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Which is more important for your medical education: Residency or Medical School?

Discussion in 'Medical Students - MD' started by Crow King, Aug 8, 2011.

  1. Crow King

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    I've heard from a relative (who is a surgeon) that residency is more important than medical school in a persons medical education.

    It would be nice to get a few different opinions on this... how much more important, how it is more important, etc....

    For a person in some area of medicine, say surgery for example, do most of their knowledge and skills come from residency or medical school? How much more?
     
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  3. turkeyjerky

    Physician 7+ Year Member

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    residency>>>>med school for every field, nothing else to add--you'll realize this w/o even thinking about it in a few years.
     
  4. projectlogic

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    residency
     
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  5. DeadCactus

    DeadCactus SDN Lifetime Donor
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    Medical school matters about as much as college and high school mattered once you get to residency...
     
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  6. Frozen

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    They both matter. Without med school, in residency you would just learn a lot of what to do, but without medical school you wouldn't have the foundation to understand WHY you do what you do.

    That is what separates MD from midlevels and nurses. An RN has years of "on the job" training, but doesn't always understand the background of why we do what we do. When a variant of the condition comes in and needs to be treated differently (zebra) MD understands and changes this accordingly, RN just continues with the status quo.


    Without residency you just have a bunch of random useless facts.
     
  7. isoquin

    isoquin Allopathetic
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    They both matter.... unless you supersubspecialize.
     
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  8. Crow King

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    Thanks for your replies.

    Any residents or attendings care to say anything?
     
  9. There are 2 main hurdles in a medical education: 1) getting accepted to med school and 2) matching into the specialty of your choice. Beyond this, nothing really matters in the grand scheme of things. Obviously, you should strive for the best program, if all else is equal, but don't make the mistake that every 4th year med student does in getting too bogged down in program name/prestige. Yes, in general, where you did your residency >>>>> where you went to med school regarding medical training. And top residencies tend to have better equipment, and a more "academic" focus, in addition to the most diverse pathology. But I can't really say that this equates to "better training" when every year, "America's top doctors" has equal representation from big names and lesser known programs. Just matching at a top residency or going to hms doesn't make you a great doctor by itself. The most important aspect of your training is still your performance as a resident. There are plenty of Terrible docs from top programs and plenty of great docs from places you've never heard of.
     
    #8 cowme, Aug 8, 2011
    Last edited by a moderator: Aug 8, 2011
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  10. BigRedBeta

    BigRedBeta Why am I in a handbasket?
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    The part where you actually learn to be functional and actually treat and manage patients - it's not even close: RESIDENCY. I mean, the difference is laughable. Whatever sort of hyperbolistic comparison you want to make, multiply it by 100 and you might be close.

    Med school primes the pump and puts you in position to handle that transition, but there's a reason why interns have so much supervision when they take care of patients.
     
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  11. Law2Doc

    Law2Doc 5K+ Member
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    While med school provides needed foundation, I don't think there is any question that residency teaches you more of what you actually need to do this job, both from a knowledge base and skillset perspective. As you go through your progression in education, you will see that each level (high school, college, med school) is more or less helpful foundation for future learning, but the didactic lecture/taking tests aspects of education deviate further and further from the apprenticeship model of medicine which is really how you need to learn a trade like this. For example, you can't learn to be eg an internist by reading about medicine, hearing lectures, taking written tests. You learn it by seeing patients, reading up on their conditions, helping them with their issues, prescribing meds, doing procedures, following their care longitudinally. In intern year you will probably realize that you learn more about critical care patient management in one overnight shift in the ICU than you learned in all of med school. Its just night and day. You need the foundation to get more out of residency, much as you needed the foundation of college to get more out of med school, but the earlier steps get dwarfed by each subsequent step. You also learn better when you are forced to make decisions that matter, and when you really need to know everything about a patient because your actions have repercussions, it encourages you to really know what you are doing or you are going to hurt somebody. And in those hopefully rare cases where you do hurt somebody, you definitely learn hard lessons that stay with you a while -- and have much more impact than missing some multiple choice question on a med school test. If you really want a breakdown, I would say that 95% of what you need to learn in medicine comes from your training (residency and fellowship), and the remaining 5% (and that's being generous) comes from stuff you've retained from med school.
     
  12. amen, L2D. I shoved a lotta crap in my brain in med school, but I feel like I've gained more USEFUL knowledge in 1.5 months of internship than all of med school. But I wouldn't discount what you learn in med school; it's the basis for all the knowledge you expand on/solidify throughout residency.

    I'd relate it to learning a new language. Obviously, 4 years of spanish will have you understanding the rules of the language, but it doesn't mean jack in terms of preparing you to speak spanish in a foreign country for 4 years.
     
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  13. mTOR

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    4 years undergrad + 4 years med ed + 200K debt to learn 5% of what you'll actually use... there's nothing wrong with that at all!

    lmao It's funny people only get candid about the true practicality of their education (or lack thereof) ONLY once it's divorced from measures to do something about it (or removed from other politically-touchy contexts). I started a thread not too long ago criticizing the length of med school, suggesting that newly minted PA's are probably as prepared to practice medicine as we are out the gates (if not moreso!). Followed it up with the proposition of hell why not let them do primary care residencies to fill the void?

    Needless to say, the position wasn't very popular :laugh:

    Anyways, back to OP's q, yes -- for most specialties residency training is several orders of magnitude more relevant to your career than medical school
     
  14. FloridaMedicine

    FloridaMedicine Bring it on.....
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    Hey you guys, I may be a bit out of place in this thread but out of curiousity what exactly makes you competitive for fellowships in residency?
     
  15. Law2Doc

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    It's 5%, but it's the 5% you need to build on. Sort of like pouring cement into the ground is only 5% of a completed building, but heaven help you if you start to build without first doing that step. So I disagree that things should or could be streamlined if that is the crux of your argument. You can't just jump into residency without the foundation. Residency is about applied knowledge. Knowledge can only be attained if you have the foundation to allow you to process it. Without that step, you get a lot less out of residency. So yeah, I'd say skipping med school would make you a lousy practitioner even if the actually knowledge base you walk out of there with is minimal. It prepares you to process the stuff you are soon to learn, how to function within the hospital system, exposes you to the attending resident fellow med student dynamics, teaches you how to effectively communicate with US patients, etc. You need med school. You need residency. It remains to be seen with duty hour changes whether you need even longer residency. We aren't going to compete with midlevels by paring down what it means to be a doctor. The goal needs to be to bring more to the table, and at the same time very publicly unmask that they are bringing less and that patients are paying for it.
     
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  16. Most fellowships are pretty easy to land. The only tough ones i can think of are some of the internal medicine ones (cards, gi, allergy) In this case what helps is:
    1) your contacts.
    2) the name of your residency (preferably a university program)
    3) research
    4) everything else
     
    #15 cowme, Aug 9, 2011
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  17. Law2Doc

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    Good letters/recs from residency, research, interview skills. In some fields inservice exams can play a role.
     
  18. FloridaMedicine

    FloridaMedicine Bring it on.....
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    Thanks you guys for the answers, I've heard that research is important for landing a GI fellowship. Do most GI applicants do 3years of IM residency and then a research year?
     
  19. Dr Love

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    Your ability to get into a good residency depends on your medical school.
     
  20. 45408

    45408 aw buddy
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    Residency.
     
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  21. Crow King

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    I heard getting into a good medical school depends on your undergrad... I'm sure it matters a small amount, but that's it. I went to a top 10 undergrad with a good MCAT and GPA and didn't exactly have a great application experience.

    Anyways in another thread a user named K31 posted this-

    http://www.nrmp.org/data/programresultsbyspecialty2010v3.pdf

    More important than your medical school are grades in clerkships, honors in clerkships, LORs, USMLE scores, class ranking, consistency of grades.

    Sure I'd be willing to bet the better programs place a premium on the medical school but how much? Not that much it seems
     
  22. isoquin

    isoquin Allopathetic
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    I think law2doc hit the nail on the head. gotta create the foundation before anything else
     
  23. Dr Love

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    Exactly, just like getting into a good med school depends on your undergrad. Not impossible, I did it, but I was at a huge disadvantage. I assure you, you might not have liked the results you had during your application coming in from a top ten school, but things would have been much worse if you came from a top 50 school.
     
  24. Mattchiavelli

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    residency, hands down. You'll have to know the basic foundations to pass all your steps, and even if you are at a crappy med school there's no one stopping you from reading Robbins or Cecil essentials of medicine or anatomy atlases etc.. but if you're at a crappy residency you can't exactly wander into a better clinical environment and ask to care for some patients.
     
  25. ZagDoc

    ZagDoc Ears, Noses, and Throats
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    Your residency is what makes you a good doctor. You can argue your medical school helps make you a good resident though.
     
  26. The Angriest Bird

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    mTOR:

    Despite the exaggerated font size, what you said is very true. The ridiculous length of the medical education serves more of a role to make sure you can endure the harshness and differentiate yourself from our individuals in your generations for the most challenging and fairly lucrative profession int he society.

    For many specialties with a fellowship, what you learned in medical school AND residency don't matter very much. Example: gastroenterology. A GI doctor who does 15 scopes in one day probably don't remember anything about managing CHF or COPD exacerbation in his IM residency, not to mention pathology and Ob-Gyn in medical school. And on top of this, he/she spent 4 years learning organic chemistry, calculus, and world history in college.
     
  27. Inception8888

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    I know this is an old post BUT I still would like to answer. I would also say that medical school is important for understanding the base and foundation of medicine. You have to learn to start thinking like a physician and you need to understand the basics even though I would take the term "basics" loosely. There is a lot to know and a lot to retain before you hit the clinical years, internship, residency and IF you choose fellowship. It's basically knowledge building.

    Will you retain all know from medical school and undergraduate sciences...NO by any means. It's too broad and deep to know all of it. However, medical school will teach you the biochemical processes, anatomical structures, physiology, immunology, neurosciences, pharmacology and etc. You need a good base.

    With ALL that being said, residency is where you really learn how to become a physician. This is nothing but an apprenticeship. You learn from a community of other interns, residences, fellows, attendings, etc. Even beyond residency you're constantly learning through continuing medical education (CME). You never stop learning. So medical school is nothing but your foundational learning so when you get to REAL practice of medicine you're not completely lost.

    So yes...RESIDENCY > MEDICAL SCHOOL > UNDERGRADUATE SCHOOL > HIGH SCHOOL...etc
     
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  28. jm192

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    How exactly do you residency without medical school?

    I remember the first Aortic Dissection I saw. ER doc gave me checkout and said his back pain was all from his gallbladder. His BP of 240 and elevated troponin gave me pause because if this was a step 1 question--I've probably crossed gallbladder off my list. If I'd never gone to medical school and had to take step 1, I don't think that way. That whole process of learning things in a way that the right things are flagged in your mind when they need to be--that's why you go to medical school.

    In that sense, this is a ridiculous discussion. You're asking an olympic sprinter which is more important--running or walking?
     
  29. Inception8888

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    I don't think its a bad question. I have heard from EVERY medical professional that residency is where you really learn medicine BUT they also said medical school provides a good foundation. Most people will forget a TON of what they learned in medical school no doubt so whatever you need will be constantly reinforced in training.

    I HIGHLY doubt most of us would be able to recall the entire cellular respiration pathway when it comes to understanding ALL the nuances in the pathophysiology of insulin and non-insulin diabetic mellitus BUT we understand the overall picture, how to daignose it, set up a Tx plan and understand the prognosis of it. If someone were to ask me about biochemistry about things that I rarely ever use then I will not retain it but at least I know WHERE to look and not just be all over the place. If someone were to ask about me about the pathophysiology about vitamin D3 (cholecalciferol) deficiency the lay person would never know where to look in the first place BUT a provider would be like ok look at me the dermis, the gastro system to see if we are able to absorb D3 in the first place. Is there something going in the hepatic and renal systems where the body cannot convert and activate the D3 in its active form to ingest calcium into the body. We also know what would generally happen to the body if we cannot utilize calcium. There would be abnormal cardiac and central nervous system functioning, which could also affect the peripheral nervous system as well, etc OR the opposite if we have chronic hypercalcemia...we would look at hypervitaminosa or hyperparathryroidism issues where more PTH is being produced to induce higher osteoclast activity to release more calcium in the bone causing bone degradation, tacchycardia, slower CNS functioning, etc.

    The cardiac case is a good example. You know that higher Troponin levels is a sign of myocardial infarction since local cardiac tissues become necrotic due to lack of blood flow and become broken down in the blood (cardiac ischemia/infarction) or else known as cardiac rhabdomyliosis. (sorry for bad spelling) this a key sign of an MI.
     
  30. TypeADissection

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    Residency/Fellowship. The last place you graduated from/finished training at.
     

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