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Minimal increase in residency spots means no change in job prospects.
Just more people getting squeezed out at the front end.
zero unfilled positions this year
- Thread starter b-real
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Minimal increase in residency spots means no change in job prospects.
Just more people getting squeezed out at the front end.
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Well, the supply of EPs is limited by the number of residency positions. So, despite any uptick in interest from med students, there won't be any sudden surge in graduating EM physicians.
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Uh, the number of EM spots increased to 1668 from 1399 in four years...that's a 20% increase in four years. That's a significant surge.
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Sweet baby Jesus! You speak the truth man. Before coming to med school this year I was a paramedic. When I was in training we had six months of "didactics" and in that six months they managed to cram in a ton. After 8 months of medical school I feel like I haven't learned sh$t about sh$t. Sure, I could tell which lysosomal enzyme is deficient in Gaucher's, but who cares? There is one, that's right ONE, attending who sees ALL the lysosomal storage disease patients in my state. First year= colossal waste of time!
Which allows me a nice segue to get back on topic and suggest an interesting idea: maybe the real threat that midlevels pose will not be made apparent until they have access to REAL residencies. I'm not talking a little one year dealio like they have now. I'm talking the real deal McCoy 3/4 year residency. Cause I'd bet dollars to doughnuts, if someone were so inclined, someone could go out and recruit the ten brightest graduating PA students and with a 3/4 year residency turn them into rockstars who would be functionally equivalent to another graduating class of EM residents. And by 'functionally equivalent' I mean there would be no difference in end outcomes between patients treated by each group.
Of course this wouldn't be sustainable in the sense that you couldn't fill every EM residency with the "brightest 10" cause, no offense to the PA profession, but I don't think they graduate that many bright PAs every year. But, crucially, it would elucidate the fact that our medical education is filled with a bunch of fluff. And people would start asking, "why the hell are we spending so much money training people for four years when we could do it in two?"
Now, I foresee that an attending will respond with some variant of "All four years are absolutely necessary. You just don't see it cause you're just a first year. In fact, just the other day I had a patient with Gaucher's!" I fully recognize that I am just a first year and I could be grossly inaccurate but I just ask that people first take a moment of genuine self-reflection and ask themselves, "Could I be doing my job just as well if I only had two years of undergraduate medical education?" And ask that people not just automatically reject my idea cause they are angry that they too had to memorize useless details about Gaucher's.
triangles,
i generally agree with you. however, reinventing the wheel in medical education is a very steep hill to climb. in the end, i think it's the depth and breadth of knowledge that makes a great physician (and what differentiates us from nurses, PA's, etc)... and we don't know in 1st year where our paths will go.
you could easily say the same thing about college... my undergrad degree got me into med school, at which point it was obsolete. i do think though, that all of the learning one does along the way ultimately trains your brain to absorb a lot of complex information and apply it to a variety of scenarios.
i will say though, that the psych 1/2 of my undergrad double major does me way more good in my practice of EM than my bio half... personality disorder = daily encounter, while all of that embryology and animal stuff doesn't cross my mind unless i'm on a nature excursion and i think about primary vs secondary forests! physics, calculus... hated it then, don't use it now!
i generally agree with you. however, reinventing the wheel in medical education is a very steep hill to climb. in the end, i think it's the depth and breadth of knowledge that makes a great physician (and what differentiates us from nurses, PA's, etc)... and we don't know in 1st year where our paths will go.
you could easily say the same thing about college... my undergrad degree got me into med school, at which point it was obsolete. i do think though, that all of the learning one does along the way ultimately trains your brain to absorb a lot of complex information and apply it to a variety of scenarios.
i will say though, that the psych 1/2 of my undergrad double major does me way more good in my practice of EM than my bio half... personality disorder = daily encounter, while all of that embryology and animal stuff doesn't cross my mind unless i'm on a nature excursion and i think about primary vs secondary forests! physics, calculus... hated it then, don't use it now!
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I just left a metropolitan area that had fewer than 20 EM trained docs. The vast majority of shifts in most hospitals were staffed by IM or Med/Peds people. The job market is going to be saturated in destination cities, however EM has a pretty high-turnover rate so there will still be jobs available it will just be a matter of timing/connections to know about them. Outside of destination cities getting employed will remain largely easy.
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If the number of EM residency spots (and residency slots in general) keeps trending up, eventually people are going to get squeezed out into the more rural, less desirable locations.
Many of these locations already are run by midlevels which will put you guys in an awkward situation. Is a single MD ER medical director "supervising" 20 midlevels at a rural site going to hire MDs to work there? Thats not a given.
Many of these locations already are run by midlevels which will put you guys in an awkward situation. Is a single MD ER medical director "supervising" 20 midlevels at a rural site going to hire MDs to work there? Thats not a given.
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Dr Lyss said:
I still like EM, and I like that there isn't call. But I don't really think it's a "lifestyle" specialty. Sure our days off we're off. But working a set of nights every month, working holidays, not seeing your family for a few days at a time isn't exactly cush. If anything I'd say outpatient peds or IM may be a more normal lifestyle. But you couldn't pay me enough to do outpatient medicine.
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I stand corrected--damn, that's kinda crazy.
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I dont want to steer the decision wrongly as nights, weekends, holidays are a large part of EM...
With that said, there are EASY jobs to find where you can do all nights (And often for a heafty increase in pay).. there is the downside that its all night shifts, but the tradeoff is a set schedule and you often can make your own schedule each month. I work with three full time night guys who have done this for near 10 years and they really like their schedules.
There are also some jobs where you have several night only folks so that the day people seldom work a night. We do 2 weeks (about 6-7 shifts) of nights every 4-5 months. I send my wife/kid to her parents during that time and keep the house to myself.
Again, not the overly common norm, but there are places out there.
Regardless of nights, weekends, holidays etc... I have worked my full complement of shifts (plus one extra) this month and I am off the next 9 (yes I said NINE) days. Weekend trip to LA next weekend. (We were in Vegas last month for a few days and nashville the month before that)..
Maybe I dont understand lifestyle, but I think EM is not too far off from a darn good lifestyle...
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I agree (that's why I put it in quotations) since I know shift work is far from the cushy lifestyle of derm or some of the other traditional lifestyle specialties, but more and more people are associating it with a better lifestyle than others (more flexibility, ability to go part time, no call) so... here we are. I think that's part of the reason why there has been a bigger surge over the years, especially from women.
IDK part of me fears what is happening with radiology could very well start to happen in EM, especially since I'm not too keen on moving to Iowa or whatever for a job.
IDK part of me fears what is happening with radiology could very well start to happen in EM, especially since I'm not too keen on moving to Iowa or whatever for a job.
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What follows are some of the data points in perspective:
Emergency medicine:
1,668 offered positions, 1,335 of 1,498 US senior applicants matched (89%).
80% of EM was filled by US Seniors this year.
Spot trending (Filled/Offered):
2012: 1668/1668
2011: 1602/1607
2010: 1540/1556
2009: 1459/1472
2008: 1370/1399
I'm very interested to see where EM lands in 10 years. This turmoil isn't becoming (mid-level turf wars), yet I think EM physicians play a critical role in our healthcare system. I wonder if these battles will escalate as they have in anesthesiology.
The article quoted on the earlier page about a NP missing the Hashimoto's disease was concerning. I do think that if DNP's or PA's, whoever, wants to participate in the activities a physician does, and be paid like one, then they should also take on malpractice and responsibility when things like that occur.
EM does seem to be heading towards rads/anesthesiology problems if something isn't done. Differentiating the physician from the mid-levels will be the challenge ahead.
Emergency medicine:
1,668 offered positions, 1,335 of 1,498 US senior applicants matched (89%).
80% of EM was filled by US Seniors this year.
Spot trending (Filled/Offered):
2012: 1668/1668
2011: 1602/1607
2010: 1540/1556
2009: 1459/1472
2008: 1370/1399
I'm very interested to see where EM lands in 10 years. This turmoil isn't becoming (mid-level turf wars), yet I think EM physicians play a critical role in our healthcare system. I wonder if these battles will escalate as they have in anesthesiology.
The article quoted on the earlier page about a NP missing the Hashimoto's disease was concerning. I do think that if DNP's or PA's, whoever, wants to participate in the activities a physician does, and be paid like one, then they should also take on malpractice and responsibility when things like that occur.
EM does seem to be heading towards rads/anesthesiology problems if something isn't done. Differentiating the physician from the mid-levels will be the challenge ahead.
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I'm not really sure what this post is trying to say...other than you're worried about a) EM is becoming more competitive and b) that the "future" of EM is in peril.
Yeah, EM is becoming more competitive.
Yeah, you could argue that EM is seeing encroachment from mid-levels.
Thing is, these points are not endemic to EM. Most fields of medicine continue to become more competitive. And every field that doesn't involve cutting patients open will, to some extent, see midlevels attempt to play doctor.
So while I share some of you concerns (particularly about matching into EM next year heh)...these are things you can't really escape, regardless of if you go into EM or derm or whatever.
But, if you ARE looking for an EM-specific problem look no further than the mess in WA where that state is trying to not pay EM physicians for seeing medicaid patients. That crap is straight up infuriating/scary...and it ain't the future...it's now.
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I'm not worried about anything.
My point with Rads is that, the job market is different due to supply. And with the trend of more residency spots and abundant mid-level training programs in EM, this could lead to oversupply. My comment on anesthesiology was more along the lines of midlevels moving in. I know the EM physicians are better trained and more knowledgeable, but does everyone know this? Hospital admin, patients, nurses, etc.? Also, in my little time spent in the ER, I did see many PC patients, which any ER physician can attest to seeing an abundance of. These patients will not always need a physician and midlevels may suffice. So midlevels arguments become appealing to administrations depending on the patient population. I don't think I'll end up in this field, but I find it to be an interesting specialty because of how unpredictable the future is for EM. The mess in Washington was interesting also, as our nation needs solutions and I'm not quite sure how they will address these problems.
I'm not sure if EM was more competitive this year than last. If anything, it seems about the same. I don't think the future of EM is in peril, it's a unique role in the healthcare system. I'm just not sure how it will play out.
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Yep. I'll jump back in. Medical education HAS to change, period. For a lot of the same reasons that you listed above; but primarily because its just... so... not... clinically... USEFUL the way its presently done.
I think that one of the biggest ways that it can change is that when you're teaching a concept... teach the WHAT and WHY first, then teach the HOW, so you restore a feeling of purposefulness to the learning that gets you through the esoteric stuff that (may not ultimately be important anyways). For example: I frequently give an EKG lecture that teaches WHAT to recognize, WHY to recognize it, and WHAT to do about it.... then.... I can wax philosophical about ion channels, relative refractory periods, etc.... this way, I haven't lost my audience by stage three of cardiac automaticity and [Ki] currents... and... whatever PhDs should go care about.
Also, biochemistry needs to be trimmed... big time. (Some) of us got it first in high-school... MOST if not ALL of us got it in undergrad... and we're effing sick of the cram-and-purge of enzyme names that is a big part of it... yet is clinically useless.
I'll argue that embryology needs to be cut en masse as well.
Things that weren't taught in medical school (that I eventually taught myself on some level), that I wish I had learned include (in no particular order).
Reading a CBC and BMP.
Reading (really reading) an EKG.
Interpreting common lab tests/values (thyroid function studies, ABGs etc.)
Reading (really reading) a chest x-ray, an abdominal series, ortho studies... etc.
... the list could go on and on...
Things that I were taught in medical school that have been freaking useless so far...
Most biochemistry. Ask me to spit out the krebs cycle now or lipid metabolism now. You'll get a two-word answer, and the first word will start with "F".
Most embryology. Can't remember if blastula came before gastrula, or at what cell-stage the neural crest forms.
Most histology. Last time I looked at a photomicrograph was..... never.
A lot of neurobiology (maybe its called something else where you're at... but I'll be damned if I care about the reticular hippocampal whatever circuit. We know the big ones, and the meaningful ones).
So... that's pretty much the first term of med-school (save anatomy).
Criticism welcome.
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I suppose the fundamental question is what is an MD? Is the purpose only to make clinicians? Or is it a scientistic/philosophic degree?
There is no question that medical school can be more clinically oriented, but is it needed? I don't know. I would like the curriculum to be lean, but I think there is benefit to a broad knowledge exposure. Not all of us will become clinicians.
Although, I think the quality of schooling could be increased by having more MDs teach. At my school, it's during the second year that the clinicians do more teaching-->thus the material sticks better (its taught more akin to Fox's description)
There is no question that medical school can be more clinically oriented, but is it needed? I don't know. I would like the curriculum to be lean, but I think there is benefit to a broad knowledge exposure. Not all of us will become clinicians.
Although, I think the quality of schooling could be increased by having more MDs teach. At my school, it's during the second year that the clinicians do more teaching-->thus the material sticks better (its taught more akin to Fox's description)
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I don't disagree... but the science/philosophy stuff can (and should be) taken care of during undergrad. If you went above and beyond this, you had better damn well ask yourself - "what the hell am I doing?" if you don't want to be a clinician.
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If you want to be a doctor of something, you had better know your stuff. An MD/DO without fundamental knowledge about the human body (biochemisty, physiology, embryology, anatomy, etc) is just a technician. The professional doctorate is bestowed upon us because we know more about the workings of the human body and disease than any other profession. Cutting out large amounts of fundamental subjects takes away our expert status.
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@RustedFox: we seriously need to get you on our curriculum committee. How can we make this happen?
@SepulvedaMd: You make a good point about breadth in medical education. Not everyone will be a clinician and what each type of physician will need as far as background science knowledge will vary. Also, as La Gringa pointed out, not everyone knows what specialty they would like to practice as a first year med student and it would be hard provide a medical education based upon the individual needs of let's say future surgeons. These are all astute observations. And I think they really boil down to two basic principles: 1) It would be hard to reorganize medical education and 2) some medical students would inevitably end up in the "wrong" specialty because they wouldn't have four years to explore all possible fields of medicine.
In times of plenty these concerns might be persuasive to a hospital administrator or politician. But, what I am hearing from the attendings on these boards is that times are lean and they are only going to get leaner. And when they get leaner one of the ways costs will be cut will be to switch to a fast track type educational model like the PAs have.
Of course, this is just all mental masturbation as clearly I don't have a crystal ball but I kind of take it this was the point of the thread, yeah?
@SepulvedaMd: You make a good point about breadth in medical education. Not everyone will be a clinician and what each type of physician will need as far as background science knowledge will vary. Also, as La Gringa pointed out, not everyone knows what specialty they would like to practice as a first year med student and it would be hard provide a medical education based upon the individual needs of let's say future surgeons. These are all astute observations. And I think they really boil down to two basic principles: 1) It would be hard to reorganize medical education and 2) some medical students would inevitably end up in the "wrong" specialty because they wouldn't have four years to explore all possible fields of medicine.
In times of plenty these concerns might be persuasive to a hospital administrator or politician. But, what I am hearing from the attendings on these boards is that times are lean and they are only going to get leaner. And when they get leaner one of the ways costs will be cut will be to switch to a fast track type educational model like the PAs have.
Of course, this is just all mental masturbation as clearly I don't have a crystal ball but I kind of take it this was the point of the thread, yeah?
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Kind sir, you are quite eloquent but I must respectfully disagree with you on a couple of points here: 1) Physicians do not know more about the human body than any other profession. Each branch of science knows more about their respective field than any other. Biochemists know more about biochemistry than any other profession cause it's what they do all day. They sit in front of a microscope (or something) and figure out biochemical pathways. Physiologists know more about physiology than any other profession and so on.
2)The physician is the expert in her branch of medicine, that is all. She is not an expert in biochemistry or physiology but rather let's say emergency medicine. And why is she the expert? Because she does it all the time. She got 3/4 years training and then has been doing for the past 15 years. That is expertise and crucially it comes from experience, not book learnin' (although, admittedly she probably has gained some knowledge from books). And this is the crux of what I see as one of the big problems with medical education: people are good at what they do and understand what they need to as it relates to what they do. They won't remember embryology/biochemistry/histology if they aren't regularly using it.
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On a macro scale, which is our (physician) forte, if not us, who does? My barber? My sister, the lunch lady? Her husband, the highway worker? My unemployed Micronesian neighbor?
You are reducing to a micro scale, and I shall grant you that. However, that is not us.
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I disagree.
Some of the "best" undergrad schools intentionally shy away from pre-professional and technical training; and for good reason.
I realize the discussion here is about med school circ, so I will avoid a lengthy discussion about the purpose of post-secondary education (that, and I doubt I am really qualified) -- but please do not say a role of an "undergrad" education should be to prepare students for professional schools.
HH
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It seems that most would agree some of the basic science must go. However, as our technology advances more and more of our therapies act on the microcellular level. This makes it more important for physicians, the ones that will be administering these treatments, to have some cursory understanding.
Also, the argument to banish these topics ignores that many medical students show up without having been a science major in undergrad. Pre-recs alone do give the foundation one needs for medicine.
Also, the argument to banish these topics ignores that many medical students show up without having been a science major in undergrad. Pre-recs alone do give the foundation one needs for medicine.
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Here's my idea: the role of an undergrad education should not be to prepare ALL students for professional schools - BUT the role of an undergrad education (for those who want to prepare for professional schools)... should be to prepare you for professional schools.
I think back about all the time that I wasted in undergrad. I had to take classes like "Russian Fairy Tales" and "Thinking about the Environment". Screw that nonsense. I'm headed for professional school. I want anatomy, biochem, physiology...
Its all about streamlining. Undergrad is 4 (bordering on five now) years, standard. Medical school is another four.... They want to drag residency out for longer now for whatever reasons...
... nobody wants to spend the first half of their life in school and in debt. Gotta streamline it.
If you're somehow showing up for medical school with an economics major... get real. "Can't be a stem cell forever" - as some of the other posters around here say.
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I think it is being streamlined into the 6-year medical school programs that combine undergrad and med school into 6 years total (rather than 8) to allow a more focused education for those pursuing only that route. I think that model could have merit for expansion, but I think it would require an examination of completion rate vs. that of the traditional route, which is information of which I am ignorant (and frankly too indifferent to look into).
However, I am thankful for the traditional 8 year route, for I took advantage of that education to pursue other interests. I enjoy having a broad education that is not only focused on medicine. I have undergraduate degrees in biology, philosophy, religious studies and psychology. I didn't take any of the pre-med style classes within my biology degree (beyond those required of the major), but other subjects that interested me like ornithology and entomology.
In my mind, "becoming a doctor" is not the only focus of my education or my life as a whole. It is one component of my life. I know those values are different for other people, but I see no inherent evil in having a well-rounded education.
However, I am thankful for the traditional 8 year route, for I took advantage of that education to pursue other interests. I enjoy having a broad education that is not only focused on medicine. I have undergraduate degrees in biology, philosophy, religious studies and psychology. I didn't take any of the pre-med style classes within my biology degree (beyond those required of the major), but other subjects that interested me like ornithology and entomology.
In my mind, "becoming a doctor" is not the only focus of my education or my life as a whole. It is one component of my life. I know those values are different for other people, but I see no inherent evil in having a well-rounded education.
I'm a non trad and I loved learning about Etruscan history (well, whatever the Greeks thought Etruscan history was
) and taking courses because they sounded interesting. I'm not saying everyone wants or needs a well rounded education involving philosophy, arts, history, economics, science and math but I sure am happy that I did. I think it has made me a much more well rounded person. I too don't see the purpose of a university to prepare you for a career. It should be to intellectually challenge you, to teach you how to take the events of the world and put them into historical context. To analyze new data in light of philosophy, logic, sociology, world history, and science. Again, I do not claim that everyone should or must go through this route but I wouldn't have it any other way. For me personally, and me only, I think that background would have helped me become better at whatever profession I chose.
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The current medical paradigm is not what it was when the current professors went through school and it wont be the same when the current students are tenured. For example, how many docs that graduated before 2005 know about epigenetics?
I think SepulvedaMD makes a great point - medical schools need to make more than just clinicians, they need to produce minds that can rise above the prevailing culture, take stock of, and alter it.
And I'll keep my undergrad humanities courses, thank you very much. If my son were to get accepted to an accelerated combined program, I would counsel him against enrolling.
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This is probably the most important argument in support of medical education in its current form.
It's clear to see that "mid-levels" in their various forms are likely a more cost-effective way - both in education and in practice - to provide direct patient care. The clamor over the inevitable misses that will come from incompletely educated and inexperienced providers will probably come to be viewed as acceptable collateral damage considering the otherwise all-consuming costs of healthcare in this country. The true value of physicians will be in supervisory roles, specialist consultation, and leadership in academics, research, and policy that continues to move the entire healthcare profession forwards. It will be a different sort of elite existence - far removed from the hands-on medicine physicians have practiced in the past - but still a valuable and rewarding one.
Perhaps. Who really knows? But, we will have to justify the cost of our education and training somehow, as well as the value of certain specialties - those specialities whose turf is rapidly being encroached upon by other practitioners (Family Medicine - no offense intended - springs to mind).
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I'm a non trad and I loved learning about Etruscan history (well, whatever the Greeks thought Etruscan history was
Again, I do not claim that everyone should or must go through this route but I wouldn't have it any other way. For me personally, and me only, I think that background would have helped me become better at whatever profession I chose.
Don't get me wrong; I like a lot of things. Military history, ecology, Spanish, animation... but I like them on my own time. That way, I can direct my learning as I so choose, and at whatever cost I'm so willing to invest in it.
I draw a stern line between "career" and "what I like to do, but would rather purse a career in something different". My "Thinking about the Environment" class was fun... but I didn't want to have to pay that much per "credit hour" for it, or have it delay my pursuit of medicine.
At least for me, self learning can't really replace the structured environment of academia with a room full of people and a professor. People who can critically analyze your ideas, hypothesis and force you to analyze your holes. Now I know this type of experience may not be wanted by everyone and many people maybe find that their experience doesn't give them this but that's what I got and I wouldn't change it for anything.
I agree that there should be a six year European style program for those who know. But I didn't know until I was well out of college and as long as there's opportunities for people like me, I'm fine with it. I enjoyed the path I took.
I agree that there should be a six year European style program for those who know. But I didn't know until I was well out of college and as long as there's opportunities for people like me, I'm fine with it. I enjoyed the path I took.
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the gas passers havent' learned yet...now besides CRNA's expanding, working unrestricted in some states, being able to bill indep, they've invented a medicine version, the AAI am very afraid!!!! I think we should take a hint from gas and stop our rampant expansion
so yes, when PA's and DNP expand...be afraid, very afraid
D
deleted6669
AA's have been around for over 40 years.
unlike the crna, an AA MUST work as part of an anesthesia team model. there are no independent AA's competing with md groups and never will be.
sure, fear the crna and the dnp but pa's and aa's must work for docs. without you guys we can't work. it's the law in every state and territory in which we practice and I don't see that changing. we are licensed by the board of medicine.
a little info on AA's:
http://www.asahq.org/For-Members/Ad...fied-Members-of-the-Anesthesia-Care-Team.aspx
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I don't know if that includes DO programs too but they've increased a whopping 20 residencies in the past 2 yrs! granted they're much smaller programs but that adds to the pool
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sorry, I shouldn't have written PA. I was learning more towards the business aspect on a large scale. numerically speaking 1 MD can run 4 OR rooms with AA/CRNA's so that bumps out a few MD's to find another job. at any given hospital, that saturates the profession. then you start heading to the rural areas and before you know it, there's CRNA's independently working your same slot which leads to a tight market. shift that similar model to EM, FM, IM....etc, my theory is in 10 yrs the DNP degree will encroach in a similar fashion
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amen. I am completely with you. 3 words that solves the education scenario. problem based learning. I went to a med school that did just that. cut out the fluff and focused on the important stuff. I will admit if you're not self motivated, it'll be tough but it is effective.
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I came across this website http://www.emnet-usa.org/nedi/20.html
It contains a research-based workforce calculator. It predicts the number of years required to meet the demand for EP's. By plugging the number of the newly-certified emergency physicians (1700 allopathic + 200 osteopathic), and that only 3% of current physicians retire or die per year, I calculated that it will take 41 years for the demand to be met.
However, there's a little problem. The calculator doesn't take into account the emergency service provided by NP's and PA's.
It contains a research-based workforce calculator. It predicts the number of years required to meet the demand for EP's. By plugging the number of the newly-certified emergency physicians (1700 allopathic + 200 osteopathic), and that only 3% of current physicians retire or die per year, I calculated that it will take 41 years for the demand to be met.
However, there's a little problem. The calculator doesn't take into account the emergency service provided by NP's and PA's.
D
deleted109597
I would argue that your school let you down then.
My school spent time during 1st/2nd years explaining lab tests, and really it made sense come third year. We had a long series of lectures about EKGs, so much so that I definitely learned more about them in med school than I did in residency (also an indictment against my residency though).
Xrays take volume, and unfortunately, we don't get enough volume of studies to look at them critically. Sure, the "basics" of CXR reading were taught to us (ABC method, or whatever), but most of it is self taught again. Read every study you ever order in residency. It's even more important if you have radiology reading them for you as well. You never know what your first job will make you read.
No argument really, but I do find it useful to have a good basis for some of the more rare diseases that we see (usually the metabolic kids).
Also, the more you know, well, the more you know. If you remember it.
But then again, I was a chemist, and not a biologist in undergrad and grad school.
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PBL is all fluff. It's a waste of time and money to going trekking through self-directed learning questions when you know that the answer is going to be lupus again this week. The easy answer is to have lectures taught by clinicians.
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I'm coming to learn that your medical school has little to do with your medical education.
As Mark Twain said:
The responsibility belongs to you.
In my experience, I agree.
As Mark Twain said:
The responsibility belongs to you.
In my experience, I agree.
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@JackShepard:
I learned these things on my own during my 3rd/4th years. Sure, responsibility was on me... you're missing my point.
What I'm saying here is that rather than waste time in 1st/2nd year reteaching Krebs cycle, or obsessing over blasula/gastrula.... teach me the skills that I'll need on the wards. Then when I'm on the wards, teach me the real nuances of patient care.... this accelerates medical education by and large, and makes it less frustrating.
I learned these things on my own during my 3rd/4th years. Sure, responsibility was on me... you're missing my point.
What I'm saying here is that rather than waste time in 1st/2nd year reteaching Krebs cycle, or obsessing over blasula/gastrula.... teach me the skills that I'll need on the wards. Then when I'm on the wards, teach me the real nuances of patient care.... this accelerates medical education by and large, and makes it less frustrating.
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Isn't that just wanting to be a nurse? The skills are hollow without the knowledge behind them. I just can't be for shortcuts. If something is truly superfluous it will be weeded out, because all over the country there are people whose job it is to root out excess in curriculum. I doubt that this hasn't been thought of before. During those first years I would have agreed with you, but I am doing light reading to prep for intern year I am surprised at how much basic science is in the texts.
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I really loved learning all that I did during school...in fact I'm am often frustrated that the bulk is information I never use.
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As an aside, I do use the "useless" biochem stuff in my practice - but I'm a medical toxicologist...
Suffice it to say, focusing solely on clinical matters detracts from the underpinnings of medicine... every specialty has its focus, and I believe it the goal of med school to teach all of them.
That is how we learn our strengths, weaknesses, and passions. To do away with it would weaken our profession (literally, by the very definition of 'profession')...
Just my $0.02
-d
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Suffice it to say, focusing solely on clinical matters detracts from the underpinnings of medicine... every specialty has its focus, and I believe it the goal of med school to teach all of them.
That is how we learn our strengths, weaknesses, and passions. To do away with it would weaken our profession (literally, by the very definition of 'profession')...
Just my $0.02
-d
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Agreed.
Too many med students and interns are so eager to be savvy during the clinical rotations that they sometimes ignore the importance of basic sciences.
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And we don't wear grass skirts... at least not in the hospital. d;-)
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Everyone is misunderstanding me.
I'm not saying "eliminate all the basic science". Not at all. Its important. Its terribly important.. but..
either A) we already covered these topics... twice, maybe three times since high-school.... or.
B) we teach the "underpinnings" of it well before the clinical necessity is ever impressed upon the student... so they're sure to tune it out as "unimportant", and we hear them say things like - "Eff this noise... teach me what I need to know... I don't have time for this nonsense."
I've used/remembered/appreciated a lot of the biochem/embryo in residency, yes.... but its taught at all the wrong times, its taught too much, and not enough emphasis is on the "daily workings of medicine".
MY POINT IS:
1) No more redundacy. Get the Krebs cycle out of the way in undergrad. Don't revisit it five times, being sure to emphasise the importance of knowing the enzyme name between "fumarate" and "whogivesaf*ckate". Take that time, and teach the clinical importance of it.
2) Teach clinically applicable things FIRST, so you have some basic competency with them... THEN go into the "how and why" for mastery purposes.
If we do this, we'll have more competent, capable, and happier student-docs and interns.
@Sepulveda: Nurses can't do what I(we) do. You imply that they can (even) interpret a CBC or BMP. You give them too much credit. 99% of nurses in my experience can't understand the difference between a Cr of 0.9 and 1.4 (HINT: that's a big deal).
Here's how we see a CBC:
WBC: 8.5 / Hgb: 10.2 / Hct: 33.3 / Plt. 303
and the diff....
Here's how they see a CBC:
WBC: 8.5/ Hgb-Hct: OMG LOLZ! /Plt: Whocares,Idon't.
Diff... whatev.dancing with the stars is on.
I'm not saying "eliminate all the basic science". Not at all. Its important. Its terribly important.. but..
either A) we already covered these topics... twice, maybe three times since high-school.... or.
B) we teach the "underpinnings" of it well before the clinical necessity is ever impressed upon the student... so they're sure to tune it out as "unimportant", and we hear them say things like - "Eff this noise... teach me what I need to know... I don't have time for this nonsense."
I've used/remembered/appreciated a lot of the biochem/embryo in residency, yes.... but its taught at all the wrong times, its taught too much, and not enough emphasis is on the "daily workings of medicine".
MY POINT IS:
1) No more redundacy. Get the Krebs cycle out of the way in undergrad. Don't revisit it five times, being sure to emphasise the importance of knowing the enzyme name between "fumarate" and "whogivesaf*ckate". Take that time, and teach the clinical importance of it.
2) Teach clinically applicable things FIRST, so you have some basic competency with them... THEN go into the "how and why" for mastery purposes.
If we do this, we'll have more competent, capable, and happier student-docs and interns.
@Sepulveda: Nurses can't do what I(we) do. You imply that they can (even) interpret a CBC or BMP. You give them too much credit. 99% of nurses in my experience can't understand the difference between a Cr of 0.9 and 1.4 (HINT: that's a big deal).
Here's how we see a CBC:
WBC: 8.5 / Hgb: 10.2 / Hct: 33.3 / Plt. 303
and the diff....
Here's how they see a CBC:
WBC: 8.5/ Hgb-Hct: OMG LOLZ! /Plt: Whocares,Idon't.
Diff... whatev.dancing with the stars is on.
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I also challenge any/all of you naysayers to really sit down and think about just how much of your basic sciences come in to play in those one-in-a-hundred-thousand cases that you see. Its easy to sit back and say - "oh yes, I understood the difference between hereditary fructosuria and galactofructokinase deficiency".... but did the chemical structures, pathway, enzymes names, cofactors, and substrates all pop right into your head as "essential" ? I bet not. What you probably understood was "one enzyme missing here = bad... give extra glucose, avoid galactose"
I saw a fella with spina bifida the other day. I didn't think about gastrula/blastula/whatever... I just thought "Yep... open neural tube defect. Alphafetoprotein. Drag."
If, when you see these things clinically, you (think about) and really have a mastery of the 24-cell sphere, the involution process, and the ontogeny-recapitulates-phylogeny of it all.... then you're a better doc than I... and that's impressive and all... but it matters not a lick clinically.
I saw a fella with spina bifida the other day. I didn't think about gastrula/blastula/whatever... I just thought "Yep... open neural tube defect. Alphafetoprotein. Drag."
If, when you see these things clinically, you (think about) and really have a mastery of the 24-cell sphere, the involution process, and the ontogeny-recapitulates-phylogeny of it all.... then you're a better doc than I... and that's impressive and all... but it matters not a lick clinically.
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Furthermore, I think that Sepulveda pretty much perfectly illustrates my point. He/she is probably a 2nd/3rd year that looks at the nurses and says - "Damn, how do they know so much ? ... Oh, well they've been doing this for awhile, they've caught on to it, they get it... I'll get it after awhile..."
In reality, the nurses know but a pittance. You already know more than they do, you just can't use it yet.
THAT is exactly the gap that I seek to bridge. Make even the most mealy-mouthed of MS-2s able to 'know and use' what the nurses just 'use'. Build from there.
In reality, the nurses know but a pittance. You already know more than they do, you just can't use it yet.
THAT is exactly the gap that I seek to bridge. Make even the most mealy-mouthed of MS-2s able to 'know and use' what the nurses just 'use'. Build from there.
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M1s can see a CBC like this. What I was getting at is that when you remove the science behind the clinical knowledge you undermine its foundation and reduce your education to that of a midlevel.
Check your facts before you make assumptions! M4, matched, and on my way out the door. Also, I sit on my med schools curriculum board and am constantly looking at how to cut things out of curriculum, to tighten it and make more relevant for both boards and wards. What you are missing is that schools are incessantly trying to evaluate their curriculum based on end of year surveys, board scores, graduation questionnaires and feedback from residency programs. Might there be some topics that could go? Sure, but not enough to erase a year of study.
You are harping on the krebs cycle, but again it's the instructor's job to make it clinically relevant.
As was mentioned earlier, if you felt unprepared for the clinical environment that's either your fault or your school's.
Also, nurses know plenty. Wise words from an old doc, "they will save your fat from the fire"
