Why don't more schools adopt a P/F Clinical?

[CommyØ]

I was reading efle's thread on the variability of clinical grades (H/HP/P/F) and was wondering why more schools don't adopt a P/F clinical system? I am just a mere applicant, but wouldn't it be better to make P/F the subjective parts of medical school, like preceptor evaluations? Perhaps make the evaluations themselves P/F, and then leave shelf exams to discern whether you get H/HP/P/F?

This is based on the premise that clerkship evaluations don't accurately or consistently assess clinical knowledge due to infinite attending biases -- which seems to be the sentiment on here and r/medicalschool. I honestly feel like I would rather have a graded preclinical than clinical period for medical school after reading some of these posts.

 

[Kracin]

What makes a good doctor? Good shelf scores and "clinical knowledge"? Good people skills and preceptor evaluations? A mix?

Medical education is stuck where we have tons of papers are coming out saying things like ______ doesn't predict ______ (for ex. step 1 doesn't predict intern competency). Likely, it's a blend of the knowledge, interpersonal skills, and at times luck that make you a good doctor. Educators weighing both evals as well as the shelf is an attempt to reflect this, albeit very poorly at times.

Re: why don't schools make P/F clinics more specifically: They're not strong enough to. You want your students to match well. If you don't have an inbuilt strong reputation, how are you going to distinguish your top students from the rest? Step exams are going P/F. Preclinical grades are a poor objective measure given the variability in how questions are written as well as what grades are given per school. Clinical grades have historically been weighed stronger.

My own personal guess is medical education will trend towards everything P/F followed by "auditions" at programs akin to what we see in emergency medicine with their standardized letters of evaluation.

 

[Lawpy]

Med school needs to be more like residency. Get rid of liability rules that treat med students like a burden, and the grades and letters will be a lot more valuable.

 

[AnonymousDoctorGuyPerson]

Whether one method or not is better - you'd be shooting in the foot people from lower-tier med schools gunning for competitive residencies or locations by removing another form of stratification.

 

[Goro]

Med school needs to be more like residency. Get rid of liability rules that treat med students like a burden, and the grades and letters will be a lot more valuable.

Tell that to the HMOs

 

[FalconSlice]

Whether one method or not is better - you'd be shooting in the foot people from lower-tier med schools gunning for competitive residencies or locations by removing another form of stratification.

Correct. There are "top schools" that can get away with this since "the name" can carry the applicants. But, there are high-performers and low-performers and they need to be identified as such (by whatever mechanism however arbitrary schools and residencies choose). Everyone can't get gold stars.

Especially with Step 1 turning P/F soon, it's getting closer and closer to everyone "getting a trophy for participation"

 

[Lawpy]

Reduce preclinical to 1 year everywhere. 3 years of clerkships have far more value

 

[AnonymousDoctorGuyPerson]

Reduce preclinical to 1 year everywhere. 3 years of clerkships have far more value

I'd love that, but for those struggling with the pace of 1.5-2year preclinical how would you justify it? Would you scrap some stuff, or have the second year clerkships be lighter in the beginning to allow the continuation of coursework?

Overall, I do wish more schools had clerkshipesque experiences during preclinical years.

 

[Lawpy]

I'd love that, but for those struggling with the pace of 1.5-2year preclinical how would you justify it? Would you scrap some stuff, or have the second year clerkships be lighter in the beginning to allow the continuation of coursework?

Step 1 is P/F. That itself is a strong justification. Anki + B&B + Pathoma + UWorld still works and is plenty. A lot of preclinicals is about self learning anyways.

I agree a lighter start to 2nd year clerkships would help. The focus should be very heavily on clerkships and Step 2, not on preclinical stuff. Things begin to click and make a lot more sense on wards.

A 1.5 yr preclinical is a good compromise.