why are class lecture notes more detailed than usmle books

[blazers]

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since the main goal of the preclinical courses is to pass step 1, why are the in class lecture notes way more detailed than what we need to know for step 1?

why cant profs just follow the kaplan lecture notes, brs, rapid review, or any of the famous reputed books? actually why are there even lecture notes. just make those books assigned reading, and test us from the books

I think thats most efficient, as that guarantees both the prof and student that the material needed to know has been mastered.

what do you all think about this?

 

[armybound]

the other sources don't have all information tested on step 1
it's good to have a good background so you understand concepts instead of just facts
it makes information easier to lecture over when there are more details
what's the point of having a professor if you can just read from a review book

I thought my class lectures and syllabi were very effective preparation for Step. If I had just read Rapid Review pathology I don't think I would have learned much,

 

[blazers]

the other sources don't have all information tested on step 1
it's good to have a good background so you understand concepts instead of just facts
it makes information easier to lecture over when there are more details
what's the point of having a professor if you can just read from a review book

I thought my class lectures and syllabi were very effective preparation for Step. If I had just read Rapid Review pathology I don't think I would have learned much,

I agree but I find that the review books for me actually are written in a way such that they are a source of learning concepts. I find them great and can easily replace class lecture notes.

but sadly thats not the case, and not going through the lecture notes and going in with just the knowledge of a review book, may not be wise as the lecture notes are way more detailed 😎. kinda frustrating for me

 

[Kevin Baker]

I'm not sure about most students, but speaking for myself, First Aid is gibberish until I've had some sort of explanation. I can memorize the 1st order facts in FA fine, but once we get to second or third order questions, I can't make the connection. Lecture gives me some sort of big picture view and lets me link all of those FA facts into the big picture.

And while lecture has some stuff not related to FA/Step 1, the vast majority of my school's curriculum is at least somewhat related. I tend to just ignore the non step 1 stuff unless it is a big part of the test. Though I'm also not trying to honor my core classes, so take that as you will.

edit: I do learn well from books that explain processes. Things like BRS and USMLE Road Map have been helpful but generally miss some stuff in FA.

 

[Dirt]

since the main goal of the preclinical courses is to pass step 1

This statement is just plain wrong.

For more info check out this thread

http://forums.studentdoctor.net/showthread.php?t=886538

 

[medigull]

since the main goal of the preclinical courses is to pass step 1,

Most med schools have been here since before you and I were born. Those were certainly were here before Step 1 was even invented. They will also be there long after Step 1 is gone. Those schools knew back then what they needed to teach the students to be equipped to be a good physician in their area. They still do. There may be a professor every now and then a little over enthusiastic about their research but if you go to a reputable long standing school it is either A relevant to practice or B they know about that professor and they make up for missed info in a different place. The preclinical years are there for the school to prepare you to enter the wards in your area in third year. Not to get ready for a test.

 

[blazers]

Most med schools have been here since before you and I were born. Those were certainly were here before Step 1 was even invented. They will also be there long after Step 1 is gone. Those schools knew back then what they needed to teach the students to be equipped to be a good physician in their area. They still do. There may be a professor every now and then a little over enthusiastic about their research but if you go to a reputable long standing school it is either A relevant to practice or B they know about that professor and they make up for missed info in a different place. The preclinical years are there for the school to prepare you to enter the wards in your area in third year. Not to get ready for a test.

i thought that the knowledge needed on step 1 is more than enough to be prepared for the wards. so why not teach to the boards?

I think in that regard the carrib schools are good in that sense. The problem is sometimes the students they accept which don't have the motivation or drive to get through the material, but the curriculum itself sounds good. I hear there is one carrib school that uses BRS books as their required reading for their preclinical years except for path in which they use baby robbins. that sounds like an excellent way of teaching for the boards imo.

 

[blazers]

I think knowing kaplan medessentials from cover to back should be more than sufficient knowledge to start on the wards.

 

[mauberley]

since the main goal of the preclinical courses is to pass step 1, why are the in class lecture notes way more detailed than what we need to know for step 1?

why cant profs just follow the kaplan lecture notes, brs, rapid review, or any of the famous reputed books? actually why are there even lecture notes. just make those books assigned reading, and test us from the books

I think thats most efficient, as that guarantees both the prof and student that the material needed to know has been mastered.

what do you all think about this?

I feel that anyone on the wrong side of Step 1 is ill-equipped to comment, which includes me. But in a general sense, I disagree with the premise that the point of pre-clinical courses is to pass Step 1, just as I would disagree with an assertion that the point of high school is to ace the SAT/ACT, or that the point of the pre-med curriculum is to ace the MCAT. Standardized tests necessarily cannot test on everything but what would be considered most important. Does the inability to test on a given topic mean that the topic is not worth the time to study? I would say no.

 

[ArcGurren]

i thought that the knowledge needed on step 1 is more than enough to be prepared for the wards. so why not teach to the boards?

I think in that regard the carrib schools are good in that sense. The problem is sometimes the students they accept which don't have the motivation or drive to get through the material, but the curriculum itself sounds good. I hear there is one carrib school that uses BRS books as their required reading for their preclinical years except for path in which they use baby robbins. that sounds like an excellent way of teaching for the boards imo.

Yes, because caribbean schools are clearly the model of excellence... 🙄

I don't know where this preclinical horsecrap notion of teaching for the boards comes from. Medical schools are not there to teach to the Step 1 any more than colleges exist to teach to the MCAT or GMAT or GRE. For that matter, high school certainly isn't there to teach to the SAT. So how do people get these wrongheaded ideas?

Yes, your teacher is going to teach you a little extra something he picked up on the wards. Yes, he's going to talk about an extra drug which may or may not - and likely may not - come up on your Step 1. That surgeon who knows a ton of clinical anatomy is most definitely going to teach that extra bit of clinical knowledge regarding the acute abdomen, whether or not it is covered on your step 1. So what?

Come third year, when you reach back into that base of knowledge, you are going to be thankful that they at least talked about this once.

 

[ArcGurren]

I think knowing kaplan medessentials from cover to back should be more than sufficient knowledge to start on the wards.

I don't know if you're a third year yet or not, but that's utter and complete nonsense.

 

[sjdsn135]

I think you go through medical school to understand in as much detail as possible the processes of disease and treatment. That's what makes you a doctor of the field. It's true that you probably won't need a good percentage of the theoretical knowledge you gain in the pre-clinical years, but having at least talked about all the basic science theories makes you a more credible educator and adviser and I think makes you more satisfied intellectually. Also, paradoxically the more detail you learn about a subject the more likely you are to remember the highest yield parts of it.

 

[sylvanthus]

The first two years of medical school are absolutely not just to pass step 1. Step 1 is a minimum competency exam, it is not the end all and be all that people make it out to be. People should really focus on learning as much as possible during the first 2 years, and THEN review for step 1.

Seems like many people are losing focus and just concentrating on step 1 and forgoing other information that they do not think will be on the exam. See all the posts about people, 1st year even!, focusing on step 1 and ignoring what they consider to be "unneeded details." That just seems to be a bad idea imo.

 

[Valadi]

I think knowing kaplan medessentials from cover to back should be more than sufficient knowledge to start on the wards.

This is like when premeds post about what they think med school should be like.

There's a big difference between the concepts/facts stated in the review book, and giving an accompanying explanation - which is where Harrison's, Robbins, or your class lectures come in.

 

[TAWS]

I think LCME accreditation requires them to cover certain subjects even if they aren't on Step1. Gross anatomy dissections anyone?

 

[link2swim06]

I think LCME accreditation requires them to cover certain subjects even if they aren't on Step1. Gross anatomy dissections anyone?

Gross dissections are not an LCME requirement. Some schools have all plastinated models/prosections and students dont actually do any dissection.

Just sayin...

 

[scarshapedstar]

Because you're supposed to learn first and review later, I guess.

 

[swamprat]

I'm rlly going with the notion u learn things in excruciating detail so for step1 ull remmeber the high yield facts about it. There is a lot of bs in my lecture notes as well.. things that won't even be tested on our exams let alone step1.. like tx regiments for infections and what to do if resistant and if ur coinfected with this or that. they always go over it then say dont worry about it.. 😕 ok.. why tell us then lol

 

[armybound]

I'm rlly going with the notion u learn things in excruciating detail so for step1 ull remmeber the high yield facts about it. There is a lot of bs in my lecture notes as well.. things that won't even be tested on our exams let alone step1.. like tx regiments for infections and what to do if resistant and if ur coinfected with this or that. they always go over it then say dont worry about it.. 😕 ok.. why tell us then lol

you don't think that information will be on Step 1, or that it isn't essential information for your success as a physician?

 

[scarshapedstar]

you don't think that information will be on Step 1, or that it isn't essential information for your success as a physician?

 

[OveractiveBrain]

since the main goal of the preclinical courses is to pass step 1, why are the in class lecture notes way more detailed than what we need to know for step 1?

The main goal of the prelinical courses is to prepare you with a fundamental knowledge of disease. To learn the pathogenesis, pattern, and prevelance of disease. To walk in understanding physiology and what goes wrong so that you can understand intervention. Understanding is what separates a physician from every other mid level practitioner that just does because they are supposed to.

i thought that the knowledge needed on step 1 is more than enough to be prepared for the wards. so why not teach to the boards?

I think in that regard the carrib schools are good in that sense. The problem is sometimes the students they accept which don't have the motivation or drive to get through the material, but the curriculum itself sounds good. I hear there is one carrib school that uses BRS books as their required reading for their preclinical years except for path in which they use baby robbins. that sounds like an excellent way of teaching for the boards imo.

You have to decide what your vision of a physician is, what is the purpose to their education, what is their purpose to patient care. This is not just you, or me, its the nation.

Consider if the vision is simlpy to deliver patient care. We develop tools to do this well. we make premade order sheets, checklists. In this case, strict memorization without understanding makes sense. In fact, it not only makes sense, but it might actually be BETTER than thinking physicians. But what do you give up? You give up free thinking, deep understanding. What the means practically, is that you try to fit things into boxes, even if they don't fit. "CHF Admit orders" for the guy with Shortness of Breath, even though he doesn't fit perfectly with CHF, and you miss the pneumonia.

In fact, this is what mid level providers do. Its why they work so well in clinics. Its also why they do so poorly on nebulous tasks like "admit this patient, his complaint is chest pain." The point is, if all you do is memorize, that is "study for the boards," then you become a mid level provider, nothing more than an NP. Some people may be happy with that. After all, some NPs provide better care than MDs.

But if your vision of the physician is to lead the medical team, this vision I share, than it is not about the 80% of cases that fit into the box, its the 20%. You do extra work so you don't miss anything. You work harder and learn more so you can be better. The reason why you are better is because you can reason, you know how and why things happen, not just what.

This is why basic science curricula are more in depth than they need to be. Do some people do too much? Of course. Do you need to learn every detail you get taught? No. It is not about memorizing every little detail. Its not about memorizing for jeopardy at conference, its about fundamental understanding of the material.

What some students do is simply memorize everything, then forget it all after the test is over. The "diarrhea" method of learning. These are the students who are frustrated by Step 1, frustrated by the volume, and usually end up saying "why do I have to learn this?" or "you don't need that after step 1."

I'm rlly going with the notion u learn things in excruciating detail so for step1 ull remmeber the high yield facts about it. There is a lot of bs in my lecture notes as well.. things that won't even be tested on our exams let alone step1.. like tx regiments for...

I agree with Doxy, even if his english pains my eyes to read.

What some students do is learn the details, making what you actually need to know stick better. What do I mean? I mean that in order to learn the small details, in order to fit them into compartments, in order to get the nuance question right, there has been a fundamental involvement of the core concepts until you it is part of you.

Let me give an example: In paramedic school, I confused "renal" and "hepatic." The words. Think about how absurd that confusion is. Hepatic artery goes where? Hepatocytes are where? Hepatocellular Carcinoma is whcih organ? DUH! But when I wasn't a doctor, that trivial detail was actually HARD. Well, not hard, just it wasn't part of my soul, the way hepatic is now part of me; it will never be lost. But why? Because I dealt with all the details. the same thing happens in basic science; not everything sticks, but in trying, important things stick.

You can't possibly manage someone with heart failure if you don't understand cardiac physiology. Sure, beta block and ace-inhibitor for the guy with Grade I dysfunction with an EF of 45%. ANYBODY can do that. What about the CHF exacerbation? Preload, Afterload, Contractility, Starling Forces. These matter in choosing which intervention to take. You do that by actually learning the knowledge you needed to.

Bottom Line: review courses help you perform well on the step 1. Performing well on Step 1 helps you get into residency, not being a good physician.

 

[Doctopus]

The reason you study off disorganized, professor-specific, sometimes-out-of-date, poorly reinforced lecture notes rather than fluently written, coherent, reinforced, reputable sources like FA/BRS is because you are a medical student who has no power over the content of your education and professors like to think they have special knowledge that only they can impart on you + institutional inertia.

*Of course* we should use systematized study material. The SDN members suggesting that such resources are not sufficient are simply parroting the status quo: after all, schools could also use Big Robbins or Gunner Training or some other *standardized* source if they truly felt that the more streamlined BRS/FA/etc were too spare. Studying off messed up powerpoints/lecture notes is a step backward from studying from textbooks. Period.

(Moreover, outside the rarefied air of SDN, most students do not even learn half of FA, let alone all the scattered material their professors present. The goal of having every med student learning all of FA being a "minimum competency standard" is one that is rarely met.)

Here's what I do: study off the standardized materials. A couple days out from the test I skim over the lecture notes. I know I will miss some professor-specific ?s come test time, but it's enough to very comfortably pass. And I know that because I am using mutually reinforcing sources that emphasize concepts and high-yield facts I will retain far more useful material than my classmates memorizing professor ppt minutiae. I will be better at Step1, better when pimped on the wards (don't forget that your attendings pimping you will have their own biases as to what you need to know, different than your preclinical profs), and better as a clinician.

 

[Rendar5]

you don't think that information will be on Step 1, or that it isn't essential information for your success as a physician?

won't be on step 1, but it is essential to your success.

 

[Nasrudin]

The reason you study off disorganized, professor-specific, sometimes-out-of-date, poorly reinforced lecture notes rather than fluently written, coherent, reinforced, reputable sources like FA/BRS is because you are a medical student who has no power over the content of your education and professors like to think they have special knowledge that only they can impart on you + institutional inertia.

*Of course* we should use systematized study material. The SDN members suggesting that such resources are not sufficient are simply parroting the status quo: after all, schools could also use Big Robbins or Gunner Training or some other *standardized* source if they truly felt that the more streamlined BRS/FA/etc were too spare. Studying off messed up powerpoints/lecture notes is a step backward from studying from textbooks. Period.

(Moreover, outside the rarefied air of SDN, most students do not even learn half of FA, let alone all the scattered material their professors present. The goal of having every med student learning all of FA being a "minimum competency standard" is one that is rarely met.)

Here's what I do: study off the standardized materials. A couple days out from the test I skim over the lecture notes. I know I will miss some professor-specific ?s come test time, but it's enough to very comfortably pass. And I know that because I am using mutually reinforcing sources that emphasize concepts and high-yield facts I will retain far more useful material than my classmates memorizing professor ppt minutiae. I will be better at Step1, better when pimped on the wards (don't forget that your attendings pimping you will have their own biases as to what you need to know, different than your preclinical profs), and better as a clinician.

This is my point of view as well.

The high minded theory of learning everything is not wrong in theory--but it neglects that we are already pushing up against the human ability to retain information in a usable form and that being a physician means life-long learning. Such that the layering of what is most important to each stage seems most prudent.

If you've got virginal monk-like dedication to medicine then go ahead and break a leg. But to me worrying about the details of aged professors is like going to mow the lawn but putting on scuba gear first and calling it performance art to impress.

I'll just mow the lawn myself. We've got a lifetime of doing it ahead of us. No use getting all romantic and revolutionary about it.

 

[armybound]

won't be on step 1, but it is essential to your success.

I'm pretty sure I had very similar questions to those on Step 1. Resistant organisms, patients with allergies, etc requiring that you know alternative/second line therapies.

 

[yohimshe]

The reason you study off disorganized, professor-specific, sometimes-out-of-date, poorly reinforced lecture notes rather than fluently written, coherent, reinforced, reputable sources like FA/BRS is because you are a medical student who has no power over the content of your education and professors like to think they have special knowledge that only they can impart on you + institutional inertia.

*Of course* we should use systematized study material. The SDN members suggesting that such resources are not sufficient are simply parroting the status quo: after all, schools could also use Big Robbins or Gunner Training or some other *standardized* source if they truly felt that the more streamlined BRS/FA/etc were too spare. Studying off messed up powerpoints/lecture notes is a step backward from studying from textbooks. Period.

(Moreover, outside the rarefied air of SDN, most students do not even learn half of FA, let alone all the scattered material their professors present. The goal of having every med student learning all of FA being a "minimum competency standard" is one that is rarely met.)

Here's what I do: study off the standardized materials. A couple days out from the test I skim over the lecture notes. I know I will miss some professor-specific ?s come test time, but it's enough to very comfortably pass. And I know that because I am using mutually reinforcing sources that emphasize concepts and high-yield facts I will retain far more useful material than my classmates memorizing professor ppt minutiae. I will be better at Step1, better when pimped on the wards (don't forget that your attendings pimping you will have their own biases as to what you need to know, different than your preclinical profs), and better as a clinician.

+1, agreed.

 

[scarshapedstar]

Question.

I'm an MS0 with a copy of Harrison's. No, I'm not trying to read it cover-to-cover, but it's great for understanding some pretty important diseases. Most people tell me it's over my head. Some parts are, other parts just require me to look up vocabulary. The sheer density is definitely intimidating.

Anyway, I read a lot about "drinking from the firehose" and the gist of this thread seems to be that most of the firehose is unnecessary to begin with.

So I'm wondering - does Harrison's represent peak flow? Or is it closer to the essentials? I'm hoping it's the former. I'm also hoping this question makes sense. 😀

 

[Doctopus]

Harrison's would represent sticking a firehose in every orifice you have simultaneously. It's a text for internal medicine residents, ie, people who have already understood and systematized the vast amount of knowledge learned during the preclinical and clinical years of medical school and are now building on that knowledge in the most intellectual/fact-heavy subset of medicine.

It's not that you can't read it, or learn useful things from it--especially if you look things up as you are doing. It's that it's not a particularly valuable use of your time. You will retain very little as you won't have an existing framework to slot in all the details, nor will you know which details are more important.

That said, people who tell you you can't possibly learn medicine until you begin medical school are IMO incorrect. The more correct argument is that you won't know exactly the way you'll be tested/what is expected of you/how to study toward those ends until beginning med school/taking a few tests. For instance, you will find that med school likes to test you on discrete, esoteric facts whereas your college professors like to test you more conceptually (very broadly speaking). There's also the part where you won't ever have the freedom you have now upon entering medicine, so you really should consider a trip to the Bahamas or at least a job at the surfshop, but I digress. So, for these reasons, I honestly wouldn't really recommend studying at this point, but if you truly insist...

Assuming you're starting med school next schoolyear, the best use of your time in terms of excelling in med school, IMO, would be to work on translating your existing relevant knowledge into medical school-type knowledge. So if you've studied biochem and genetics already, pick up Board Review Series or High-Yield Biochem and read through it/do the questions/etc. Or you might pick up a Kaplan Qbank and selectively do the biochem/genetics questions, which also have nice explanations if you get them wrong. In that manner you'll have a good "head start" upon starting med school.

It looks like you hunger for what we call the 'pathology' side of medicine though, the part that is not basic science based but is focused on diseases and such. At my school, we started studying path in the second semester of first year, so it's not completely a waste of time to start studying path, but in some schools, it comes during year two, which means you really shouldn't hit it just yet despite your eagerness to get into the medicine-y type of stuff. Anyway, for path, I'd recommend Pathoma for the most simplified but still very useful distillations of the fundamental concepts of Path. If you have time after that you can hit the more detailed stuff like (in order of detailed-ness) Pathoma Textbook-->BRS Path-->Goljan Rapid Review Path-->Robbins Pathology-->Harrison's--after med school. You could also plug away at the path portion of a qbank as I suggested in biochem.

Or perhaps try to come across a copy of Goljan audio and check that out for some sense of what you'll be up against come med school, but presented in a relatively entertaining and conceptual manner.

 

[Valadi]

Harrison's would represent sticking a firehose in every orifice you have simultaneously. It's a text for internal medicine residents, ie, people who have already understood and systematized the vast amount of knowledge learned during the preclinical and clinical years of medical school and are now building on that knowledge in the most intellectual/fact-heavy subset of medicine.

What did medical students read before all the review books?

Don't know how it is where you are, but we still had assigned reading in Cecil's/Harrison's/Robbins (not that most people did it. we usually opted for a review text).

In my opinion you're never going to have as much time as you do during your M1-2 years to crush these giant books. Or at least go through the important chapters.

 

[Rendar5]

I'm pretty sure I had very similar questions to those on Step 1. Resistant organisms, patients with allergies, etc requiring that you know alternative/second line therapies.

basics sure, detailed treatment regimes, not as much.

 

[scarshapedstar]

Thanks for the input! I found the Goljan lectures (as well as the slides and notes, neat!) and not only are they great to listen to while exercising but I can answer many of the questions he asks. I'm glad I work out late at night because people would surely wonder why I'm shouting out "BPG? YES!!!"

Yeah, this is definitely my kind of pre-studying material. I see what you mean about the importance of the school schedule, though. Pathology won't be until my second year. Gotta crawl before you can run. 😳

I've got some plans for gross anatomy and the basic sciences, though. Between Anki and some software of my own I think I'll have a system that I can readily adapt to whatever it is I actually need to learn.

 

[FIREitUP]

This thread seems to have degenerated into "study for step 1 or study to be a good dr.", which I feel are not necessarily mutually exclusive. I personally try not to put too much faith in my teachers (PhD's at this point) to teach me to be a good physician; I feel that it is up to the student to seek out the best resources out there to supplement his/her knowledge in order to know the material conceptually first, and then to fill that in with specific details. I think the OP might be alluding to the fact that many PhD's oftentimes go on tangents that are peripherally and or not related at all the subject matter, which can be quite frustrating at times. I find that there is a great deal of utility in utilizing sources that many use for Step 1 prep (I wouldn't necessarily consider first aid to be a source, since it is more of an outline than anything) such as solid review books (Costanzo physio, Lippincott's Illustrated Review, Rapid Review Path, Pathoma, etc.) since these books focus on high yield information and tailor towards teaching concepts first, which I feel is something lacking in the pedagogy of my teachers. My point is, you must learn how to both rely on outside resources as well as your teachers in order to learn and memorize effectively. Just my .02.