Will med schools move to a model where you can skip the basic sciences?

[tiedyeddog]

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Wouldn't the amount of studying done during residency also depend on the type of residency? Which residents have a notorious bulk of studying to do?

Path, derm, and Radonc have a ton. The Radonc residents have to be quote clinical trials regarding regimens and patient classifications. I was really impressed at the amount of reading they have to do.

 

[Law2Doc]

Wouldn't the amount of studying done during residency also depend on the type of residency? Which residents have a notorious bulk of studying to do?

Absolutely it depends on the type of residency, how close you are to board exams, whether inservice exams/absites "count" etc. But all residents are going to do some amount of reading, and even then most will feel like they should probably do more. Not a huge difference than med school, except the stakes are much higher because (a) you are actually applying whatever knowledge you have/don't have, (b) you and your work product are being evaluated by attendings a lot more than the med students who pass through for two weeks and are only seen by attendings a few minutes each day, and (c) board exams have far more career significance than any shelf exam.

 

[Law2Doc]

Nobody is evaluating you at morning report or grand rounds, at least not anywhere I've been...

then you haven't really been around enough, or you only have a vague sense of how residents are evaluated. In med school you just float in for a month, never really glean how things are run. Residents are under the gun for much longer, every attending is evaluating you, you get evaluations every month from multiple people -- attendings, nurses, staff, and you have to meet with your PD a couple of times a year to discuss all of those evaluations and your progress or lack thereof, per the ACGME. You are habitually unprepared in rounds, it gets mentioned. Your knowledge base us lacking, it gets mentioned. Educating yourself isn't voluntary, it's part of your job, and you will get evaluated. Nobody is winging it except on the days they were up all night doing patient care. If it seemed like that to you, it seemed like that to attendings too and the resident will hear about it. The expectations for residents are lot higher than for med students. And you won't know more than the med students just by having been around longer, you learn precisely because you are putting in the time reading.

 

[username456789]

Come on, don't even try to pretend that residents spend most days off studying. Yes, you'll need to study for Step 3 or licensing exams at some point but you aren't going home every night to study because you aren't taking a test every 4-12 weeks that determines your grade for that time period.

Every resident I've been on service with told me being a medical student sucks and they would way rather be a resident than be back as a student.

Depends on the specialty. I'm in Derm, and literally spend every day (with occasional exceptions) studying like crazy. The volume of information is absurd for some specialties, and for things like Derm, Path, and Radiology, 99% of it is brand new information.

Now if you're in IM, that's a different story. But one of the reasons Derm residency hospital/clinic hours are so 'reasonable' compared with other fields is that the amount and pace of the outside reading requires is crazy.

 

[Law2Doc]

Path, derm, and Radonc have a ton. The Radonc residents have to be quote clinical trials regarding regimens and patient classifications. I was really impressed at the amount of reading they have to do.

I wouldn't put any of these in the top three in terms of reading. which just goes to show that you are likely going to be doing a lot of reading in residency. It's also as much program dependent as specialty dependent -- for example at a program that will throw you out of the program for low inservice exam scores, you are going to be studying a lot harder than at a program where they are not job determinative.

In some fields the board exam is a big test that covers more material than anything you will have taken in med school, not something you can cram for at the end of residency. In some places you will be doing a lot of presentations at grand rounds, journal club, med student lectures, M&M, etc that will involve a lot of reading on subjects you will be discussing -- these presentations can be on a pretty regular basis. And it always looks bad to the attendings, who evaluate you, if med students know things a resident doesn't on rounds, so residents are wise to read up on topics daily. The residents aren't remembering those things from med school -- they have refreshed those memories the night before.

 

[username456789]

I wouldn't put any of these in the top three in terms of reading.

You should.

 

[Law2Doc]

You should.

I'm not disagreeing that those fields read a ton. I'm just saying they aren't the only ones and I'd probably list a few others ahead of them, based on knowing multiple residents in all of these. Let's not get into a pissing contest as to who works harder. Let's just agree that anyone suggesting that residents aren't reading/studying pretty significantly in their "free time" doesn't have a clue.

 

[username456789]

I'm not disagreeing that those fields read a ton. I'm just saying they aren't the only ones and I'd probably list a few others ahead of them, based on knowing multiple residents in all of these. Let's not get into a pissing contest as to who works harder. Let's just agree that anyone suggesting that residents aren't reading doesn't/studying pretty significantly in their "free time" doesn't have a clue.

Yeah, even my friends in IM are reading a lot on top of their crappy hours (same goes for surgery, but I would suggest that, despite the vast amount of material needed to know for IM, it is the specialty a medical student is best prepared for, fund-of-knowledge-wise, right out of med school).

And to the person who says 'no one evaluates residents at morning report/grand rounds' . . . I'm not even sure what to say to that. Sure, the attendings are probably not filling out a grading rubric for you, but you are absolutely being evaluated and scrutinized both by them and by your peers. It is blatantly evident at these functions who is doing the leg work/keeping up with reading and who is not.

 

[calvnandhobbs68]

Maybe I'm at a disconnect, but the amount of reading time for 3rd years isn't that bad to begin with. Like you said, maybe it's an experience thing, or maybe I'm having early dementia 😳

It's much less as a 3rd year compared to 1st and 2nd, that I believe everyone can agree on. Which is one thing I liked about rotations, depending on downtime, you can go home and not worry about studying. After all, after a day of rotations, it's overkill to go home and read for 4-5 hours...unless it's like the week of the exam or something. 6 weeks for OB for example is more than enough time to get through Blueprints in one pass and be ok for the shelf.

However, calvin, I see where you are coming from in terms of needing to study to pass/honor a rotation which is based on a shelf. That feeling can suck. I'm not sure which rotations you've done, but a lot of services give you time during the day where you can get through some reading. IM for example has a lot of info to know, but there will be time to read all of it, trust me. I thought I would never finish Step Up to medicine but found that I was able to do so just fine. Same feeling with most of my peers.

Utilize your downtime wisely! Be active and involved in rotations, but when your resident says you can go read something for a bit, do it! It's not a trick or a test, when residents tell you to go read, they are basically saying "Yeah, we have nothing for you. You can stand and watch me do discharge paperwork, or do something productive".

Haha maybe all you guys are just smarter than me though...I always feel like I know f**king nothing and I've studied close to every night on rotations. So maybe thats where I'm coming from with that and a lot of you guys learned and retained information way faster than I have.

 

[username456789]

Okay didn't think this would turn into some big argument but we're using "evaluating" pretty loosely here I'd say. Half the interns didn't even show up to morning report until halfway through it on IM and I'd have to say every team I worked with must not have shown up at all at least 2-3 times (weren't all call days either). Yes I guess they'd notice if you never show up and never say anything at all but it most people were pretty content with answering 1-2 questions at morning report. You guys either have some crazy intense morning reports or the hospitals I've been at (one being a hospital with a very strong IM program) are not very representative.

Interns, while expected to read, are not necessarily the people I'm talking about (and IM is probably not the best specialty example).

It'll all make sense when you get to residency, I assure you (and I'm not saying that to be condescending in any way at all).

 

[Law2Doc]

Interns, while expected to read, are not necessarily the people I'm talking about (and IM is probably not the best specialty example).

It'll all make sense when you get to residency, I assure you (and I'm not saying that to be condescending in any way at all).

Yeah, early in the year, the interns aren't really as in the focus on some of this because they have other things they are getting beaten down for for other reasons -- the learning curve intern year is steep on so many things. but they had better be reading as they go, because they are expected to know a lot more by the time the next year starts.

I would agree that med students don't always have the best vantage point because they are only there for a short window of time and don't really see what the residents are doing at night or on the weekends -- they apparently presume not much. Nor are they present for evaluations to know what attendings did or didn't make note of. Plus they don't usually know which residents are killing it and which are a hair away from remediation -- they guy who shows up late and never seems to read might still be an intern when you (the med student) get there.

 

[ferning]

Being an intern wherever you are is like being a secretary, more so at certain institutions from what I've seen.

But I've been at 6 different hopsitals (community, va, university, inner city, suburb) for third year and if I had to describe their occupation in one word its secretary. Executive administrator if you want to decorate it

I've heard more than 1 IM senior say their medical knowledge peaked after step 2 studying. And its not cause they're lazy or unintelligent, but when you are at the hospital 80 hours + and 50% + of that time is doing mind numbing charting, orders you don't leave much energy. Physical or mental, let alone time.

Juggling however many patients at a time does not make it feasible from what I've seen to superficially manage patients. And when you get the time to seriously read up and look into one patients case or reflect on it, you not infrequently see a very different approach and more likely patient path unexplored.

But, I don't get this argument for who has it "easier" or generalizing as we are all in the same game. If there was less BS and less pressures to treat patients like mcnuggets of pathology on an assembly line everyone would be better off. Patients used to stay for a month at a hospital, now you see 4-5 times as many patients for that one months inpatient bed. I wonder how much better you could learn about medicine and manage patients with the luxury of time. Its clearly not for better outcomes with hospital readmission rates what they are

 

[todds]

Nobody is evaluating you at morning report or grand rounds, at least not anywhere I've been. You just show up and answer questions generally asked to the room. This is kinda what I mean, don't act like some things are more than they are.

As for the other things...come on man medical students get pimped on that exact same stuff. Yeah you have more patients you get asked about but I've yet to hear a question posed to a intern that was somehow deeper than something I'd be expected to know from reading uptodate. Not as much management wise but on the flip side, whenever a question pops up about the molecular mechanics or basic science behind something the medical student is on the spot becuase "you just took step 1 so you should know this right?".

I'm not saying being an intern/resident isn't HARDER than being a third year because there's absolutely no doubt about that. I just think that most third years have to do more studying on a daily basis than most interns/residents and the residents I've worked with seem to think the same thing. Of course, this would make sense as we're years behind you guys in experience. It'd be like saying I think residents study more than attendings...I don't think anyone would disagree with that.

I don't know where you go but residents get pimped on much more advanced topics, such as indepth management, clinical studies etc...

As a medical student you rotate through a whole bunch of new disciplines so you have to study to seem competent, but as a resident you also rotate through monthly in different subspecialties and its required for you to be at the very least competent. You have to be at least for the patient's sake, and thats something a medical student doesn't worry about. Screwing up to a point where you might hurt someone, it'll motivate you to study consistently. Furthermore, you can't just meander through. Want that fellowship? Well you need to build a reputation as that great resident and thats done through consistent hard work usually through reading, testing yourself, basically being an awesome independent learner.

For example, I rotate through the ICU next month and you bet you I'm reading quite a bit to make sure I fully understand vents, pressors, indications for certain classes of drugs etc...You are the person on call to deal with this, not the fellow. I took ICU elective as a medical student, but this is much more in depth and you NEED to know it this time. I do a fair bit of CCU as well in my program, you bet I have my hand on EKG book and a Cardiology textbook, doing questions on EKGs etc.. Not only are you judged about your skills, but you HAVE to be good for the patient's sake. As a medical student, you just do enough so you can recognize it on an exam and answer the question. As a resident, you have to make sure that you can interpret the real world which is way more complicated.

It difficult for you to understand. We've all been 3rd year medical students not too long ago. We know how much we studied. It does suck to be a 3rd year student, but if you want to be good, the stress and the amount you put forth in your reading will likely be the same.

 

[mvenus929]

Nobody is evaluating you at morning report or grand rounds, at least not anywhere I've been. You just show up and answer questions generally asked to the room. This is kinda what I mean, don't act like some things are more than they are.

I'll speak about my peds program, just because that's what I know the most about. Except on Mondays and Thursdays, morning report is not only case discussions for the kids on the wards, but also one of the upper levels gives a presentation. At several of the noon conferences throughout the year, residents are also giving presentations. There is always some sort of faculty member there to evaluate their presentations. And when it's specifically case discussions, the faculty do, to some degree, grill the presenting resident about management choices.

I should also note that generally, third year students aren't invited to either morning report or noon conference. That was the case on both Peds and IM at my hospital.

 

[calvnandhobbs68]

I'll speak about my peds program, just because that's what I know the most about. Except on Mondays and Thursdays, morning report is not only case discussions for the kids on the wards, but also one of the upper levels gives a presentation. At several of the noon conferences throughout the year, residents are also giving presentations. There is always some sort of faculty member there to evaluate their presentations. And when it's specifically case discussions, the faculty do, to some degree, grill the presenting resident about management choices.

I should also note that generally, third year students aren't invited to either morning report or noon conference. That was the case on both Peds and IM at my hospital.

That's pretty much the exact scenario I'm talking about, so I'm not sure if you were trying to make a point against my post or not. Having to be involved in a case discussion with 15 other residents isn't really something you have to go study the night before for. A case discussion is "questions generally asked to the room". You aren't particularly put on the spot when the chief asks the room for a differential or what tests they want to order. I also understand that the person presenting needs to know their particular case inside and out, but again you aren't presenting every day (or even every other week).

If you're somehow implying that I haven't been to morning reports/noon conferences/grand rounds so I don't know what I'm talking about...I have. Sorry third years at your school aren't invited.

Like GuyWhoDoesStuff said though, I was probably paying too much attention to the interns. This may all become crystal clear in a couple years and I'll look back and laugh at my foolishness.

 

[GUH]

At the same time, there is a ton of fluff that could be cut out and no one would be the wiser. There are 2-4 lectures each block/system that are basically seminars of the research of the teaching professor.

I guess one of the silver linings of going to a non-research intensive school is that we don't have to deal with this!

 

[mvenus929]

That's pretty much the exact scenario I'm talking about, so I'm not sure if you were trying to make a point against my post or not. Having to be involved in a case discussion with 15 other residents isn't really something you have to go study the night before for. A case discussion is "questions generally asked to the room". You aren't particularly put on the spot when the chief asks the room for a differential or what tests they want to order. I also understand that the person presenting needs to know their particular case inside and out, but again you aren't presenting every day (or even every other week). .

You apparently missed the part where I talked about actual presentations... as in a powerpoint on a topic. Usually based on a patient they saw during that rotation. I'm not entirely sure how often interns give them, but senior residents have to give one for every service that they rotate on. Generally, those do take some preparation. Those are what the faculty have to be there to evaluate.

As far as the case discussions, those are given by the senior residents on the wards, and they give them every day. The night senior leaving gives the cases that he/she admitted overnight, and the day senior, plus the day heme/onc senior, gives those admitted the day before (or however long since the last presentation). The NICU team comes in and talks about their admitted patients once a week. The presentations are generally brief, but all of the major departments are represented to discuss the patients if there are any questions. The chiefs rarely participate in the discussion.

That was very different from the case presentations we talked about during our student morning report, which is why I brought it up in the first place. I wasn't implying that you didn't know what you were talking about, just that my experience as a third year student was very different from my perception of the residents as a fourth year student.

 

[username456789]

I think some of you are also overlooking the fact that "evaluation" doesn't necessarily mean a formal evaluation. Attendings/superiors are constantly assessing and evaluating your fund of knowledge, understanding of disease and management, and so much more on a regular basis; discussion/presentation venues like conferences/morning report/grand rounds serve as prime showcases.

Regardless of the nuances of your individual program's didactic set up, attendings generally know who is on top of their game and who's just skating by. Other residents can easily pick up on it too.

 

[235009]

Not sure if anyone has mentioned this but don't forget that as a junior and senior resident you go from being pimped on rounds to doing the pimping/teaching and that is how the attending is evaluating you.

 

[Donald Juan]

I don't know why there are so many residents on here trying to argue against a single medical student. Until you residents are M3s, you won't really know what residency is like so all your points are really null and void.

 

[calvnandhobbs68]

I don't know why there are so many residents on here trying to argue against a single medical student. Until you residents are M3s, you won't really know what residency is like so all your points are really null and void.

Har har

I pretty much conceded anyway I was just annoyed by the guy who thought I didn't know what morning report was because med students weren't allowed to go at his school. I'll also stand by the point that engaging in a case study discussion with 15 other residents isn't really something you have to intently study for. However, I can also see there are a lot of other areas residents are evaluated in that I may not have been aware of before.

 

[KnuxNole]

I don't know why there are so many residents on here trying to argue against a single medical student. Until you residents are M3s, you won't really know what residency is like so all your points are really null and void.

😕

I wasn't really arguing, just sharing some perspective, and sprinkled some advice here and there.

 

[Donald Juan]

😕

I wasn't really arguing, just sharing some perspective, and sprinkled some advice here and there.

Sorry, I meant everybody but you.

 

[Law2Doc]

... However, I can also see there are a lot of other areas residents are evaluated in that I may not have been aware of before.

yeah, we were all in your shoes a few years back and equally clueless as to what residency really entailed -- Thought we could figure it out based on what we saw as students, but didn't appreciate that we weren't getting enough of the picture to appreciate all the details. You will see. And you will be reading a lot more than you currently suspect.

 

[SpecterGT260]

Sorry if this has been discussed to death, but are any medical schools implementing programs where you can show up, test out of the basic sciences, and get on with the business of learning medicine?

In the world we live in, anybody with an internet connection and a bit of self discipline can teach themselves the sciences in a far more time-efficient and cheap way than paying a med school $100K for the privilege of spending 2 years trudging to a lecture hall to watch a bunch of powerpoints on somebody else's time schedule.

I'll give you 2 days in the clinic to decide what you think of people with their internet connections. "self-study" like this is becoming the bane of many physicians' existences as people think they know something about disease.

Medical schools dont want you to just be a test taking machine. The tests may be the metric by which we are assessed, but more is going on here.

 

[rakotomazoto]

I am skeptical that the first two years could be learned independently online. There is so much more going on than classroom lectures. This is either a problem of perception and you are missing a lot of the hidden curriculum items that your medical school is trying to impart to you. Or, you go to a bad medical school that is stealing your money and wasting your time. Either way, this question implies to me that you probably need to do something to remedy the situation, although your options at this point may not be that great. I still reflect on things I learned in clinical settings first and second year that helped me make connections to the basic science lectures and understand why learning about pharmacology and pathology mattered. Every year in medical school gets better, but that being said, I still loved 1st year for what it was: a necessary phase of my development.

There are probably some lectures that aren't totally necessary, but others were so awesome to see and experience in person. Sitting in front of a screen, mindlessly memorizing/reading/cramming for tests is not what being a physician is about for me personally, those are just some of the many necessary evils to earn legitimacy as a doctor.

But in fairness, we all learn and function differently and I guess the type of person who feels "cheated" by learning in a community of peers and would rather sit in a room alone day after day will make a great radiologist or pathologist, no offence intended to either specialty. Overall, I think I would prefer the current system to an online, low-cost experience, not that my opinion will have any effect on how medical school works in the future.

 

[mvenus929]

I pretty much conceded anyway I was just annoyed by the guy who thought I didn't know what morning report was because med students weren't allowed to go at his school.

Reading comprehension is your friend.

That was very different from the case presentations we talked about during our student morning report, which is why I brought it up in the first place. I wasn't implying that you didn't know what you were talking about, just that my experience as a third year student was very different from my perception of the residents as a fourth year student.

Also, I'm female.

 

[SpecterGT260]

.



Also, I'm female.

Irrelevant.

 

[yehhhboiii]

Reading comprehension is your friend.



Also, I'm female.

do you want us to be impressed by your boobs

 

[hemoglobinemia]

Lame, she was tired of being called a guy. Venus, start referring to everyone on here as a she

 

[Law2Doc]

...
But in fairness, we all learn and function differently and I guess the type of person who feels "cheated" by learning in a community of peers and would rather sit in a room alone day after day will make a great radiologist or pathologist, no offence intended to either specialty...

doubtful - you need to meet more people in these specialties. The "great" ones are the more interactive consults, not the ones alone in a room with the "don't bother me" attitude.

 

[notbobtrustme]

😕

I wasn't really arguing, just sharing some perspective, and sprinkled some advice here and there.

 

[SpecterGT260]

Lame, she was tired of being called a guy. Venus, start referring to everyone on here as a she

🙄
It is a vain attempt at a point that happens over and over again on the internet. Like it or not, "guy" is a gender neutral term in the majority of cases. While it does denote a male, when used as such, it is also the default "I don't know what set of gibblets this person comes with" term.

The annoyance is that women on this site (and others) from time to time feel that everyone else should simply know who and/or what they are (because expectation of telepathy isn't cliche at all 🙄 ) and try to make the point that the person they are arguing with is somehow ignorant for being "mistaken" about their gender.

Basically, it was an irrelevant statement and nobody gives a damn. She could refer to everyone by the female pronouns if she wants. The only result would be that she is absolutely incorrect, while those using "guy" are at worst simply being ambiguous in their language. I'd personally choose to not be flat wrong simply to make a non-point

 

[Anastomoses]

🙄
It is a vain attempt at a point that happens over and over again on the internet. Like it or not, "guy" is a gender neutral term in the majority of cases. While it does denote a male, when used as such, it is also the default "I don't know what set of gibblets this person comes with" term.

The annoyance is that women on this site (and others) from time to time feel that everyone else should simply know who and/or what they are (because expectation of telepathy isn't cliche at all 🙄 ) and try to make the point that the person they are arguing with is somehow ignorant for being "mistaken" about their gender.

Basically, it was an irrelevant statement and nobody gives a damn. She could refer to everyone by the female pronouns if she wants. The only result would be that she is absolutely incorrect, while those using "guy" are at worst simply being ambiguous in their language. I'd personally choose to not be flat wrong simply to make a non-point

I never point out gender because I actually find it slightly empowering that when mocking or arguing with someone, they assume you to be male - which in itself is an issue. That said I have noted on SDN seems to be some default assumption (not by all) that posters are male. Either way, 3 posters felt the need to berate her? Overkill. Resentment? She didn't shimmy her boobies side to side or anything.

 

[SpecterGT260]

I never point out gender because I actually find it slightly empowering that when mocking or arguing with someone, they assume you to be male - which in itself is an issue. That said I have noted on SDN seems to be some default assumption (not by all) that posters are male. Either way, 3 posters felt the need to berate her? Overkill. Resentment? She didn't shimmy her boobies side to side or anything.

I explained my rationale. If you think my post is a beratement we will have to talk about sensitivity. I just called it irrelevant. However, it is done time and time again as a "well you were wrong here" short of nonsense jab . Its exactly the same as if some D-bag called me "Mr. Specter" and I cut him (or her) off to say "um excuse me, that's Dr. Specter" (in a little under 2 years anyways). It isn't that everybody assumes we are all males here. That is just the default for internet forums in general. There is a gross under representation of women in these things. SDN just happens to be one of the places that is more proportionately mixed so the issue arises somewhat more often.

 

[Substance]

They already have that. It's called nursing school.