Which medical schools make the best doctors?

[runningpenguin]

I think they mean gaps during your MD, not premed

I see. I've seen threads on this before for students trying to enter competitive residencies who then do a research year or individuals who are taking the Step over again. Usually the threads indicate that as long as the gap year was productive, it's a positive. But does this data indicate otherwise then....that gap years during the medical school schools are frowned upon?

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[calivianya]

My mentor said the worst fellow he ever trained, and one of the few he ever outright failed with no hope of remediation, was from Harvard.

In his opinion, the worst MDs were from research heavy programs. He stated that in general, the faculty of the top tier programs are so research focused that many have poor clinical skills. Those are the people who are teaching the med students at those programs. He stated it takes more work to be a good clinician coming from one of those programs than it does coming from an institution that doesn't value research as heavily.

This person held faculty positions at various MD programs/residencies/fellowships for >10 years.

 

[AnatomyGrey12]

I see. I've seen threads on this before for students trying to enter competitive residencies who then do a research year or individuals who are taking the Step over again. Usually the threads indicate that as long as the gap year was productive, it's a positive. But does this data indicate otherwise then....that gap years during the medical school schools are frowned upon?

Research years are beneficial, particularly in the competitive specialties. If you're taking a gap year to retake the boards then you have bigger issues (a board failure). Gap years are a big issue when they aren't really accounted for, when you do them but have nothing to show for the time off. Overall gaps in education are a big red flag (outside of research years).

 

[mcloaf]

In his opinion, the worst MDs were from research heavy programs. He stated that in general, the faculty of the top tier programs are so research focused that many have poor clinical skills. Those are the people who are teaching the med students at those programs. He stated it takes more work to be a good clinician coming from one of those programs than it does coming from an institution that doesn't value research as heavily.

This must be why all the tertiary care centers associated with research faculty send all their sickest patients and biggest cases out to the community.

 

[runningpenguin]

Research years are beneficial, particularly in the competitive specialties. If you're taking a gap year to retake the boards then you have bigger issues (a board failure). Gap years are a big issue when they aren't really accounted for, when you do them but have nothing to show for the time off. Overall gaps in education are a big red flag (outside of research years).

Are there cases where people take time off in medical school but are not productive (e.g. research, etc.)? What are they doing during their time off then?

 

[efle]

Are there cases where people take time off in medical school but are not productive (e.g. research, etc.)? What are they doing during their time off then?

I think they're mostly looking for red flags like you randomly left after a semester and then came back the following year, or like needing to repeat things. Taking 5 years because you want a year of research is very different than taking 5 years because you missed too much and/or had academic difficulties and needed 5 years to get the MD

 

[deleted393595]

I humbly disagree. MIT-SOM > Princton-med

Uhm, nope. You're forgetting the South Harmon Institute of Technology - School of Med.

 

[runningpenguin]

I think they're mostly looking for red flags like you randomly left after a semester and then came back the following year, or like needing to repeat things. Taking 5 years because you want a year of research is very different than taking 5 years because you missed too much and/or had academic difficulties and needed 5 years to get the MD

Makes sense, thanks for clarifying.

 

[bioboy23]

Harvard

Somebody missed the joke

 

[runningpenguin]

in case you haven't seen this before:NRMP program director survey

Also, why are categories such as Interactions with faculty during interview and visit, Interpersonal Skills, and Interactions with house staff during interview and visit rated as so much more important than something like Step?

Does this also apply to medical school interviews where so much emphasis is placed on interview (over MCAT)?
Also, when interviewing for residency, how does someone excel in these categories-- Interactions with faculty, Interpersonal skills, etc.? Are these categories ranked highly because it's important to not offend someone important (which would be the crucial mistake) or that it's important to have a good personality/interviewing skills/"shine"?

 

[efle]

Also, why are categories such as Interactions with faculty during interview and visit, Interpersonal Skills, and Interactions with house staff during interview and visit rated as so much more important than something like Step?

Does this also apply to medical school interviews where so much emphasis is placed on interview (over MCAT)?
Also, when interviewing for residency, how does someone excel in these categories-- Interactions with faculty, Interpersonal skills, etc.? Are these categories ranked highly because it's important to not offend someone important (which would be the crucial mistake) or that it's important to have a good personality/interviewing skills/"shine"?

I think it's analogous, yeah. The big stats screening occurs at the interview stage - this is where having a 518 vs 508 MCAT can govern a lot of your interview invites. Once you're past that and at the decision making stage, the MCAT isn't as important any more because almost all the interviewed people had scores like yours. Now, the big way of separating candidates is what they were like to interview. Stats still play a role, just less so.

Same idea for residency. You step is competitive? Great, so are these other interviewed peoples'. That's not as much of what makes you the most desirable any more.

 

[calivianya]

This must be why all the tertiary care centers associated with research faculty send all their sickest patients and biggest cases out to the community.

I fail to see how the treatment options offered to the patients at a particular facility are related to whether or not the research faculty are teaching the med students at that facility to be competent clinicians.

 

[efle]

in general, the faculty of the top tier programs are so research focused that many have poor clinical skills

I fail to see how the treatment options offered to the patients at a particular facility are related to whether or not the research faculty are teaching the med students at that facility to be competent clinicians.

Goalposts moved a bit in between these posts. The initial idea was that Harvard faculty are themselves not competent enough/have poor skills. That's different than saying Harvard faculty are clinically fantastic and choose not to prioritize med student education.

It's the first one that is clearly at odds with the fact that patients in need of the best, most expert care get sent to major academic centers.

 

[663697]

Goalposts moved a bit in between these posts. The initial idea was that Harvard faculty are themselves not competent enough/have poor skills. That's different than saying Harvard faculty are clinically fantastic and choose not to prioritize med student education.

It's the first one that is clearly at odds with the fact that patients in need of the best, most expert care get sent to major academic centers.

Would pre-clinical education differ much between Harvard-tier schools and mid-tier schools if in fact the top doctors aren't involved in teaching during the pre-clinical years? Also what difference does it make if pre-clinical is largely self-study?

 

[efle]

Would pre-clinical education differ much between Harvard-tier schools and mid-tier schools if in fact the top doctors aren't involved in teaching during the pre-clinical years? Also what difference does it make if pre-clinical is largely self-study?

Pre-clinically I don't think the person giving you a lecture determines much of the quality of your education. It absolutely is mostly self study, and mostly material that is standard to teach across schools.

 

[runningpenguin]

If you were running a residency program, would you rather work everyday alongside someone who is lovely to work with, lukewarm, or completely insufferable?

Yeah, I agree. I just assumed that candidates would have at least decent interpersonal skills. Most of the medical students/residents that I know have at least decent skills. Not everyone is very extroverted, but most everyone is friendly or, at the very least, knows how to act friendly. I don't see things this way because I'm still pre-medical and, at this stage, there is less weight given to interpersonal skills (though still significant). I do work, so I know how important it is to have these skills. Just is hard to accept that interviews (which last 1-2 days?) would be the most crucial factor at that point.

 

[runningpenguin]

I think it's analogous, yeah. The big stats screening occurs at the interview stage - this is where having a 518 vs 508 MCAT can govern a lot of your interview invites. Once you're past that and at the decision making stage, the MCAT isn't as important any more because almost all the interviewed people had scores like yours. Now, the big way of separating candidates is what they were like to interview. Stats still play a role, just less so.

Same idea for residency. You step is competitive? Great, so are these other interviewed peoples'. That's not as much of what makes you the most desirable any more.

I see. What are mistakes that interviewees for residency might make during the interview? Just curious. It seems like so much of getting into medical school and then medical school involves honing interpersonal skills. Wouldn't 4th year medical students who are interviewing for residency be relatively adept at giving an interview by that stage?

 

[efle]

Can't tell you from experience since I'm not a 4th year, but I imagine it's the same kinds of interpersonal skills you use for things like job interviews or admissions interviews.

 

[663697]

Pre-clinically I don't think the person giving you a lecture determines much of the quality of your education. It absolutely is mostly self study, and mostly material that is standard to teach across schools.

How about clinical? I've heard some say that as a med student in a large academic center you'll have less to do because of so many people being above you.

 

[efle]

Also not on the wards yet, so again can't say from experience, but I think the feeling that much of rotations are "glorified shadowing" is not exclusive to major academic centers. You're a clueless newbie student that can't be trusted with doing anything important on your own.

I will say that I think the reputations of big-name schools is mostly a product of the people they matriculate, more than their curriculum working some magic that imbues greatness. Like if a PD likes the fact that an applicant went to Penn, it's probably because they associate certain traits with Penn students, not because their curriculum taught them anatomy better or they got to do more stuff on their surgery rotation.

 

[getdown]

Yeah, I agree. I just assumed that candidates would have at least decent interpersonal skills. Most of the medical students/residents that I know have at least decent skills. Not everyone is very extroverted, but most everyone is friendly or, at the very least, knows how to act friendly. I don't see things this way because I'm still pre-medical and, at this stage, there is less weight given to interpersonal skills (though still significant). I do work, so I know how important it is to have these skills. Just is hard to accept that interviews (which last 1-2 days?) would be the most crucial factor at that point.

You would be surprised some of the stuff that happens in interviews. It's also more obvious when you're looking at these people. It's very easily discernible those that are genuinely interested and those that are just going through the motions of the interview process. You observe them when and how they interact with others.

How about clinical? I've heard some say that as a med student in a large academic center you'll have less to do because of so many people being above you.

Actually, being a med student in "elite" universities is more of a detriment that many of the patient's are "important" people and don't want to be cared for by a medical student. Liability also is playing a large role in how much you can do as a med student. When I was a student I learned to put arterial lines, pulled central lines, intubated and generally was more involved in the care of my patients. At the program I did residency in they don't even let the students put in a foley let alone pull central lines. It's just a shame and especially frightening knowing that the first time my doctor is doing a procedure is when they're an intern already busy and overworked and learning to do it as they go. Medical education is just such a shame these days. No wonder interns come in less and less prepared.

 

[663697]

You would be surprised some of the stuff that happens in interviews. It's also more obvious when you're looking at these people. It's very easily discernible those that are genuinely interested and those that are just going through the motions of the interview process. You observe them when and how they interact with others.



Actually, being a med student in "elite" universities is more of a detriment that many of the patient's are "important" people and don't want to be cared for by a medical student. Liability also is playing a large role in how much you can do as a med student. When I was a student I learned to put arterial lines, pulled central lines, intubated and generally was more involved in the care of my patients. At the program I did residency in they don't even let the students put in a foley let alone pull central lines. It's just a shame and especially frightening knowing that the first time my doctor is doing a procedure is when they're an intern already busy and overworked and learning to do it as they go. Medical education is just such a shame these days. No wonder interns come in less and less prepared.

Wow, was not aware of this. So are all those claims by schools about 'clinical exposure since day 1!!' just a really embellished way of saying you can shadow since day 1? 😛

 

[AnatomyGrey12]

Also, why are categories such as Interactions with faculty during interview and visit, Interpersonal Skills, and Interactions with house staff during interview and visit rated as so much more important than something like Step?

Are these categories ranked highly because it's important to not offend someone important (which would be the crucial mistake) or that it's important to have a good personality/interviewing skills/"shine"?

It's a concept that is difficult for pre-meds to grasp sometimes (not you specifically just pre-meds in general), but residency is not a continuation of school. While academics and training play a large role, residency is a job. Just like any job there will be people who fit in better than others for certain jobs, with certain programs, or with certain people, etc. That's why these metrics are higher than something like Step scores. It doesn't matter if you score a 280 if the attendings and other residents don't feel like they can trust you, or they can't stand the idea of working with you. Remember in residency you basically spend 80+ hours a week with the same people for years, and fit is huge in that scenario.

I just assumed that candidates would have at least decent interpersonal skills

You would be surprised

Wow, was not aware of this. So are all those claims by schools about 'clinical exposure since day 1!!' just a really embellished way of saying you can shadow since day 1? 😛

Pretty much lol. I guess we do have a "clinical skills lab" this first semester where we do get to get out the stethoscopes and are shown how to run through certain parts of the physical exam on SPs. It is fun I'll admit and reminds us what the end goal is when we are studying anatomy for 12 hours straight, but it's P/F and isn't really with the intent to make us competent at anything. Sometimes schools make it sound as if you are scrubbing cases day 1 and handing out prescriptions.

 

[runningpenguin]

It's a concept that is difficult for pre-meds to grasp sometimes (not you specifically just pre-meds in general), but residency is not a continuation of school. While academics and training play a large role, residency is a job. Just like any job there will be people who fit in better than others for certain jobs, with certain programs, or with certain people, etc. That's why these metrics are higher than something like Step scores. It doesn't matter if you score a 280 if the attendings and other residents don't feel like they can trust you, or they can't stand the idea of working with you. Remember in residency you basically spend 80+ hours a week with the same people for years, and fit is huge in that scenario.

.

Could you give an example? I've been working for a while now (in premedical terms I mean, not compared to the attendings on the forum of course). I know that there are certain things that to never do (don't go over your superiors, don't badmouth anyone, don't be too demanding/think (or act) like you are more than your position implies, etc.)...just stuff learned through the experience of working/watching. Then there are things to do to show that I'm competent/trustworthy. Is this part of what this is getting at? If it is, I would have thought a MS4 who has been on the wards with patients for over a year and is essentially working in a team that is highly hierarchical with constant feedback/evaluations would know or have picked these things up.

Or is there something else? Is it about having this amazing personality that is outgoing, great with superiors/patients, being "that" person?

Thanks!

 

[runningpenguin]

You would be surprised some of the stuff that happens in interviews. It's also more obvious when you're looking at these people. It's very easily discernible those that are genuinely interested and those that are just going through the motions of the interview process. You observe them when and how they interact with others.



Actually, being a med student in "elite" universities is more of a detriment that many of the patient's are "important" people and don't want to be cared for by a medical student. Liability also is playing a large role in how much you can do as a med student. When I was a student I learned to put arterial lines, pulled central lines, intubated and generally was more involved in the care of my patients. At the program I did residency in they don't even let the students put in a foley let alone pull central lines. It's just a shame and especially frightening knowing that the first time my doctor is doing a procedure is when they're an intern already busy and overworked and learning to do it as they go. Medical education is just such a shame these days. No wonder interns come in less and less prepared.

Could you also give an example? I posted above as well. Thanks!

 

[getdown]

Could you also give an example? I posted above as well. Thanks!

The most obvious red flags are being disinterested in the program, not engaging and keeping to yourself/looking at your phone the entire time, being rude to residents or staff. Other things we look at is just overall demeanor and if you are super awkward. I understand some people are introverted, shy, not comfortable in big groups but some people are just plain awkward. There are a lot of very smart kids who just really come off weird. It can be unfair in that you have those few hours to really make an impression on the people you're interviewing with. A lot of it is very basic things: be respectful to EVERYONE, punctual, show interest, ask good/well thought out questions, mind your manners. I mean a lot of times just being a decent human being prepares you for these interactions but if you're generally an ass then I wouldn't be surprised if it comes out at one point or another.

To address what AnatomyGrey had mentioned. He/She is talking about how you are perceived as a resident when you've actually been accepted into the program. It's quite hard to tell if someone is trustworthy or reliable from just meeting them once though not impossible. However, you can get a general feeling on how someone is. People who are down to earth, easily approachable, genuine tend to be much easier to work with than someone who is very strongly opinionated, easily offended, takes criticism/direction poorly. Like AnatomyGrey said, no one wants to work with someone who is like the latter.

 

[AnatomyGrey12]

I know that there are certain things that to never do (don't go over your superiors, don't badmouth anyone, don't be too demanding/think (or act) like you are more than your position implies, etc.)...just stuff learned through the experience of working/watching.

Is this part of what this is getting at?

Pretty much yeah.

I would have thought a MS4 who has been on the wards with patients for over a year and is essentially working in a team that is highly hierarchical with constant feedback/evaluations would know or have picked these things up.

Again, you would be surprised. Just being a normal person that is easy to get along with goes a long way.

 

[runningpenguin]

The most obvious red flags are being disinterested in the program, not engaging and keeping to yourself/looking at your phone the entire time, being rude to residents or staff.

Pretty much yeah.

Makes sense, thanks!

 

[Planes2Doc]

The one they talk about on ValueMD that allows you to come straight in without needing an MCAT score.

 

[Anti-PD1]

Medical schools don't make doctors, medical students do. Don't believe otherwise.

And among medical students, the best doctors are usually the ones that read more.

 

[mcloaf]

I fail to see how the treatment options offered to the patients at a particular facility are related to whether or not the research faculty are teaching the med students at that facility to be competent clinicians.

I think your impression of what happens at large research schools and of clinical education in general is inaccurate. It's not as if most med students are receiving their clinical education from bench research MDs who rarely see patients. Academic medical centers are full of practicing clinicians, only some of whom spend significant amounts of time doing research. I go to a large research school (not HMS) and while I received plenty of preclinical lectures from research focused faculty, across the entirety of M3 and M4 I had only a single attending who I felt was too research focused to be an effective clinical instructor (and he was only on to cover the weekend for somebody else who had a family emergency). The impression that I received a good clinical education from these academic faculty has been confirmed both by Step 2 and away rotations.

I'm also not sure that beyond a minimum threshold the clinical education of a medical student is much impacted by attending quality, though quality would be difficult to measure. As an M3 you're learning the very basics of patient care; assuming your attendings know how to take care of common problems appropriately and are reasonably effective teachers I'm not sure you'd notice much of a difference. An M3 on a surgery rotations isn't going to benefit much in the long run from seeing the difference between a high volume technically gifted surgeon doing a hernia repair and somebody less skilled but still adequate. The nuances of being an excellent clinician are learned as a resident, not as an M3 when you're learning how to not kill people.

All of this is a bit beside the original point, which was that I disagree with the idea that MDs from research heavy places are systematically lower performing than those from non-research places. All medical schools graduate good and bad doctors. The only difference is that when we hear about a crappy clinician coming from HMS or Hopkins we feel a twinge of satisfaction and spite, whereas if we hear about a crappy doctor from some random place nobody thinks twice about it. There are probably some high tier schools that produce less well prepared interns due to coddling or whatever, but I'm sure there are just as many low tier schools that do as well.

And yes, you can get treatment options at big research centers that you couldn't find elsewhere. If you need an investigative cancer therapy or some wild tumor resection you probably aren't going to get it at your local community hospital.

Actually, being a med student in "elite" universities is more of a detriment that many of the patient's are "important" people and don't want to be cared for by a medical student. Liability also is playing a large role in how much you can do as a med student. When I was a student I learned to put arterial lines, pulled central lines, intubated and generally was more involved in the care of my patients. At the program I did residency in they don't even let the students put in a foley let alone pull central lines. It's just a shame and especially frightening knowing that the first time my doctor is doing a procedure is when they're an intern already busy and overworked and learning to do it as they go. Medical education is just such a shame these days. No wonder interns come in less and less prepared.

I think to some degree this affects all medical schools, not just elite ones. Maybe Hopkins or Stanford have some rich patients that the students can't touch, but I don't think that's the norm at most places regardless of tier--the only "no students" patients I had were on OB. The most useful rotation I had as an M3 was my VA internal med rotation because we actually got to write the notes in CPRS and take ownership of the patients. Recently we were informed that due to national VA policy med students are no longer allowed to be writing the notes there, so the students going through in coming years won't get that experience. The whole thing is dumb and negatively affects all of us. I'm going to be graduating from somewhere known for strong clinical education and I've never intubated or placed an art line (still have a few months so we'll see I guess). I've pulled one central line, though I have placed my fair share of foleys. Part of why I didn't get to do more is that the interns and PGY2's needed the practice since they didn't get to do it as students either. The terrifying thing is knowing that I'm expected to be comfortable doing this stuff next year when I'm an intern even though I was never able to practice it as a student.

 

[PreMedMissteps]

Medical schools don't make doctors, medical students do. Don't believe otherwise.

True. The interview process helps uncover the nutjobs. Of the 100 or so that matriculate at each med school, it's really dependent upon the individuals as to how good they are as physicians. Good meaning how competant and how personable they are.