoming an independent GP takes 11 years if I understand correctly:

Usually six years of medical school
Two years of FP
Three years to become a GP

As compared to:

Four years of college
Four years of medical school
Three years of IM/FP

Things are different in Germany and Spain, IIRC.

Big difference is that you are not $200,000 in debt 😛

EDIT: I see you already looked up the German system. Here is an interesting link for those interested:

http://ic.daad.de/imperia/md/content/informationszentren/icdamaskus/facharztausbildung_engl.pdf

I've been saying for some time that the solution isn't to shorten training but to control costs. My med school charges 15k more now than it did when I graduated in 2010. That's over a 50% increase in 7 years.

 

[WiseOne]

Education is the US is extremely inefficient, playing to the lowest denominator. People try to come up with reasons like social development/maturity/experiences, but these have nothing to do with actual learning. For some reason we think intellectual and social development have to follow the same trajectory (ie. you can't teach a 5th grader high school math o/w they will be forced out of their peer group and that is not good for them etc.). There's no reason we can't have kids stay with their peer group but advance intellectually as fast as they want to. I'm liking the trend towards competency based education and allowing people to progress as fast as they want to. We also must remember that in the majority of countries, kids go to med school straight after high school. Also in many countries, such as Japan, people don't move out of their parents home until they have a stable job or are married. So to say that undergrad experience gives maturity is to imply that US doctors are on average more mature than doctors from abroad?...I don't think so. (You could even argue that the dorm life and general undergrad college scene actually contributes to greater immaturity, but that is another topic)

 

[Stagg737]

This can work in the opposite directly depending on how you are raised, many students ace thru high school and college (if you go to a difficult school/major) can screw your GPA over . It is much easier for someone to perform well in highschool and get in, than drag their education (just to get into medical school) until they are 25 (the average age). Our generation has a nasty habit of procrastination and repentance later in life.

Many people ace through high school because even at the better high schools in the U.S., a 4.0 isn't really all that difficult to obtain. I don't consider myself to be much more intelligent compared to the average med student, but I had almost a 4.0 in high school and literally did not study for a single test. At the same time, there's no way in hell I would have lasted even 1 semester in med school if I'd gone in as a 19 year old. At the same time, I know plenty of people who had the work ethic to earn nearly a 4.0 in high school that are complete *****s and barely got through undergrad. I can't imagine how fast they would have failed in a med school caliber curriculum. So unless you're also suggesting greatly increasing the standards set for high school education, I don't buy your argument for a second.

So in all your extensive years of training and undergraduate experience they never taught you how to use the search function?
Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study | The BMJ
Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology. - PubMed - NCBI

Besides the point, if foreign graduates are spending more years training in residencies and less on useless crap - in undergrad and even basic sciences of MS I, they will be the more prepared physician for their field. End of story.

The first article clearly indicates they are better.
The second article indicates they are the same in surgery, wait, what was that? The same? And they had to waste less time on useless crap ( I feel like I am repeating myself and you aren't getting the point, just trying to prove yourself about undergrad being necessary and digress from the original topic that undergrad is not really needed). Stop nitpicking tiny words here and there and accept the fact there is no point to an extensive variable undergrad in hundreds of topics covered in various majors at different colleges of variable caliber. When the result is the same if not better for the foreign graduates
So based on the second article, in a simple analogy, if you had to walk across the Sahara desert to get to a lake with drinking water and if the guy who lives right next to the lake has to walk 2 feet, and get the SAME drinking water, who has it better? What is the purpose of that walk across the Sahara. Nothing

It's already been addressed in either this thread and another that your first article is a weak study using weak methods (if you don't know how to evaluate this, then your UG education truly was lacking) in which IMGs in the comment section of the article itself are even saying it should be taken with a grain of salt. Ignore that if you want, but it's just a bad article to base your argument on. The second article has already been addressed and it doesn't support what you were arguing.

Education is the US is extremely inefficient, playing to the lowest denominator. People try to come up with reasons like social development/maturity/experiences, but these have nothing to do with actual learning. For some reason we think intellectual and social development have to follow the same trajectory (ie. you can't teach a 5th grader high school math o/w they will be forced out of their peer group and that is not good for them etc.). There's no reason we can't have kids stay with their peer group but advance intellectually as fast as they want to. I'm liking the trend towards competency based education and allowing people to progress as fast as they want to. We also must remember that in the majority of countries, kids go to med school straight after high school. Also in many countries, such as Japan, people don't move out of their parents home until they have a stable job or are married. So to say that undergrad experience gives maturity is to imply that US doctors are on average more mature than doctors from abroad?...I don't think so. (You could even argue that the dorm life and general undergrad college scene actually contributes to greater immaturity, but that is another topic)

It is inefficient. The average high school graduate reads at the 5th grade level while the average college freshman reads at the 7th grade level and people here are seriously trying to advocate that a high school education is a good enough pre-req to deem someone ready to enter medical school? This doesn't even touch on the immaturity issues that most 18 year old kids have or their lack of independence. Sure, there are some kids that are ready to go straight from high school into medical school, but they are the rare exception. If more people had the pre-requisite intelligence and maturity to enter medicine straight out of high school you'd see far more of these individuals in medical school already. I'm all for a more competency based model as you're suggesting. I had that in my school system and several of us got exemptions from the 4 year math requirement because we took the highest level math available when we were sophomores or juniors, and I wouldn't have minded if such a system were implemented for other areas as well.

The biggest problem I see with that system is that some people will test out of certain subjects early while being "average" in other subjects. Meaning they'll either be stuck taking less classes and not continuing with the subjects they tested out of or there would have to be special classes made available to those students. With how much public education funding already struggles, Idk how one would justify implementing a system on a mass scale in the public sector here (though I wouldn't be opposed to it if someone actually came up with a reasonable plan to do so).

 

[libertyyne]

Many people ace through high school because even at the better high schools in the U.S., a 4.0 isn't really all that difficult to obtain. I don't consider myself to be much more intelligent compared to the average med student, but I had almost a 4.0 in high school and literally did not study for a single test. At the same time, there's no way in hell I would have lasted even 1 semester in med school if I'd gone in as a 19 year old. At the same time, I know plenty of people who had the work ethic to earn nearly a 4.0 in high school that are complete *****s and barely got through undergrad. I can't imagine how fast they would have failed in a med school caliber curriculum. So unless you're also suggesting greatly increasing the standards set for high school education, I don't buy your argument for a second.




It's already been addressed in either this thread and another that your first article is a weak study using weak methods (if you don't know how to evaluate this, then your UG education truly was lacking) in which IMGs in the comment section of the article itself are even saying it should be taken with a grain of salt. Ignore that if you want, but it's just a bad article to base your argument on. The second article has already been addressed and it doesn't support what you were arguing.



It is inefficient. The average high school graduate reads at the 5th grade level while the average college freshman reads at the 7th grade level and people here are seriously trying to advocate that a high school education is a good enough pre-req to deem someone ready to enter medical school? This doesn't even touch on the immaturity issues that most 18 year old kids have or their lack of independence. Sure, there are some kids that are ready to go straight from high school into medical school, but they are the rare exception. If more people had the pre-requisite intelligence and maturity to enter medicine straight out of high school you'd see far more of these individuals in medical school already. I'm all for a more competency based model as you're suggesting. I had that in my school system and several of us got exemptions from the 4 year math requirement because we took the highest level math available when we were sophomores or juniors, and I wouldn't have minded if such a system were implemented for other areas as well.

The biggest problem I see with that system is that some people will test out of certain subjects early while being "average" in other subjects. Meaning they'll either be stuck taking less classes and not continuing with the subjects they tested out of or there would have to be special classes made available to those students. With how much public education funding already struggles, Idk how one would justify implementing a system on a mass scale in the public sector here (though I wouldn't be opposed to it if someone actually came up with a reasonable plan to do so).

You keep on saying weak, but you never quite say why it is weak or what fundamental issue the study has. And when I quoted the FMG you said I was cherry picking. Is there a stronger study that proves that IMGS provide worse outcomes ?

 

[Goro]

So in all your extensive years of training and undergraduate experience they never taught you how to use the search function?
Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study | The BMJ
Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology. - PubMed - NCBI

Besides the point, if foreign graduates are spending more years training in residencies and less on useless crap - in undergrad and even basic sciences of MS I, they will be the more prepared physician for their field. End of story.

Burden of proof lies with the presenter.