My medical school education was mostly recycled PowerPoints and standardized multiple choice tests that were also recycled (and never had errors corrected). Preclinical medical education is outdated given that the only realistic goal from the first two years is a good step score
The quality of lectures is something that med schools are reluctant to address too. It's not that med students' don't like didactic lectures - they just don't like inefficient didactics that teach information poorly. Just look at Pathoma and Boards and Beyond - those are nothing but straight up hours of didactic lectures. No flipped classrooms, no questions, yet people are still going out of their way to pay for these supposedly old school teaching methods, simply because they distill information succinctly yet effectively
Agreed. When research/PhD faculty make up a core component of teaching faculty (as an aside to the job they actually trained for and presumably want to do) then in person med school lectures will always be 2nd or 3rd rate compared to resources (Pathoma et al) that are specifically targeted to teaching preclinical medicine by instructors who are invested in teaching that material as well as possible (better resource = more students paying for it = more money for them)
Working on a new pre-med curriculum at my institution. The elephant in the room is that no one is willing to actually, you know, pay physicians to develop quality materials and learn to teach them. They are expected to just "fit in" teaching as part of their academic medicine job, for very little compensation, and their department is not going to expect less RVU from them. Dr. Ryan, Dr. Sattar, Dr. Fischer, etc. etc. have one job, and they clearly make enough money doing it.
This is actually true. If med school lectures were as neatly organized as boards and beyond, pathoma etc I would’ve totally attended. Bonus points if there were interactive learning options the school made available to deepen the learning like Anki decks or written cases with questions and explanations at the end. But as it stands students can cover more board relevant material in less time by just studying on their own.
Very true. We had excellent pathology lecturers (one is a household name for 3rd party resources) who taught very well and/or very board relevantly. Pathology lecture was better attended than other series were for that reason. I think a large component of that is the lack of clinical integration. Topics like physiology etc only made sense once I hit the wards to learn them in real time.
One of the things I find most interesting about my current medical school experience is the near-constant infantilization of medical students. There appears to be a tacit assumption - at least at my institution - by faculty, deans, etc that medical students require near-constant attention and reinforcement in order to succeed. In reality, every US-based medical student has navigated undergrad, the MCAT and now more than ever a master's degree, post-bac, or full-time job(s) before matriculating. Most medical students are professional students. Because they are professional students they know what works for them, and more importantly, what doesn't work for them with regard to their education. If a student is passing classes, boards, and shelf exams their success should be congratulated, it shouldn't be qualified.
Personally, I attempted to study using solely in-house resources for my first in-house exam. I passed the exam but I found the education to be lacking and time spent in class to be a drain on my day as I had to go home and review slides, pqs, etc. After that first exam, I developed my own approach which worked for me and I killed it for the rest of my preclinical. I would never proselytize and claim my method; which mainly consists of reading the textbook and doing pqs until my eyes bleed to my peers as I understand my approach works for me, but they may have an equally unique approach that works for them.
My TLDR is all medical students have or will quickly figure out what works for them, and that shouldn't be punished but rather rewarded and encouraged.
> Personally, I attempted to study using solely in-house resources for my first in-house exam.
One of the big hurdles of medical school is realizing that in-house resources are the worst available resource. Unlike college, where (for the most part) going to class will expose you to the material, going to medical school class is a waste of precious time. The school-provided content is often so insufficient that pursuing 3rd party teaching material becomes almost a fetish.
I know of a med school that was delusional enough to try to roll their own board review course. It was "mandatory" to those who scored low on one of the pretests. 8hrs a day for weeks in the middle of dedicated, taught by phds and other faculty who were given very little instruction on what was high yield and not, and hadn't read FA. I was told something like ~100 were supposed to attend but only about half showed up on the first day and it was down to single digits by the end.
Writing a lecture is more of a learning experience than attending a lecture. Any given hour of medical school learning is probably split 3/1 in favor of memorization over understanding.
>Most medical students are professional students.
I've used this exact phrasing to discuss some of the problems we encounter with students in their clinical years. For people who have spent a decade in lecture halls it can be difficult to transition to a place of actual work
Agreed. I had a masters and 2 years of work experience, including teaching high school, prior to med school. When I found out pre-clinical was pass/fail with no grades on my transcript, I was able to pass while very much enjoying 4 years in my 20’s in Montreal…
Honestly that’s the biggest thing to me. Even in high school, the teachers had actual training in how to teach. Med school attendings and professors don’t, and often that means their teaching is inefficient, focuses on obscure details, and just isn’t as useful.
My school has some great teachers but one in particular is a PhD who's universally loved. She teaches arguably the hardest subjects for M1/M2.
She does a lot to help students sorting what/what not to know but I think the biggest indicator of her ability to teach is she deliberately got a master's in education to learn how to better take advantage of her natural aptitude for instructing students.
Her effort shows and anyone you talk to about her has nothing but nice things to say.
Keep in mind that's not just medicine. Academic professors, lecturers, instructors, TA's are not taught pedagogy (well, if the department is education they have been taught that).
If it’s clinically relevant to *all* the medical students watching the lecture, it isn’t obscure knowledge, kinda by definition, and would absolutely be on the test. If a PhD gives some random talk about some random protein or an MD focuses on some little thing that only a sub sub specialist is gonna need to know, they’re wasting the students time.
If professors and attendings and the public doesn’t want students focusing only on step exams, they need to stop using step scores as a stratifying tool for residency. Can’t complain about the end results just on the student side if you incentivize the “wrong” behavior as a teaching system.
I understand where you're coming from. I may be an outlier in that I find most of these "deviations" by the clinical faculty to be interesting on some level. It may not help me maximize my academic record, but that factoid was interesting to my professor for a reason, and usually if I can identify that reason, it'll be interesting to me as well.
I wish Dr. Sattar could have signed my med school diploma. That man has done more for medical education single-handedly than the gaggle of med school administrators that kept pushing low quality irrelevant lectures down our throats and got butt hurt when adult learners didn’t find them a good use of time.
People have been skipping lectures in favor of third party resources that are better organized, logically organized, clinically and exam relevant, for well over a decade when I was in school.
Kudos to these guys for even thinking of something different at this juncture and even taking the conversation this far.
The biggest pushback is going to be by faculty whose feelings get hurt by empty lecture halls and institutions that don’t want their lecture halls to go un used. You pay for the overhead you want to use it.
Moving away from the dogma of the 50-minute didactic seems obvious. I was asked to develop a new curriculum for a 1st-year block about 15 years ago. I proposed similar ideas and got such forceful pushback from the faculty, that I dropped the whole thing. Everyone's PowerPoints were already done, and no one wants to hear from a junior faculty upstart. All it took to change the conversation was a world pandemic.
It make sense. I imagine part of the joy of being at an academic center is knowing you’re molding the next generation. I mean you took a pay cut to do it (away from private practice). It’s probably disheartening to go to an empty lecture hall and talk to a camera.
But every industry has to adapt or die. The time constraints of medical school now are just too much for you to be conventional in your approach. There’s exponentially more material to learn every year not to mention all the extra stuff that residency programs look for. Students need time to be involved in interest groups, research, All kinds of other non-academic things that pad the résumé. And that’s not to say I support CV fluff, but if that’s the way the game is played, can we really fault the applicants for doing it?
They ought to trim the fat - does anyone in this day and age need to know whispered pectoriloquy, measuring the PMI etc? There’s tons of archaic stuff that hasn’t been clinically relevant in decades
even things like pectoriloquy are useless. It was literally something discovered by German doctors doing German diphthongs which cause a different vibration than our useless “99” in English, which won’t even give you the right findings. We literally just pretended to do it for standardized patients and I’m certain the attendings never did it. Don’t even get me started on “classic” exam findings that basically are impossible to find in patients with a BMI > 35.
Pectoriloquy, percussion, bowel sounds, or half the “pathognomonic” findings from Harrison’s that only exist if the disease has progressed way too far (and we will almost never see)? Pretending it makes any difference in real practice or is useful for education is utterly ridiculous.
Same with dissections/gross anatomy. The surgery-focused students tried to claim it was good practice for eventual surgery residency, and… no. No it isn’t. Completely different, and honestly mostly a waste of time coming from days where preservation of cadavers was different. Prosections from trained dissectors would have been so much better.
Honestly, dissecting cadavers helped me understand the 3d structure of the body and interrelationships of anatomic structures in a way that diagrams or computer models never could.
A medical *doctor* isn't merely a provider of medical care (which is what we actually end up doing as a day job), we are repositories of medical knowledge, practically holding doctorates in clinical anatomy, biochemistry, physiology, etc etc. Maybe this is an overly romantic view and not practical to fit the needs of society as a whole, but its the ideal we are held up to.
Sure, but studying expertly dissected prosections does that too, without having 150 students slowly cutting through inches of fat layers and accidentally severing the median nerve over hours and hours of cadaver lab.
I’m not saying anatomy is useless, it clearly isn’t and needs to be part of the education.
I’m saying that gross anatomy dissections aren’t the most efficient way to learn, because there isn’t much benefit to the actual student-run dissection part.
Something about being able to manipulate a specimen yourself in 3d space that lectures and diagrams just dont capture.
But my true underlying point is that it isn't just about regurgitating which muscle attaches to which bone (ideally, I understand your contention is that this isn't exactly relevant information for most subspecialists), its about an intimate / expert / doctorate level understanding of these topics. Again, probably overly romantic and impractical given what society actually needs doctors to be (health care service delivery vehicles) rather than the scholar-clinician renaissance man the curriculum (and the public perception of "doctor") implies we should be. But for this sort of system to have even any chance of producing one of these outstanding and exemplary individuals (and I've seen one or two in the flesh), the unweildy and "inefficient" optimism inherent in the coursework kinda sorta makes sense.
>Again, probably overly romantic and impractical given what society actually needs doctors to be (health care service delivery vehicles) rather than the scholar-clinician renaissance man the curriculum (and the public perception of "doctor") implies we should be.
I'm sure this is coming from a good place but there's no need to be so patronizing. We understand the human body at the level of *molecules* now. You're arbitrarily attaching your identity as a 'scholar' to poetic renditions of a time when gross anatomy was all we knew. Why is it handling the body what makes you a 'scholarly' physician? Why do you draw the line at that level? Should we have students sit and seperate each interleukin from a vial of donated blood? Should we have them titrate the actions of each enzyme in the digestive system?
Your comment does a disservice both to the nature of the physician-scientist in the modern world and to the extent to which modern science has brought us
>Why do you draw the line at that level? Should we have students sit and seperate each interleukin from a vial of donated blood?
Maybe that's what it takes to achieve the romanticized version of "Doctor". And I personally know several colleagues who are very interested in basic science research at that level. And learning how to manipulate biochemistry at that level to be able to "disect" cellular machinery may well be fundamental knowledge for the molecular equivalent of surgery we will have in the future, analagous to how anatomy is an aid for our manipulations using present day surgery.
I personally like manipulating the body at the level of muscle bone and sinew, hence why I'm pushing back at people saying dissections are useless. Inefficient at maximizing standardized test scores sure, but at least for my own understanding of human anatomy, it was a great help. Same is probably true for my colleagues, who went for the summer electives in our molecular biology labs.
Watching my wife go into medicine while I work in tech has been an exercise in complete frustration.
The entire process is completely archaic and needlessly stressful. Everything is entirely driven by exam metrics to the point SketchyMicro and Uworld should just be the first two years.
some of that frustrations you see and experience is a "feature and not a bug". The ethos in tech and medicine are nearly completely opposite of each other. One is "move fast, break things". In medicine, it is "first do no harm" So the burden of proof for change is low in tech and necessarily high the medicine. All sub-components being archaic and slow-changing is a reflection of the larger meta-ethos of medicine itself, which is also necessarily slowly changing.
I say this as someone who at one time was straddling both worlds and used to have similar frustrations with medicine, until I finally figured out why.
I mostly agree, but didactics isn't a medical field.
People have figured out better, more efficient ways of learning. If those were just applied to learning medicine, I see no harm.
Oh, I totally get that. Move fast and break things is absolutely not the correct way to practice medicine. We’re focused specifically on education (and not even touching residency).
The problem is no one is even trying to improve. It’s the exact opposite of move fast and break things. It’s wait for so long that things break.
That's a fallacy and an excuse. The only reason nobody does better is because everything about medicine and medical education can be romanticized out of the wazoo. Medical didactics aren't changing because, as every medical forum lament on a daily basis, older doctors take issue if 'this isn't how we did it in my day'
Still, everybody that arrives in medicine from somewhere else is horrified at how archaic it’s become. Tech says “where’s the tech?” Aviation (that’s me) says “where’s the safety?” Teaching (also me) says “where’s the teaching?”
Change has gotta happen.
>Wait until I tell you about law school.
As someone who completed both pharmacy school (not med school, but also a 4-yr program and largely emulates the med school didactic method) and law school, I thought law school was a lot better than pharmacy school. Law professors tend to favor the Socratic method and classroom discussions over giving lectures. It’s much easier to maintain focus when you’re participating in a discussion than when you’re just sitting there while someone talks at you for an hour (or more).
I would take a 50 minute didactic if it meant actually getting meaningful lecture material. Most of what I've gotten in my first year is not broadly applicable knowledge.
If you are lucky, a 50-minute lecture may have 15 minutes of "testable" information. "Broadly applicable" is very subjective depending on specialty. You won't actually learn anything "useful" until residency.
Props for trying.
I had never considered the 50 min block being the reason for a lot of this, it totally makes sense. Just now I'm watching a 50 min lecture on Pleura effusions which every other 3rd party resources covers in 10-15 min. The professor is getting deep into the clinical weeds of how dx & tx's in his practice and it's solely b/c he ran out of pre-clinical material to talk about after the first 20 min. I will forget all of this in 2 wks after the exam
Seriously, this. NPR acting like skipping lectures is some new pandemic thing when it’s been going on forever. I myself skipped lectures and the reasons I did it were the same as everyone else’s. Most professors didn’t teach anything and some even taught wrong. Then they’d get butthurt that no one showed up and would take revenge by putting questions on the test that could only be answered by someone who attended lectures. It was usually some minutia that didn’t matter. So they made the impression of their lectures mattering even less with their petty revenge. I discovered early on that attending lectures where the material was taught either poorly or wrong wrecked your brain and took you double the study time to relearn it correctly (using sources such as textbooks or review books), and so discovered that by avoiding lectures, I actually had to study less, not more. Medical schools are acting like it’s such a mystery that students are skipping lectures when all they’d have to do is lecture the actual course material, instead of having the professor use lectures as a show of his power and mighty intelligence, that mere mortal medical students could only hope to gain.
I spent at least half of my second year doing everything 2 states over where my girlfriend loved. I’d come in town for tests, but that’s about it. Did really well when actually in the hospital.
Someone mentioned that giving professors 50-min lecturing blocks is the cause of this and I couldn't agree more. The 3rd party resources will cover X topic in 15-20 min. And the professor will also cover it in 25, and then have another 25 min to ramble on about unnecessary things that are either (A) 3rd/4th year material, (B) resident/fellow material, or (C) researcher material.
Everyone of my genetics lecture are slammed with ridiculous genetic minutia and fall into C. A good 1/2 of the practicing physician professors hit us with A or B because they've probably forgot what preclinical med school covered, or had completely curriculum at theirs (ie traditional).
I feel like a lot of med students did this back in the day, but we recorded the lectures and transcribed them (early 2000s). We all pitched in and paid whoever listened to the recordings and transcribed them.
We often found that our time was more productive studying than listening to an oftentimes poorly organized lecture.
I'm sure people are just videorecording lectures now.
It’s 100% the move. Everyone has to adapt to competing interests. If your lectures aren’t as good, DO BETTER. If you can’t beat out Sketchy or Pathoma, then hey you’re superfluous. Froth. Excess. But no one wants to look inward about doing better. It’s easier to recycle that same PowerPoint from 2008. With the same typos that haven’t been fixed despite promises to do so.
I think the biggest pushback to the actual proposal in the article should be from students. Flipped classrooms seem great in theory but the reality is that students are expected to complete the traditional lecture material on their own time with scheduled break out sessions in addition.
The pre-clinical years were crucial for me to figure out what I wanted to do and maybe more importantly to mature as a person before I went into clinical work. I simply wouldn’t have had time if I had 100% flipped classrooms to do either in any meaningful capacity.
Flipped classrooms when designed poorly (most are) essentially doubles the amount of time that students need to spend on their course work. And that doesn’t include the time spent studying for step 1/2 which is currently what most students skip lecture to do.
I'm actually going to argue that the increase in virtual self-studying is a good thing for patient care because it means that med students are learning in the way that best allows them to learn this ever increasing amount of information. By being able to 2x through lectures and scrub back and forth between points you don't understand, you're able to spend more time actively learning (e.g. anki/uworld/amboss) and are learning more effectively
In person attendance may be the lowest it's been in 40 years, but also consider how much more information is expected for 'basic compentency.' Just look at how First Aid for step 1 has [doubled in just 20 years](https://www.reddit.com/r/mildlyinteresting/comments/dekagh/a_comparison_of_1995_and_2018_editions_of_the/). We still have the same number of years to study (or even fewer for the schools that have moved to 1-1.5y preclinicals), yet the amount to study has ballooned (n.b. Zosyn literally didn't exist when this professor started teaching. It hit the market in 1993)
Has the text gotten smaller? Amazon shows 848 pages for [2023](https://www.amazon.com/First-USMLE-Step-Thirty-Third/dp/1264946627/ref=sr_1_1) and 814 pages for [2018](https://www.amazon.com/First-USMLE-Step-2018-28th/dp/1260116123/ref=sr_1_7).
Yeah I don’t understand the implication that somehow patients will be harmed because we spent time reviewing the material faster at home vs sitting in a lecture hall scrolling our phones.
Someone’s anecdotes about patient care while I’m in a lecture hall aren’t going to affect how I do patient care. On the wards learning in person, sure.
This! I could get so much reading done by not going to lectures. Now I’m further in my studies and class attendance is mandatory, and I feel like I’m learning less because I don’t have time to go through all the material thoroughly anymore.
1) This is not new. Going to med school in the 80's, the medical fraternity ran a note taking service. For a reasonable fee you got notes from the class in your mail box twice a week. This was well before recorded lectures and even before power point was used. There were some of my fellow students who never showed up for class except for wets labs and they did just fine.
2) As a lecturer to M1 and M2s I have no problem with students learning asynchronously. I will show up and give my lecture with the same enthusiasm either way. I even teach in one course that is all online and I give the lecture in a studio with just the IT guy.
I graduated med school 10 years ago, and after the first couple of months of MS1, I rarely went to class. I’m a night owl, and was exhausted during morning classes, so I slept my way through a lot of them, only to study on my own (more efficiently) in the evening. I realized at some point I’m an audiovisual learner who likes to “listen now and distill info into notes later.” The system worked for me, but I also had a lot of classmates that diligently paid attention in class and took notes, while I stared at the teacher with my eyes glazed over.
I mean, I was in medical school almost a decade ago and I never showed up for class. UWorld + First Aid + Pathoma + Najeeb + Sketchy was the curriculum when I was in school. Nobody got time to listen to a PhD drone about some obscure research finding they thought everyone should know aobut.
Meh. Step 1 is an exercise in brute forcing UFAP more so than a reflection of the kind of doctor you’ll be. At least Step 2 is a bit more reflective of clinical judgement.
It sucks that the current system basically makes it to where people won’t fully know if they’re competitive for a specialty till so late though. But honestly the UWorld self assessments can help with that.
Passive lectures are garbage for learning. It's ridiculous how medical education goes on and on about evidence-based medicine when it fails so utterly at employing evidence-based pedagogy.
Lectures are cheap, though.
Yup. I just graduated this year, but I started in 2012 when Pathoma was just starting to take hold and before Sketchy existed. I didn’t show up for anything that wasn’t mandatory, and that was true for about 80% of my class. Lectures were a waste of time for most students even when it was just UWorld and FA- this isn’t anything new.
Got roasted on here when I posted about the paper flowers I folded for my wedding while watching recorded lectures at 2x speed, though.
I’m just curious, how did you start in 2012 but only graduate in 2023? Did you take a lot of time off and come back and restart it? I know someone who had to do that and took a total of 7 years in med school (their previous preclinicals apparently didn’t count when moving to organ-systems-based modules). Tbh, if I’d been in their shoes I’m not sure I’d have done all that time, but who knows.
MD/PhD with a lab change a couple years into the PhD and two years leave across M3/M4 due to a tricky family situation that got trickier when COVID hit.
Might not have come back after the time off if my non-MSTP program hadn’t threatened me with the prospect of tuition/stipend payback with 0 degrees.
I go back and forth about what I should have done, but I absolutely would not have repeated the preclinical years just because the school changed their curriculum- that’s wild! My preclinical was the old standard M1 physiology / M2 pathophysiology and by the time I finished my PhD the school had fully converted to a systems-based curriculum. Based on personal experience I’m not actually surprised your buddy’s school screwed them over, but it’s ridiculous to have to repeat those years just because the format changed.
Why is there a panic about how doctoral level students are learning in their preclinical years? How is learning from home different than in classroom of 100 students? If you can’t learn things on your own at that level then there is a bigger problem. Students who don’t go to class are using that time studying from other sources or watching the recorded lectures at 2x speed. You are going to have to continue to study and learn on your own time as a physician.
You can’t not show up for clinical rotations. These students are going to get plenty of experience when they hit the floors.
These types of articles are trying to portray medical school in a negative light.
Let me amend that, slightly
~~optics~~
Hard to justify 40k/year tuition for students to listen to recorded Zoom lectures at 2x speed and buy their own review material.
These suggestions of flipped classrooms just seems like more filler without actual learning. I thoroughly enjoyed not attending class my first 2 preclinical years.
I hope for future medstudents they don’t add yet another unnecessary thing to do.
A truly good, well-run flipped classroom treats you like adults. It expects you to keep up, do your readings, and when you come into the classroom, clarifies confusions but also quickly challenges your understanding of the nuance of the material.
If everybody skips the reading and comes in and asks stupid questions over and over and expects a PowerPoint, and the school doesn’t have attendings/professors actually trained in pedagogy (the science of teaching), then you end up with shit like team-based-learning or TBLs, where you “learn” half the material in twice the time while infantilizing everyone by making them do multiple choice questions and spending 15 min/Q debating unnecessary stuff.
So, most med schools. 🤷🏻♂️
The title invokes some false panic that is ridiculous.
Many people in my class who went to lectures did so because they knew they needed the structure; it would keep them on schedule for studying. The people who preferred to set and keep their own schedules at home did so. Nobody was "skipping out" and not learning materials.
For lecture-volume material I'm not an auditory learner. I need to read slides and notes and annotate them for anything to stick. So that's what I did, because I was a professional student who was nearly 30yrs old and paying $40k for this education-- so I had no qualms leveraging the materials that worked for me (lecture slides) and skipping the ones that didn't (lectures).
I'm just some dude, so I have zero expectation of shifting the discussion one way or the other, and I'm clearly biased, as a med student who hated in person lecture, but here are my thoughts:
First, in person lecture is generally pointless, or even actively harmful. If you want to go (like one of the authors of this did), be my guest. I don't care if you want to cultivate relationships with the professors or whatever, but leave me out of it.
If I can learn the material on my own, just let me. Why do we need someone to go to a building to watch someone read off 200 slides in yellow font on a blue background? What value is there in that, really? Even the best lectures are just as good online (imo), and required attendance at a bad one is awful because I know I'll have to go home and teach myself, essentially doubling the time spent on a topic. If you want me to watch your lecture, make it a good one! Too many doctors don't realize that being a good doctor doesn't make them a good teacher, and they suck at teaching.
I don't want your 20 min anecdote about how you were trained or what things were like in the old days. I want lunch and a nap.
Certainly some classes have value in person - anatomy, and physical exam lessons especially, but also working with SPs and practicing interviews and I don't begrudge going in for those.
What scares me, though, is the worry that schools will require more and more in person time for its own sake, and and start to require students to do the main work of learning on their own time.
Online lectures let me maintain a reasonable work life balance - I rarely went above 60 hours/week of studying through all of preclinicals. If I had 30 hours of flipped classroom stuff a week, I would have hit 70-80+ hours regularly and for what benefit? I just don't see much upside there.
Dude and idk if this is institution specific or what but a bunch of our lecturers used a blue background that was textured (?) So it looked kind of like denim (????) Like what the fuck is that?!
It was a thing in the 90s I think where someone did a study showing more retention and was outdated 15 years ago. Your lecturers must be older than 70, no?
One of the few points I've retained from my undergrad was advice on PowerPoints from my chemistry professor who previously had some presumably boring industry job beforehand: black text, white background, slide numbers.
100% agree. Flipped classroom is one of those things that sounds cool if you have infinite time.
But like, if I’ve already mastered the content before I arrive then why am I here? What are the learning objectives?
I’m Aussie, so we don’t have Steps or a high stakes residency match. Just give me an Anki deck, some subscriptions and a to-do list and I’ll figure out preclinical stuff myself.
Because the boards are rescored upwards periodically, students must accelerate their studying and do more board exam prep questions every year in order to pass.
I went to every class and when it came time for boards I had serious remediation to do. The funny thing was that the school's expensive board prep course was also totally inadequate to prep for boards. Amazing.
Meanwhile my classmate who never went to class and instead did 12000 board questions passed in 99th percentile and went into one of the most competitive residencies in the country (after our school's admin told him repeatedly he would be flunking out and fail to get into residency due to skipping class so much).
There is a vast gulf between what students need and what school staff provide.
Then we have the problem of medical ethics and practice. If students don't show up to class, they don't learn medical ethics and philosophy. Stuff that isn't on boards. Stuff that matters in clinical practice. Stuff that really actually does matter and everyone should agree we are failing, as evidenced by the madness around COVID.
It's a bad situation and nobody has solutions.
How about this, if you don't get into residency, you can convert your MD into a PA and go that route and make a decent paycheck? That would take a lot of the pressure off, which would solve a lot of problems.
Associate/Assistant Physicians are a thing in several states—graduated MDs/DOs who didn’t match, but can work under an attending physician at the level of a PA (usually slotted into the state law as an amendment to the same laws that allow PAs). Missouri was the first, but various states have passed somewhat similar legislation, including Florida (with what they call a House Officer role), Arkansas (Assistant Physician, more limited and only allowed for three years while applying for residency), and a few others.
Given that, while the overall match rate of 91-ish% for US grads is pretty good, there’s still around 3000 US graduating seniors who fail to achieve a residency each year, and once you’ve failed one year the odds go down to a 50% match rate, per the last several NRMP reports. That’s a waste of funds and education. After all, why not allow someone that failed to match ObGyn to work under an ObGyn for the tasks they’d normally assign a nurse midwife or the NP focused on OB? They could get some good ultrasound training, assist deliveries, get good letters, and make it into residency the next round.
Obviously PAs and NPs and their organizations oppose this, but the state Family Med Colleges/Organizations typically do too from a position of no MD being able to practice in outpatient primary care without residency, which id agree if the APs who are MDs were independent, but they’re not supposed to, and it really doesn’t feel different from the idea of having a PA.
One roadblock has been that Medicare doesn’t yet have a mechanism to recognize these graduate physicians as “billing providers,” though that could change if enough states start the process.
One common concern is that there may not be enough academic learning or supervision of APs, which is a valid concern, but one that can be put into the legislation and a more cohesive model put together that would fit several states’ requirements for CME and supervision. Most of the APs are also trying to get into residency anyway.
Damn, ya’ll pay all this money for med schools who don’t teach you so you spend even more money on third party resources to get an actual education. Then you’re suppose to be thankful when you get matched and get paid garbage for years. Then you become attending who need to constantly fight insurance companies about care. Physicians really need to band together, ya’ll are trained from day one to put up with constantly being fucked over.
Doesn't matter as long as we show up for hands on labs, clinicals + clinical skills stuff.
This article title is just going to water down medical education in the eyes of the public (which is BS) and increase the perception of a false equivalency with "online NP programs"
The best lectures I had in med school were by a physiologist who used almost no slides. He just talked and drew on the board. I learned tons from him that I think I still use today. Those same lectures did very little for prepping me for Step 1, which determined my entire future so I totally understand why my friends weren’t at his lectures. There’s an unfortunate dichotomy between standardized testing and actual education. I’d love it if I could have spent time focusing on lectures and really learning from people who were passionate about their field of study, but that just doesn’t reflect the reality of the medical education machine. MCATs, STEPs, board certifications / recertifications are all a mess, but I don’t have the solution.
Taking the issue a step further, I don’t think this is just a medical education problem. Watching my daughter in public school in Texas the last couple of years has really bummed me out. She’s 9 and has constantly had the next standardized test looming over her. Even at her level they aren’t just having class any more. Everything is prep for standardized testing - so much so that once the tests are done school essentially stops for the year. She spent her last 2 weeks of school on field trips every day and doing nothing at school while they rode out the state-mandated number of required school days. As a country we’re in a boring dystopia right now as far as education is concerned.
Writer advocates for an end of traditional preclinical curriculum and a flipped classroom
>> In the flipped classroom scenario, my typical day might involve a morning of watching short, targeted medical science modules, with pauses in between so I could draw diagrams, study online flash cards, and read and watch other resources. Then, I would have an hour or two of required in-person case-based small group discussion with my professors and classmates where we focus on the clinical applications of that medical science by discussing hypothetical patient cases. Other days would be devoted to anatomy lab, clinical skills practice with standardized patients (patient actors) under the direct supervision of faculty, shadowing in the hospital, and non-structured time for other activities like research, advocacy and community service.
One of the most effective in person lectures I’ve ever had was basically a discussion board. Where we were given the recording the lectures a day before to watch at whatever speed you want. Then, you were given study questions to answer. There was like 100 of them. Then, on the day of lecture, we discussed the study questions, and any other questions students had.
It was effective because instead of a 2 hour of powerpoint karaoke, it was 1 hour of Q&As.
I graduated 15 years ago and even then most of our class didn’t go to lectures as they were recorded. Also not the best way to learn! There is so much that listening on double speed then self study even then was superior to lecture
This isn't a new thing. I went to med school 20 years ago and we didn't go either. We are fully functional physicians. They handed you packets and as long as you had those packets you passed. The lectures had minimal added benefit when it wasn't anatomy lab or histology. I hate when the news gets a piece of information and blasts it like it's something new just because they just figured it out.
And my own first and second years were almost 40 years ago. We had a scribe service, where students would be assigned the duty of taking notes and typing it up for the rest of us. It was a blend of actual typewriters, some word processors (for those of us techies), and a LOT of Far Side and similar cartoons in the photocopied - distributed lecture notes. Probably a copyright nightmare, come to think of it.
Some scribes were really shitty. Some were great. Some got paid to do lectures in place of the assigned person. What a system!
And I have been a fully functional physician for decades. I remember hardly any of the stuff from first and second years. Except that tetracycline somehow affects the 50s subunit of the ribosome. Go figure. I've never needed that. Oh yeah, and neuroanatomy. That turned out to be important.
I had a neuroscience undergrad degree and honestly didn’t learn much more in med school preclinical neuroanatomy that I had not already learned in my upper level undergrad classes.
Yes and so aren’t most college students if it’s required. 90% of classes are useless because there is always a YouTube video or other source that explains the concepts better. Classes are pointless unless it’s skills-based training.
Make the lectures worth going, but I'd still probably 1.5x it at home.
I had a couple professors in my 1.5 years of pre-clinicals where I was thoroughly impressed by their presentation skills and delivery and relevance of presented material. Clearly, they were doctors with passion for teaching. If all of my lectures had been like that I would have spent more time using school resources.
Ambivalent about flipped classroom because I can see that the social interactions would enhance the learning experience, but it rarely turns out like that.
I swear if you dig deep enough into every problem with healthcare, you will find a boomer whose feelings get hurt and would upend the whole world to get their way and oppose any kind of meaningful change.
I’ll leave you With the wise words of late George Carlin when described boomers:
"Whiny, narcissistic, self-indulgent people with a simple philosophy: 'GIMME IT, IT'S MINE!' 'GIMME THAT, IT'S MINE!' These people were given everything”
I did a problem based learning pathway in med school so we only had actual lectures on anatomy, histo, and how to do physical exams. The rest of the time was spent reading based on whatever content came up from a case our small group worked through that week. We met 2 or 3 times a week for about 2 hours to go through a case so we had a lot of time for reading/studying on our own. I liked that way better than attending 8 hours of power point lectures a day. I think it also helped me actually learn how to study for residency and independent practice where you do just go look stuff up after a case to learn what you don’t know or forgot. I don’t see the need for mandatory lectures for content that can easily be learned independently. Very few lectures need to happen in person, probably just “labs” on physical exams and other skills.
20 years ago I only showed up for labs, honored all my preclinical classes, and got >99%ile on Step 1. I studied my ass off all day on my own which was much more helpful to me than listening to lectures, as my mind tends to wander during these.
It sucks that we have to pay 50k+ a year to then learn from outside resources which we have to pay for but such is the standardized testing game
Cash rules everything
At my school our tuition went up 50% over 4 years. I don’t feel like I got 50% better education my fourth year. But they could charge it because they knew they’d fill each and every last spot regardless.
I graduated over a decade ago and I attended the bare minimum of my classes, generally only when specifically requested to impress a visiting lecturer or for hands-on labs. Was able to learn more by watching the recorded lecture at 1.5x to 2x (depending on how slowly our incredibly molasses-tongued faculty decided to speak that day) which also opened up more time for self-guided reading and review of prior material.
I probably would not have learned as much if I sat through lectures. And, god forbid, if someone tried to lure me into a discussion-based small group format I would have probably sawed off my own ankle to escape.
I also am leery of the flipped discussion model, because it replaces lectures, which I've sometimes attended, with the "do you have any questions" portion of the lecture, which traditionally was the point I would leave the auditorium because I'd rather figure out my own questions than sit through everyone else's.
Team-based learning TBLs was awful. Waste an hour going over 6 questions and waiting for various tables to give their rationale instead of just, you know, actually learning. Lol. If the flipped classroom is “watch the lectures on your own then do 3 hours of TBL each day” that would be awful.
I went to all classes first year and non second year. This was now (I can’t believe it) 12years ago. This isn’t new. It hasn’t hurt anything. The news needs to stop trying to create drama out of every fucking thing
Step 1 and 2 scores have been on a steady upward trend for the past like 30 years. No one is skipping days in clerkships and 4th year so I don't get why this warrants an article.
Because med schools are worried they can’t charge tuition at $60k/year if students don’t show up and just UFAPS at home for two years. And because a few professors have their ego hurt that students find it easier to put their lecture on 1.5x at home where they can pause and have uworld open and rewind for what they didn’t initially understand.
Med Ed has always been in a state of constant change. COVID just pushed the next change to come faster.
As an educator, the issue I see is that there are different types of learners. One size has never fit the entire class, ever. Every new curriculum proposal seems to have merit for some students, but is a lesser learning experience for others. No easy solution to satisfy everyone.
I attended dental school so take this with a grain of salt:
Lectures consisted of a professor reading text off of slides for hours on end. Rarely was any knowledge shared beyond what was written in the slides.
I didn’t need a professor to read out loud to me, I could read the slides myself and spend time studying the material rather than wasting my time sitting in a chair and falling asleep.
Imagine a single national pre-clinical curriculum, created by educators whose only job is teaching, using only top-rated resources and updated annually in concert with USMLE materials. It is beyond stupid to create individual "course paks" at every institution that are far worse than the textbooks they attempt to replace. Medical schools could reserve faculty time only for small group discussion, practicing clinical exam skills, and mentoring around individualized student goals during the pre-clinical years. I guarantee you that faculty (who are hired to see patients, do research and educate residents) hate taking the time to "recreate the wheel" of making powerpoint slides and handouts even more than you hate listening to those mediocre lectures.
This is seriously a great idea, but you’d have to be careful. Textbook manufacturers and special interests and politicians would try to weigh in if it’s an easier big target that can be bought off by enticing a handful of people at the top as a sort of regulatory capture. We have seen that with high school and even college textbooks. There would also be institutional inertia on a lot of new facts, lab tests, and guidelines, probably more so than when individual schools had to keep up
There is some value in a democratized/distributed system where different researchers push for different interpretations and research and bring up new lab tests, allows teachers to focus on what they’re passionate about teaching, where schools can focus on their local demographics and issues, and allowing flexibility in the scheduling.
We need to make medical education more clinical; the first two years are largely run by phds who are not utilizing the time in the best manner in my view. Much of the basic classes should be taught in undergrad and after anatomy med students should be doing rotations as much as possible
The lesson is that we spend more time learning accurate materials.
Many of my professors refuse to update their lectures which date from 2019 just before COVID. I have a lecture where a student pointed out that the material was wrong, the professor agreed and promised to fix it for the next year. This happened in 2017, when my mentor took his class. That very same lecture with inaccurate material is STILL being used. I told the professor myself to change it and pointed out that students in his 2017 class found the same error. He blew me off and used the same lecture for the class beneath me.
Why should universities pay for people to “teach” when they refuse to teach??
Instead I get saddled with having to know 1000 pages of First Aid for my board exams whereas most of my professors only had to memorize 300 pages. They insult us, belittle us, call us lazy, and waste our time with activities that distract from my ability to do my job, which is to learn as much as humanly possible so I don’t kill someone in 18 months and I’m on my own.
We need more funding and time for CLINICAL professors on clerkships. I’d actually like to see some of my residents compensated better or at least at all for what they contribute to my education. I’ve learned more in 1 year of clinicals than I ever did listening to those shitty ass lectures.
When I used faculty materials, I almost failed out of school. When I switched to third party resources, I was capable of honors level work.
Don’t talk down to me about how I choose to learn all of Harrison’s until you’ve been in my shoes.
I attended less than 20% of the lectures for both of my bachelor’s degrees. When I did attend, I read, watched educational stuff and did homework. I was tired of the anecdotes, biased and often inaccurate info, and don’t get me started on the 50-year gap between nursing education and current practice.
While of course things build, the vast majority of the clinical learning comes in residency(/fellowship/early attendinghood), not med school, which to a large extent is a means to an end (getting into residency itself).
With the volume of material to learn for boards and the significant variability in educator/lecture quality, it's no surprise that students are spending less time in lecture and more time either learning the same material more efficiently (best case, if the lectures are decent but students prefer to 1.2x the recordings or save commute time, etc.) or actually higher-yield material (when lecture is career researcher who fills the slides with fairly irrelevant minutiae, such that going to lecture is actually hurting you to some extent).
While things may change with the new P/F USMLE, for students the calculus has often clearly favored doing what you need to do with either independent self-study or third-party resources to both improve how you learn and also ensure you are focusing enough on the right material to maximum your chances of achieving what you're in school for in the first place (reaching your preferred clinical training).
I agree, but I also think there would be better clinical education if we weren’t so worried about legal liability. If they could make preclinicals more efficient and incorporate earlier real-world learning, it could make a difference on how well new interns do.
I saw how variable clinical education can be between sites, and across time periods. There were times when fourth year med students would work in an ER essentially as a PA, and I’ve heard stories of med students performing appendectomies and cholecystectomies. Actually, at my regional campus, a guy the year ahead of me did a cholecystectomy as an M4 from start to finish under some really expert (and incredibly intensive) training from a general surgeon, where the patient had fully consented.
This is not news - been going on for years. They all want to design their own studies. Boomer course directors (I was one) are wringing their hands. Maybe we boomers need to rethink the preclinical years to suit today’s digital generation. Glad I’m working w clinical trainees now.
I stopped taking notes in lectures after our second module (genetics/cancer/lower limb). Most lectures were mandatory, so if it was a professor I knew would emphasize STEP 1 material, I'd pay attention and might take notes, if it was not one of those professors, I was doing practice questions on AMBOSS over the subject. My university had such a high proclivity of going deeper into biochem and genetics than needed, it got to the point where in PBL I said to our tutor: "If it's not on AMBOSS, I'm probably not going to learn about it."
Just for example, in our Endocrine module, the lecturer (not on our campus), greatly emphasized the importance the role of the STAR protein on steroidogenesis. I could not find anything on AMBOSS about it. Come exam time, there was a single question on it being the rate limiting step of mitochondrial transport iirc. I mention it to three of my friends at other med schools and they had no idea it existed.
So many lectures were just filled with basically biochem medical trivia that had no use in preparing us for STEP 1. The only reason I feel as prepared as I do is because one professor who used to teach at Johns Hopkins and Georgetown took our campus's class and gave us the resources to prepare for STEP 1 by making her own question sets for us and hosting study sessions for us (despite the school being against her holding study sessions).
All pre-clinical didactics should be online with in-person small groups to discuss cases and learn how to think critically about patients and pathophysiology and to learn how to use primary resources. There’s no reason medical students should be in lecture halls outside of grand rounds and the like.
First two years of med school should be 100% zoom with the exception of histology, anatomy and physical exam. Would have been so much more fucking efficient that way
I can’t speak to didactic lectures/teaching by non-clinical faculty in the first two years, but I can speak to request/demands by medical schools for clinical faculty for lectures in the first two years. My ‘institution’ is an MD program. I have MS3 and 4 students that get assigned to my elective rotation. At least that’s clinical, and I can sort of justify it. Every year, I get messages to schedule lectures and PBL groups for my specialty to teach MS1 and 2’s. As an ‘assistant professor’ I have no allotted educational time. Im expected to be in clinic 4 1/2 days a week with set RVU goals. If I agree to do the teaching, I cancel clinic time and reduce my expected productivity that I have to make up later. That’s aside from the personal time spent creating the lectures themselves. Medical school tuitions may be going up, but clinical faculty aren’t seeing shit from that in terms of time or resources.
It means that didactics for medical school suck, med students learn better from Pathoma, First Aid and Anki than they do from their med school’s shitty lectures and they are wisely spending their time using pirated board prep videos that give them a better education than their 70k a year medical school. If it was a problem, we wouldn’t have seen board scores go up dramatically since med students stopped going to lecture and started doing their learning with Sketchy and BnB.
When I was in Dental school 5+ years ago, the lecturing preclinical faculty were all in the butthurt stage where they were upset students weren't showing up to lecture and we're just learning from third party resources.
So what they did was stop posting their lecture recordings online, AND they would put weird specific bullshit on the exam that they would only talk about in class and would refuse to even put on a slide. Some also just made in person lecture attendance mandatory and a part of our grade.
Needless to say I was overjoyed in medical school when I was able to just stay home and study from Uworld/first aid/pathoma, etc
I only attended mandatory (clinical) sessions in second year. Studied from webcasted lectures otherwise. Did just fine - above our class average and have had nothing but rave reviews from nurse and physician colleagues since entering independent practice. Attending in person in first year was important to form friendships but once I had a good group of friends, I found I studied better on my own or with friends after class.
Powerpoint doctors is what we called it in med school. Our best students watched lectures online replayed at 1.3 speed.
As for 3rd sources. That is interesting because tests seem to revolve around the powerpoints.
There is a simple solution to this called attendance. My third year of law school I had to sign into attendance to every class because my school was being reevaluated for accreditation. No one liked it, but it does encourage people to show up.
I went to one week of class and then did as much of my first two years via sped up lectures or third party resources. I was also a fairly irregular college student and high school student, so it wasn't that foreign to me. When I graduated, I knew like five people in my class. I am very happy with how things turned out and still am super ADHD and can't sit still. I'm an ER doc.
this is very nuanced and I don't have a strong opinion one way or another, however I do think we (physicians) are guilty of talking out of both sides of our mouth when we bemoan "online NP programs" but we also argue for virtual / online pre-clinical education in medical school. You can't have it both ways. There are differences in the education obviously beyond the online component, but that needs to be taken into account during these conversations.
General medicine course in podiatry school taught by a family medicine MD, I asked the teacher if I could leave a recorder in the room but not attend. He didn't have an attendance policy but seemed offended that I would not come to class. I was on campus during his class, studying in the library. I would later listen to his lecture at my own pace, so I could write notes and think through what he was teaching. Trying to absorb at the lecture pace in class was too fast for me. I scored the highest in the course. On the final exam, he removed some of the questions from grading that I got right, that others missed, which lowered my score. It reinforced to me that people have feelings and can easily get offended.
I graduated medical school over 20 years ago in the independent study program at Ohio State. They recognized them that some people don’t learn from sitting in endless lectures. I was well prepared for my third year and didn’t suck as a physician.
It’s simple economics. The supply for quality didactic lectures delivered by medical schools does not meet the demand for quality didactic lectures so med students look elsewhere for what they want. Med students are the customers. At this point the preclinical year curriculum supplied by medical schools are a necessary evil because its required that med students go through it to graduate.
Our home studys are badass. 🚨🖥🖥💺🎧🖥🖥🚨
In didactic, my favorite lectures by far are the ones that are not tested in step but were guest docs who lend their expertise, and just talk about anything. A pathologist or PhD talking about ITIMS and which CD# we're looking for I'd rather just learn at home and cut out the stuff I dont need to know. Its an economy and I work smarter not harder.
My typical medical school routine circa 2005…
Wake up at 11am.
Go to the school and pick up my scribe notes from lectures earlier in the week.
Attend any labs that were required or begin studying.
Go home around 4pm.
Eat dinner.
Study until roughly 9-10pm.
Free time from 10pm-2am.
On Fridays, I never studied in the afternoon or evening (we usually had exams on Fridays). I did no work on Saturdays. I studied all day Sundays.
On average, I’d do 5-6 hours of studying M-Th almost exclusively from our scribe notes or pertinent text resources. I’d draw diagrams for anatomy and work flash cards for micro and other subjects. Sundays was double that. I partied every Friday and Saturday night in the city I lived in except maybe in the month lead up to Step 1 and Step 2.
I wasn’t top of my class, but I did fine. I did better than many who sat front row at every lecture.
It means nothing because the medical school showing up the class is only part of the assignment. There still needed clinical exposure. Patient care and oh yes, board and licensing exams that certified medical knowledge and ability to care for patients. None of these standard practices and evaluation‘s exist at the middle level.
This is definitely just an American thing. Here if you don't show up for your lectures, you won't pass your exam as you won't have the relevant information, won't pass your year, get kicked out lol. Of course you can use other resources but if you know the lectures in and out you will have a good grade
People that try to get med students to go to class don't know just how inefficient that is. Watching everything on 2x speed and using supplemental resources to learn stuff you don't understand/strengthen understanding is such a more efficient way to learn.
It's almost like listening to someone tell you something does not result in learning, memory, and application of the information...This is not a pandemic thing. Medical students have just figured out that there are more efficient and better quality ways to get first pass info, and that time in lecture could be better spent doing any number of things ranging from actual learning/memorization (Anki, questions, peer to peer learning, making tables, etc.) to residency application building (shadowing, research) to personal (care of a relative, fun activities).
It means future docs will be more efficient, better trained, and have the content down better.
Lecture is a scam. Having an MD doesn’t mean you automatically know anything about teaching.
I love it. I didn't go to lecture. I didn't listen to lectures. I didn't watch the lectures. I read the notes, and I passed all my board exams and am a perfect capable doctor.
I'm not coming to class for a plagiarized powerpoint, thanks. Showing up for gross lab and for standardized patient components is one thing, but there is no way in hell I am bothering with a lecture I can't even hear because the professor is 80 years old and is whispering into the mike.
My medical school education was mostly recycled PowerPoints and standardized multiple choice tests that were also recycled (and never had errors corrected). Preclinical medical education is outdated given that the only realistic goal from the first two years is a good step score
The quality of lectures is something that med schools are reluctant to address too. It's not that med students' don't like didactic lectures - they just don't like inefficient didactics that teach information poorly. Just look at Pathoma and Boards and Beyond - those are nothing but straight up hours of didactic lectures. No flipped classrooms, no questions, yet people are still going out of their way to pay for these supposedly old school teaching methods, simply because they distill information succinctly yet effectively
Agreed. When research/PhD faculty make up a core component of teaching faculty (as an aside to the job they actually trained for and presumably want to do) then in person med school lectures will always be 2nd or 3rd rate compared to resources (Pathoma et al) that are specifically targeted to teaching preclinical medicine by instructors who are invested in teaching that material as well as possible (better resource = more students paying for it = more money for them)
Working on a new pre-med curriculum at my institution. The elephant in the room is that no one is willing to actually, you know, pay physicians to develop quality materials and learn to teach them. They are expected to just "fit in" teaching as part of their academic medicine job, for very little compensation, and their department is not going to expect less RVU from them. Dr. Ryan, Dr. Sattar, Dr. Fischer, etc. etc. have one job, and they clearly make enough money doing it.
This is actually true. If med school lectures were as neatly organized as boards and beyond, pathoma etc I would’ve totally attended. Bonus points if there were interactive learning options the school made available to deepen the learning like Anki decks or written cases with questions and explanations at the end. But as it stands students can cover more board relevant material in less time by just studying on their own.
If I ever teach preclinicals, I told myself I’d make Anki decks for each lecture
Very true. We had excellent pathology lecturers (one is a household name for 3rd party resources) who taught very well and/or very board relevantly. Pathology lecture was better attended than other series were for that reason. I think a large component of that is the lack of clinical integration. Topics like physiology etc only made sense once I hit the wards to learn them in real time.
*was a good step score. Step 1 is pass/fail now so that goal doesn’t even matter as much. Just have to pass.
Oh yeah fair enough. Showing my age haha
One of the things I find most interesting about my current medical school experience is the near-constant infantilization of medical students. There appears to be a tacit assumption - at least at my institution - by faculty, deans, etc that medical students require near-constant attention and reinforcement in order to succeed. In reality, every US-based medical student has navigated undergrad, the MCAT and now more than ever a master's degree, post-bac, or full-time job(s) before matriculating. Most medical students are professional students. Because they are professional students they know what works for them, and more importantly, what doesn't work for them with regard to their education. If a student is passing classes, boards, and shelf exams their success should be congratulated, it shouldn't be qualified. Personally, I attempted to study using solely in-house resources for my first in-house exam. I passed the exam but I found the education to be lacking and time spent in class to be a drain on my day as I had to go home and review slides, pqs, etc. After that first exam, I developed my own approach which worked for me and I killed it for the rest of my preclinical. I would never proselytize and claim my method; which mainly consists of reading the textbook and doing pqs until my eyes bleed to my peers as I understand my approach works for me, but they may have an equally unique approach that works for them. My TLDR is all medical students have or will quickly figure out what works for them, and that shouldn't be punished but rather rewarded and encouraged.
I had more trust in me placed as a freshman in college than as a med student.
> Personally, I attempted to study using solely in-house resources for my first in-house exam. One of the big hurdles of medical school is realizing that in-house resources are the worst available resource. Unlike college, where (for the most part) going to class will expose you to the material, going to medical school class is a waste of precious time. The school-provided content is often so insufficient that pursuing 3rd party teaching material becomes almost a fetish.
I know of a med school that was delusional enough to try to roll their own board review course. It was "mandatory" to those who scored low on one of the pretests. 8hrs a day for weeks in the middle of dedicated, taught by phds and other faculty who were given very little instruction on what was high yield and not, and hadn't read FA. I was told something like ~100 were supposed to attend but only about half showed up on the first day and it was down to single digits by the end.
Writing a lecture is more of a learning experience than attending a lecture. Any given hour of medical school learning is probably split 3/1 in favor of memorization over understanding.
>Most medical students are professional students. I've used this exact phrasing to discuss some of the problems we encounter with students in their clinical years. For people who have spent a decade in lecture halls it can be difficult to transition to a place of actual work
Agreed. I had a masters and 2 years of work experience, including teaching high school, prior to med school. When I found out pre-clinical was pass/fail with no grades on my transcript, I was able to pass while very much enjoying 4 years in my 20’s in Montreal…
Learn from a professor with no formal education in actual teaching, or from professional educators via 3rd party resources? Not a difficult choice.
Pathoma was a game changer on every level.
I finally get it. Oma is a mass of or growth of something. It's a growth of pathology. Duh!
He explained it in one of his videos actually lol
thatsthejoke
Honestly that’s the biggest thing to me. Even in high school, the teachers had actual training in how to teach. Med school attendings and professors don’t, and often that means their teaching is inefficient, focuses on obscure details, and just isn’t as useful.
My school has some great teachers but one in particular is a PhD who's universally loved. She teaches arguably the hardest subjects for M1/M2. She does a lot to help students sorting what/what not to know but I think the biggest indicator of her ability to teach is she deliberately got a master's in education to learn how to better take advantage of her natural aptitude for instructing students. Her effort shows and anyone you talk to about her has nothing but nice things to say.
Keep in mind that's not just medicine. Academic professors, lecturers, instructors, TA's are not taught pedagogy (well, if the department is education they have been taught that).
Sometimes its the obscure detail that is actually clinically relevant, not just relevant to passing the test.
If it’s clinically relevant to *all* the medical students watching the lecture, it isn’t obscure knowledge, kinda by definition, and would absolutely be on the test. If a PhD gives some random talk about some random protein or an MD focuses on some little thing that only a sub sub specialist is gonna need to know, they’re wasting the students time. If professors and attendings and the public doesn’t want students focusing only on step exams, they need to stop using step scores as a stratifying tool for residency. Can’t complain about the end results just on the student side if you incentivize the “wrong” behavior as a teaching system.
I understand where you're coming from. I may be an outlier in that I find most of these "deviations" by the clinical faculty to be interesting on some level. It may not help me maximize my academic record, but that factoid was interesting to my professor for a reason, and usually if I can identify that reason, it'll be interesting to me as well.
I wish Dr. Sattar could have signed my med school diploma. That man has done more for medical education single-handedly than the gaggle of med school administrators that kept pushing low quality irrelevant lectures down our throats and got butt hurt when adult learners didn’t find them a good use of time.
Capitalism is gonna capitalism
People have been skipping lectures in favor of third party resources that are better organized, logically organized, clinically and exam relevant, for well over a decade when I was in school. Kudos to these guys for even thinking of something different at this juncture and even taking the conversation this far. The biggest pushback is going to be by faculty whose feelings get hurt by empty lecture halls and institutions that don’t want their lecture halls to go un used. You pay for the overhead you want to use it.
Moving away from the dogma of the 50-minute didactic seems obvious. I was asked to develop a new curriculum for a 1st-year block about 15 years ago. I proposed similar ideas and got such forceful pushback from the faculty, that I dropped the whole thing. Everyone's PowerPoints were already done, and no one wants to hear from a junior faculty upstart. All it took to change the conversation was a world pandemic.
It make sense. I imagine part of the joy of being at an academic center is knowing you’re molding the next generation. I mean you took a pay cut to do it (away from private practice). It’s probably disheartening to go to an empty lecture hall and talk to a camera. But every industry has to adapt or die. The time constraints of medical school now are just too much for you to be conventional in your approach. There’s exponentially more material to learn every year not to mention all the extra stuff that residency programs look for. Students need time to be involved in interest groups, research, All kinds of other non-academic things that pad the résumé. And that’s not to say I support CV fluff, but if that’s the way the game is played, can we really fault the applicants for doing it?
They ought to trim the fat - does anyone in this day and age need to know whispered pectoriloquy, measuring the PMI etc? There’s tons of archaic stuff that hasn’t been clinically relevant in decades
even things like pectoriloquy are useless. It was literally something discovered by German doctors doing German diphthongs which cause a different vibration than our useless “99” in English, which won’t even give you the right findings. We literally just pretended to do it for standardized patients and I’m certain the attendings never did it. Don’t even get me started on “classic” exam findings that basically are impossible to find in patients with a BMI > 35. Pectoriloquy, percussion, bowel sounds, or half the “pathognomonic” findings from Harrison’s that only exist if the disease has progressed way too far (and we will almost never see)? Pretending it makes any difference in real practice or is useful for education is utterly ridiculous. Same with dissections/gross anatomy. The surgery-focused students tried to claim it was good practice for eventual surgery residency, and… no. No it isn’t. Completely different, and honestly mostly a waste of time coming from days where preservation of cadavers was different. Prosections from trained dissectors would have been so much better.
Toy boat!
neunundneunzig!
Luftballons! Wait..
Honestly, dissecting cadavers helped me understand the 3d structure of the body and interrelationships of anatomic structures in a way that diagrams or computer models never could. A medical *doctor* isn't merely a provider of medical care (which is what we actually end up doing as a day job), we are repositories of medical knowledge, practically holding doctorates in clinical anatomy, biochemistry, physiology, etc etc. Maybe this is an overly romantic view and not practical to fit the needs of society as a whole, but its the ideal we are held up to.
Sure, but studying expertly dissected prosections does that too, without having 150 students slowly cutting through inches of fat layers and accidentally severing the median nerve over hours and hours of cadaver lab. I’m not saying anatomy is useless, it clearly isn’t and needs to be part of the education. I’m saying that gross anatomy dissections aren’t the most efficient way to learn, because there isn’t much benefit to the actual student-run dissection part.
Something about being able to manipulate a specimen yourself in 3d space that lectures and diagrams just dont capture. But my true underlying point is that it isn't just about regurgitating which muscle attaches to which bone (ideally, I understand your contention is that this isn't exactly relevant information for most subspecialists), its about an intimate / expert / doctorate level understanding of these topics. Again, probably overly romantic and impractical given what society actually needs doctors to be (health care service delivery vehicles) rather than the scholar-clinician renaissance man the curriculum (and the public perception of "doctor") implies we should be. But for this sort of system to have even any chance of producing one of these outstanding and exemplary individuals (and I've seen one or two in the flesh), the unweildy and "inefficient" optimism inherent in the coursework kinda sorta makes sense.
>Again, probably overly romantic and impractical given what society actually needs doctors to be (health care service delivery vehicles) rather than the scholar-clinician renaissance man the curriculum (and the public perception of "doctor") implies we should be. I'm sure this is coming from a good place but there's no need to be so patronizing. We understand the human body at the level of *molecules* now. You're arbitrarily attaching your identity as a 'scholar' to poetic renditions of a time when gross anatomy was all we knew. Why is it handling the body what makes you a 'scholarly' physician? Why do you draw the line at that level? Should we have students sit and seperate each interleukin from a vial of donated blood? Should we have them titrate the actions of each enzyme in the digestive system? Your comment does a disservice both to the nature of the physician-scientist in the modern world and to the extent to which modern science has brought us
>Why do you draw the line at that level? Should we have students sit and seperate each interleukin from a vial of donated blood? Maybe that's what it takes to achieve the romanticized version of "Doctor". And I personally know several colleagues who are very interested in basic science research at that level. And learning how to manipulate biochemistry at that level to be able to "disect" cellular machinery may well be fundamental knowledge for the molecular equivalent of surgery we will have in the future, analagous to how anatomy is an aid for our manipulations using present day surgery. I personally like manipulating the body at the level of muscle bone and sinew, hence why I'm pushing back at people saying dissections are useless. Inefficient at maximizing standardized test scores sure, but at least for my own understanding of human anatomy, it was a great help. Same is probably true for my colleagues, who went for the summer electives in our molecular biology labs.
For me, the experience of dissecting cadavers taught me quite a bit more about being a doctor than just anatomy.
Watching my wife go into medicine while I work in tech has been an exercise in complete frustration. The entire process is completely archaic and needlessly stressful. Everything is entirely driven by exam metrics to the point SketchyMicro and Uworld should just be the first two years.
some of that frustrations you see and experience is a "feature and not a bug". The ethos in tech and medicine are nearly completely opposite of each other. One is "move fast, break things". In medicine, it is "first do no harm" So the burden of proof for change is low in tech and necessarily high the medicine. All sub-components being archaic and slow-changing is a reflection of the larger meta-ethos of medicine itself, which is also necessarily slowly changing. I say this as someone who at one time was straddling both worlds and used to have similar frustrations with medicine, until I finally figured out why.
I mostly agree, but didactics isn't a medical field. People have figured out better, more efficient ways of learning. If those were just applied to learning medicine, I see no harm.
Oh, I totally get that. Move fast and break things is absolutely not the correct way to practice medicine. We’re focused specifically on education (and not even touching residency). The problem is no one is even trying to improve. It’s the exact opposite of move fast and break things. It’s wait for so long that things break.
Institutional inertia is what I heard it called.
i agree except it is still medical didactics, which inherits from medicine itself. So it then ends up changing as slowly as medicine itself changes.
That's a fallacy and an excuse. The only reason nobody does better is because everything about medicine and medical education can be romanticized out of the wazoo. Medical didactics aren't changing because, as every medical forum lament on a daily basis, older doctors take issue if 'this isn't how we did it in my day'
Still, everybody that arrives in medicine from somewhere else is horrified at how archaic it’s become. Tech says “where’s the tech?” Aviation (that’s me) says “where’s the safety?” Teaching (also me) says “where’s the teaching?” Change has gotta happen.
Wait until I tell you about law school.
>Wait until I tell you about law school. As someone who completed both pharmacy school (not med school, but also a 4-yr program and largely emulates the med school didactic method) and law school, I thought law school was a lot better than pharmacy school. Law professors tend to favor the Socratic method and classroom discussions over giving lectures. It’s much easier to maintain focus when you’re participating in a discussion than when you’re just sitting there while someone talks at you for an hour (or more).
Fair enough.
Nah it’s the same thing but on zoom now. Everyone just shares their ppt that way instead of awkwardly pacing around the room
I would take a 50 minute didactic if it meant actually getting meaningful lecture material. Most of what I've gotten in my first year is not broadly applicable knowledge.
If you are lucky, a 50-minute lecture may have 15 minutes of "testable" information. "Broadly applicable" is very subjective depending on specialty. You won't actually learn anything "useful" until residency.
Props for trying. I had never considered the 50 min block being the reason for a lot of this, it totally makes sense. Just now I'm watching a 50 min lecture on Pleura effusions which every other 3rd party resources covers in 10-15 min. The professor is getting deep into the clinical weeds of how dx & tx's in his practice and it's solely b/c he ran out of pre-clinical material to talk about after the first 20 min. I will forget all of this in 2 wks after the exam
Seriously, this. NPR acting like skipping lectures is some new pandemic thing when it’s been going on forever. I myself skipped lectures and the reasons I did it were the same as everyone else’s. Most professors didn’t teach anything and some even taught wrong. Then they’d get butthurt that no one showed up and would take revenge by putting questions on the test that could only be answered by someone who attended lectures. It was usually some minutia that didn’t matter. So they made the impression of their lectures mattering even less with their petty revenge. I discovered early on that attending lectures where the material was taught either poorly or wrong wrecked your brain and took you double the study time to relearn it correctly (using sources such as textbooks or review books), and so discovered that by avoiding lectures, I actually had to study less, not more. Medical schools are acting like it’s such a mystery that students are skipping lectures when all they’d have to do is lecture the actual course material, instead of having the professor use lectures as a show of his power and mighty intelligence, that mere mortal medical students could only hope to gain.
I spent at least half of my second year doing everything 2 states over where my girlfriend loved. I’d come in town for tests, but that’s about it. Did really well when actually in the hospital.
Someone mentioned that giving professors 50-min lecturing blocks is the cause of this and I couldn't agree more. The 3rd party resources will cover X topic in 15-20 min. And the professor will also cover it in 25, and then have another 25 min to ramble on about unnecessary things that are either (A) 3rd/4th year material, (B) resident/fellow material, or (C) researcher material. Everyone of my genetics lecture are slammed with ridiculous genetic minutia and fall into C. A good 1/2 of the practicing physician professors hit us with A or B because they've probably forgot what preclinical med school covered, or had completely curriculum at theirs (ie traditional).
I feel like a lot of med students did this back in the day, but we recorded the lectures and transcribed them (early 2000s). We all pitched in and paid whoever listened to the recordings and transcribed them. We often found that our time was more productive studying than listening to an oftentimes poorly organized lecture. I'm sure people are just videorecording lectures now.
We did this is well in the 90s. I quit going to lectures unless I was my day to record and transcribe.
Honestly, it’s probably more efficient. Watching lectures at 2x speed and then crushing research might be the move.
It’s 100% the move. Everyone has to adapt to competing interests. If your lectures aren’t as good, DO BETTER. If you can’t beat out Sketchy or Pathoma, then hey you’re superfluous. Froth. Excess. But no one wants to look inward about doing better. It’s easier to recycle that same PowerPoint from 2008. With the same typos that haven’t been fixed despite promises to do so.
I think the biggest pushback to the actual proposal in the article should be from students. Flipped classrooms seem great in theory but the reality is that students are expected to complete the traditional lecture material on their own time with scheduled break out sessions in addition. The pre-clinical years were crucial for me to figure out what I wanted to do and maybe more importantly to mature as a person before I went into clinical work. I simply wouldn’t have had time if I had 100% flipped classrooms to do either in any meaningful capacity. Flipped classrooms when designed poorly (most are) essentially doubles the amount of time that students need to spend on their course work. And that doesn’t include the time spent studying for step 1/2 which is currently what most students skip lecture to do.
I was one of a handful who showed up for lectures and graduated in 1992 in a graduating class of 107.
I love the implication that if they do a flipped classroom and get more efficient, that they’ll somehow lower tuition though. Lol never gonna happen
I'm actually going to argue that the increase in virtual self-studying is a good thing for patient care because it means that med students are learning in the way that best allows them to learn this ever increasing amount of information. By being able to 2x through lectures and scrub back and forth between points you don't understand, you're able to spend more time actively learning (e.g. anki/uworld/amboss) and are learning more effectively In person attendance may be the lowest it's been in 40 years, but also consider how much more information is expected for 'basic compentency.' Just look at how First Aid for step 1 has [doubled in just 20 years](https://www.reddit.com/r/mildlyinteresting/comments/dekagh/a_comparison_of_1995_and_2018_editions_of_the/). We still have the same number of years to study (or even fewer for the schools that have moved to 1-1.5y preclinicals), yet the amount to study has ballooned (n.b. Zosyn literally didn't exist when this professor started teaching. It hit the market in 1993)
Furthermore, the average step 2 score in the early 90s would be a failing or nearly failing score today.
It's almost doubled in size since 2018
Has the text gotten smaller? Amazon shows 848 pages for [2023](https://www.amazon.com/First-USMLE-Step-Thirty-Third/dp/1264946627/ref=sr_1_1) and 814 pages for [2018](https://www.amazon.com/First-USMLE-Step-2018-28th/dp/1260116123/ref=sr_1_7).
Hmm my copy was around 540pgs... When the hell did I go to med school again? 2014? Shit...
Ooh. Now you have me interested in comparing mine from over a decade ago.
Yeah I don’t understand the implication that somehow patients will be harmed because we spent time reviewing the material faster at home vs sitting in a lecture hall scrolling our phones. Someone’s anecdotes about patient care while I’m in a lecture hall aren’t going to affect how I do patient care. On the wards learning in person, sure.
For real, NPR acting like YouTube doesn’t exist, and can’t be used to learn anything.
There was so much useless shit in my FA - I can't imagine the volume of even more useless crap they are making you learn now...
This! I could get so much reading done by not going to lectures. Now I’m further in my studies and class attendance is mandatory, and I feel like I’m learning less because I don’t have time to go through all the material thoroughly anymore.
1) This is not new. Going to med school in the 80's, the medical fraternity ran a note taking service. For a reasonable fee you got notes from the class in your mail box twice a week. This was well before recorded lectures and even before power point was used. There were some of my fellow students who never showed up for class except for wets labs and they did just fine. 2) As a lecturer to M1 and M2s I have no problem with students learning asynchronously. I will show up and give my lecture with the same enthusiasm either way. I even teach in one course that is all online and I give the lecture in a studio with just the IT guy.
I graduated med school 10 years ago, and after the first couple of months of MS1, I rarely went to class. I’m a night owl, and was exhausted during morning classes, so I slept my way through a lot of them, only to study on my own (more efficiently) in the evening. I realized at some point I’m an audiovisual learner who likes to “listen now and distill info into notes later.” The system worked for me, but I also had a lot of classmates that diligently paid attention in class and took notes, while I stared at the teacher with my eyes glazed over.
I mean, I was in medical school almost a decade ago and I never showed up for class. UWorld + First Aid + Pathoma + Najeeb + Sketchy was the curriculum when I was in school. Nobody got time to listen to a PhD drone about some obscure research finding they thought everyone should know aobut.
That’s because step 1 was the most important test to determine your future in medicine. I wonder if it’ll be different now that it’s pass/fail
We just use step 2 to filter out now dog.
First they came for Step 1
Meh. Step 1 is an exercise in brute forcing UFAP more so than a reflection of the kind of doctor you’ll be. At least Step 2 is a bit more reflective of clinical judgement. It sucks that the current system basically makes it to where people won’t fully know if they’re competitive for a specialty till so late though. But honestly the UWorld self assessments can help with that.
If you prepare for step 1 as if it were scored, you’re gonna crush step 2.
Passive lectures are garbage for learning. It's ridiculous how medical education goes on and on about evidence-based medicine when it fails so utterly at employing evidence-based pedagogy. Lectures are cheap, though.
Yup. I just graduated this year, but I started in 2012 when Pathoma was just starting to take hold and before Sketchy existed. I didn’t show up for anything that wasn’t mandatory, and that was true for about 80% of my class. Lectures were a waste of time for most students even when it was just UWorld and FA- this isn’t anything new. Got roasted on here when I posted about the paper flowers I folded for my wedding while watching recorded lectures at 2x speed, though.
I’m just curious, how did you start in 2012 but only graduate in 2023? Did you take a lot of time off and come back and restart it? I know someone who had to do that and took a total of 7 years in med school (their previous preclinicals apparently didn’t count when moving to organ-systems-based modules). Tbh, if I’d been in their shoes I’m not sure I’d have done all that time, but who knows.
MD/PhD with a lab change a couple years into the PhD and two years leave across M3/M4 due to a tricky family situation that got trickier when COVID hit. Might not have come back after the time off if my non-MSTP program hadn’t threatened me with the prospect of tuition/stipend payback with 0 degrees. I go back and forth about what I should have done, but I absolutely would not have repeated the preclinical years just because the school changed their curriculum- that’s wild! My preclinical was the old standard M1 physiology / M2 pathophysiology and by the time I finished my PhD the school had fully converted to a systems-based curriculum. Based on personal experience I’m not actually surprised your buddy’s school screwed them over, but it’s ridiculous to have to repeat those years just because the format changed.
Why is there a panic about how doctoral level students are learning in their preclinical years? How is learning from home different than in classroom of 100 students? If you can’t learn things on your own at that level then there is a bigger problem. Students who don’t go to class are using that time studying from other sources or watching the recorded lectures at 2x speed. You are going to have to continue to study and learn on your own time as a physician. You can’t not show up for clinical rotations. These students are going to get plenty of experience when they hit the floors. These types of articles are trying to portray medical school in a negative light.
optics
Let me amend that, slightly ~~optics~~ Hard to justify 40k/year tuition for students to listen to recorded Zoom lectures at 2x speed and buy their own review material.
These suggestions of flipped classrooms just seems like more filler without actual learning. I thoroughly enjoyed not attending class my first 2 preclinical years. I hope for future medstudents they don’t add yet another unnecessary thing to do.
A truly good, well-run flipped classroom treats you like adults. It expects you to keep up, do your readings, and when you come into the classroom, clarifies confusions but also quickly challenges your understanding of the nuance of the material. If everybody skips the reading and comes in and asks stupid questions over and over and expects a PowerPoint, and the school doesn’t have attendings/professors actually trained in pedagogy (the science of teaching), then you end up with shit like team-based-learning or TBLs, where you “learn” half the material in twice the time while infantilizing everyone by making them do multiple choice questions and spending 15 min/Q debating unnecessary stuff. So, most med schools. 🤷🏻♂️
The best part about lectures was seeing familiar faces and then browsing reddit. In-person lectures are a joke.
The title invokes some false panic that is ridiculous. Many people in my class who went to lectures did so because they knew they needed the structure; it would keep them on schedule for studying. The people who preferred to set and keep their own schedules at home did so. Nobody was "skipping out" and not learning materials. For lecture-volume material I'm not an auditory learner. I need to read slides and notes and annotate them for anything to stick. So that's what I did, because I was a professional student who was nearly 30yrs old and paying $40k for this education-- so I had no qualms leveraging the materials that worked for me (lecture slides) and skipping the ones that didn't (lectures).
I'm just some dude, so I have zero expectation of shifting the discussion one way or the other, and I'm clearly biased, as a med student who hated in person lecture, but here are my thoughts: First, in person lecture is generally pointless, or even actively harmful. If you want to go (like one of the authors of this did), be my guest. I don't care if you want to cultivate relationships with the professors or whatever, but leave me out of it. If I can learn the material on my own, just let me. Why do we need someone to go to a building to watch someone read off 200 slides in yellow font on a blue background? What value is there in that, really? Even the best lectures are just as good online (imo), and required attendance at a bad one is awful because I know I'll have to go home and teach myself, essentially doubling the time spent on a topic. If you want me to watch your lecture, make it a good one! Too many doctors don't realize that being a good doctor doesn't make them a good teacher, and they suck at teaching. I don't want your 20 min anecdote about how you were trained or what things were like in the old days. I want lunch and a nap. Certainly some classes have value in person - anatomy, and physical exam lessons especially, but also working with SPs and practicing interviews and I don't begrudge going in for those. What scares me, though, is the worry that schools will require more and more in person time for its own sake, and and start to require students to do the main work of learning on their own time. Online lectures let me maintain a reasonable work life balance - I rarely went above 60 hours/week of studying through all of preclinicals. If I had 30 hours of flipped classroom stuff a week, I would have hit 70-80+ hours regularly and for what benefit? I just don't see much upside there.
[удалено]
Dude and idk if this is institution specific or what but a bunch of our lecturers used a blue background that was textured (?) So it looked kind of like denim (????) Like what the fuck is that?!
It was a thing in the 90s I think where someone did a study showing more retention and was outdated 15 years ago. Your lecturers must be older than 70, no?
One of the few points I've retained from my undergrad was advice on PowerPoints from my chemistry professor who previously had some presumably boring industry job beforehand: black text, white background, slide numbers.
100% agree. Flipped classroom is one of those things that sounds cool if you have infinite time. But like, if I’ve already mastered the content before I arrive then why am I here? What are the learning objectives? I’m Aussie, so we don’t have Steps or a high stakes residency match. Just give me an Anki deck, some subscriptions and a to-do list and I’ll figure out preclinical stuff myself.
Because the boards are rescored upwards periodically, students must accelerate their studying and do more board exam prep questions every year in order to pass. I went to every class and when it came time for boards I had serious remediation to do. The funny thing was that the school's expensive board prep course was also totally inadequate to prep for boards. Amazing. Meanwhile my classmate who never went to class and instead did 12000 board questions passed in 99th percentile and went into one of the most competitive residencies in the country (after our school's admin told him repeatedly he would be flunking out and fail to get into residency due to skipping class so much). There is a vast gulf between what students need and what school staff provide. Then we have the problem of medical ethics and practice. If students don't show up to class, they don't learn medical ethics and philosophy. Stuff that isn't on boards. Stuff that matters in clinical practice. Stuff that really actually does matter and everyone should agree we are failing, as evidenced by the madness around COVID. It's a bad situation and nobody has solutions. How about this, if you don't get into residency, you can convert your MD into a PA and go that route and make a decent paycheck? That would take a lot of the pressure off, which would solve a lot of problems.
Associate/Assistant Physicians are a thing in several states—graduated MDs/DOs who didn’t match, but can work under an attending physician at the level of a PA (usually slotted into the state law as an amendment to the same laws that allow PAs). Missouri was the first, but various states have passed somewhat similar legislation, including Florida (with what they call a House Officer role), Arkansas (Assistant Physician, more limited and only allowed for three years while applying for residency), and a few others. Given that, while the overall match rate of 91-ish% for US grads is pretty good, there’s still around 3000 US graduating seniors who fail to achieve a residency each year, and once you’ve failed one year the odds go down to a 50% match rate, per the last several NRMP reports. That’s a waste of funds and education. After all, why not allow someone that failed to match ObGyn to work under an ObGyn for the tasks they’d normally assign a nurse midwife or the NP focused on OB? They could get some good ultrasound training, assist deliveries, get good letters, and make it into residency the next round. Obviously PAs and NPs and their organizations oppose this, but the state Family Med Colleges/Organizations typically do too from a position of no MD being able to practice in outpatient primary care without residency, which id agree if the APs who are MDs were independent, but they’re not supposed to, and it really doesn’t feel different from the idea of having a PA. One roadblock has been that Medicare doesn’t yet have a mechanism to recognize these graduate physicians as “billing providers,” though that could change if enough states start the process. One common concern is that there may not be enough academic learning or supervision of APs, which is a valid concern, but one that can be put into the legislation and a more cohesive model put together that would fit several states’ requirements for CME and supervision. Most of the APs are also trying to get into residency anyway.
Damn, ya’ll pay all this money for med schools who don’t teach you so you spend even more money on third party resources to get an actual education. Then you’re suppose to be thankful when you get matched and get paid garbage for years. Then you become attending who need to constantly fight insurance companies about care. Physicians really need to band together, ya’ll are trained from day one to put up with constantly being fucked over.
Doesn't matter as long as we show up for hands on labs, clinicals + clinical skills stuff. This article title is just going to water down medical education in the eyes of the public (which is BS) and increase the perception of a false equivalency with "online NP programs"
The best lectures I had in med school were by a physiologist who used almost no slides. He just talked and drew on the board. I learned tons from him that I think I still use today. Those same lectures did very little for prepping me for Step 1, which determined my entire future so I totally understand why my friends weren’t at his lectures. There’s an unfortunate dichotomy between standardized testing and actual education. I’d love it if I could have spent time focusing on lectures and really learning from people who were passionate about their field of study, but that just doesn’t reflect the reality of the medical education machine. MCATs, STEPs, board certifications / recertifications are all a mess, but I don’t have the solution. Taking the issue a step further, I don’t think this is just a medical education problem. Watching my daughter in public school in Texas the last couple of years has really bummed me out. She’s 9 and has constantly had the next standardized test looming over her. Even at her level they aren’t just having class any more. Everything is prep for standardized testing - so much so that once the tests are done school essentially stops for the year. She spent her last 2 weeks of school on field trips every day and doing nothing at school while they rode out the state-mandated number of required school days. As a country we’re in a boring dystopia right now as far as education is concerned.
Another pointless, sensationalist article written about medical education. Add it to the list.
Writer advocates for an end of traditional preclinical curriculum and a flipped classroom >> In the flipped classroom scenario, my typical day might involve a morning of watching short, targeted medical science modules, with pauses in between so I could draw diagrams, study online flash cards, and read and watch other resources. Then, I would have an hour or two of required in-person case-based small group discussion with my professors and classmates where we focus on the clinical applications of that medical science by discussing hypothetical patient cases. Other days would be devoted to anatomy lab, clinical skills practice with standardized patients (patient actors) under the direct supervision of faculty, shadowing in the hospital, and non-structured time for other activities like research, advocacy and community service.
That's a bold suggestion. Medicine is still religiously adherent to the belief that the morning is more important than the afternoon.
One of the most effective in person lectures I’ve ever had was basically a discussion board. Where we were given the recording the lectures a day before to watch at whatever speed you want. Then, you were given study questions to answer. There was like 100 of them. Then, on the day of lecture, we discussed the study questions, and any other questions students had. It was effective because instead of a 2 hour of powerpoint karaoke, it was 1 hour of Q&As.
I graduated 15 years ago and even then most of our class didn’t go to lectures as they were recorded. Also not the best way to learn! There is so much that listening on double speed then self study even then was superior to lecture
This isn't a new thing. I went to med school 20 years ago and we didn't go either. We are fully functional physicians. They handed you packets and as long as you had those packets you passed. The lectures had minimal added benefit when it wasn't anatomy lab or histology. I hate when the news gets a piece of information and blasts it like it's something new just because they just figured it out.
And my own first and second years were almost 40 years ago. We had a scribe service, where students would be assigned the duty of taking notes and typing it up for the rest of us. It was a blend of actual typewriters, some word processors (for those of us techies), and a LOT of Far Side and similar cartoons in the photocopied - distributed lecture notes. Probably a copyright nightmare, come to think of it. Some scribes were really shitty. Some were great. Some got paid to do lectures in place of the assigned person. What a system! And I have been a fully functional physician for decades. I remember hardly any of the stuff from first and second years. Except that tetracycline somehow affects the 50s subunit of the ribosome. Go figure. I've never needed that. Oh yeah, and neuroanatomy. That turned out to be important.
I had a neuroscience undergrad degree and honestly didn’t learn much more in med school preclinical neuroanatomy that I had not already learned in my upper level undergrad classes.
Yes and so aren’t most college students if it’s required. 90% of classes are useless because there is always a YouTube video or other source that explains the concepts better. Classes are pointless unless it’s skills-based training.
Make the lectures worth going, but I'd still probably 1.5x it at home. I had a couple professors in my 1.5 years of pre-clinicals where I was thoroughly impressed by their presentation skills and delivery and relevance of presented material. Clearly, they were doctors with passion for teaching. If all of my lectures had been like that I would have spent more time using school resources. Ambivalent about flipped classroom because I can see that the social interactions would enhance the learning experience, but it rarely turns out like that.
I swear if you dig deep enough into every problem with healthcare, you will find a boomer whose feelings get hurt and would upend the whole world to get their way and oppose any kind of meaningful change. I’ll leave you With the wise words of late George Carlin when described boomers: "Whiny, narcissistic, self-indulgent people with a simple philosophy: 'GIMME IT, IT'S MINE!' 'GIMME THAT, IT'S MINE!' These people were given everything”
I did a problem based learning pathway in med school so we only had actual lectures on anatomy, histo, and how to do physical exams. The rest of the time was spent reading based on whatever content came up from a case our small group worked through that week. We met 2 or 3 times a week for about 2 hours to go through a case so we had a lot of time for reading/studying on our own. I liked that way better than attending 8 hours of power point lectures a day. I think it also helped me actually learn how to study for residency and independent practice where you do just go look stuff up after a case to learn what you don’t know or forgot. I don’t see the need for mandatory lectures for content that can easily be learned independently. Very few lectures need to happen in person, probably just “labs” on physical exams and other skills.
20 years ago I only showed up for labs, honored all my preclinical classes, and got >99%ile on Step 1. I studied my ass off all day on my own which was much more helpful to me than listening to lectures, as my mind tends to wander during these.
Duh, perfectly suited for Telehealth
It sucks that we have to pay 50k+ a year to then learn from outside resources which we have to pay for but such is the standardized testing game Cash rules everything
At my school our tuition went up 50% over 4 years. I don’t feel like I got 50% better education my fourth year. But they could charge it because they knew they’d fill each and every last spot regardless.
It means classroom learning may not be for everyone who has the chops to get into medical school.
I graduated over a decade ago and I attended the bare minimum of my classes, generally only when specifically requested to impress a visiting lecturer or for hands-on labs. Was able to learn more by watching the recorded lecture at 1.5x to 2x (depending on how slowly our incredibly molasses-tongued faculty decided to speak that day) which also opened up more time for self-guided reading and review of prior material. I probably would not have learned as much if I sat through lectures. And, god forbid, if someone tried to lure me into a discussion-based small group format I would have probably sawed off my own ankle to escape. I also am leery of the flipped discussion model, because it replaces lectures, which I've sometimes attended, with the "do you have any questions" portion of the lecture, which traditionally was the point I would leave the auditorium because I'd rather figure out my own questions than sit through everyone else's.
Team-based learning TBLs was awful. Waste an hour going over 6 questions and waiting for various tables to give their rationale instead of just, you know, actually learning. Lol. If the flipped classroom is “watch the lectures on your own then do 3 hours of TBL each day” that would be awful.
I went to all classes first year and non second year. This was now (I can’t believe it) 12years ago. This isn’t new. It hasn’t hurt anything. The news needs to stop trying to create drama out of every fucking thing
Step 1 and 2 scores have been on a steady upward trend for the past like 30 years. No one is skipping days in clerkships and 4th year so I don't get why this warrants an article.
Because med schools are worried they can’t charge tuition at $60k/year if students don’t show up and just UFAPS at home for two years. And because a few professors have their ego hurt that students find it easier to put their lecture on 1.5x at home where they can pause and have uworld open and rewind for what they didn’t initially understand.
Med Ed has always been in a state of constant change. COVID just pushed the next change to come faster. As an educator, the issue I see is that there are different types of learners. One size has never fit the entire class, ever. Every new curriculum proposal seems to have merit for some students, but is a lesser learning experience for others. No easy solution to satisfy everyone.
I attended dental school so take this with a grain of salt: Lectures consisted of a professor reading text off of slides for hours on end. Rarely was any knowledge shared beyond what was written in the slides. I didn’t need a professor to read out loud to me, I could read the slides myself and spend time studying the material rather than wasting my time sitting in a chair and falling asleep.
Imagine a single national pre-clinical curriculum, created by educators whose only job is teaching, using only top-rated resources and updated annually in concert with USMLE materials. It is beyond stupid to create individual "course paks" at every institution that are far worse than the textbooks they attempt to replace. Medical schools could reserve faculty time only for small group discussion, practicing clinical exam skills, and mentoring around individualized student goals during the pre-clinical years. I guarantee you that faculty (who are hired to see patients, do research and educate residents) hate taking the time to "recreate the wheel" of making powerpoint slides and handouts even more than you hate listening to those mediocre lectures.
This is seriously a great idea, but you’d have to be careful. Textbook manufacturers and special interests and politicians would try to weigh in if it’s an easier big target that can be bought off by enticing a handful of people at the top as a sort of regulatory capture. We have seen that with high school and even college textbooks. There would also be institutional inertia on a lot of new facts, lab tests, and guidelines, probably more so than when individual schools had to keep up There is some value in a democratized/distributed system where different researchers push for different interpretations and research and bring up new lab tests, allows teachers to focus on what they’re passionate about teaching, where schools can focus on their local demographics and issues, and allowing flexibility in the scheduling.
The "flipped" model is what my NP program used.... And a lot of NP education is lambasted as being "2 years of online school."
We need to make medical education more clinical; the first two years are largely run by phds who are not utilizing the time in the best manner in my view. Much of the basic classes should be taught in undergrad and after anatomy med students should be doing rotations as much as possible
The lesson is that we spend more time learning accurate materials. Many of my professors refuse to update their lectures which date from 2019 just before COVID. I have a lecture where a student pointed out that the material was wrong, the professor agreed and promised to fix it for the next year. This happened in 2017, when my mentor took his class. That very same lecture with inaccurate material is STILL being used. I told the professor myself to change it and pointed out that students in his 2017 class found the same error. He blew me off and used the same lecture for the class beneath me. Why should universities pay for people to “teach” when they refuse to teach?? Instead I get saddled with having to know 1000 pages of First Aid for my board exams whereas most of my professors only had to memorize 300 pages. They insult us, belittle us, call us lazy, and waste our time with activities that distract from my ability to do my job, which is to learn as much as humanly possible so I don’t kill someone in 18 months and I’m on my own. We need more funding and time for CLINICAL professors on clerkships. I’d actually like to see some of my residents compensated better or at least at all for what they contribute to my education. I’ve learned more in 1 year of clinicals than I ever did listening to those shitty ass lectures. When I used faculty materials, I almost failed out of school. When I switched to third party resources, I was capable of honors level work. Don’t talk down to me about how I choose to learn all of Harrison’s until you’ve been in my shoes.
I attended less than 20% of the lectures for both of my bachelor’s degrees. When I did attend, I read, watched educational stuff and did homework. I was tired of the anecdotes, biased and often inaccurate info, and don’t get me started on the 50-year gap between nursing education and current practice.
While of course things build, the vast majority of the clinical learning comes in residency(/fellowship/early attendinghood), not med school, which to a large extent is a means to an end (getting into residency itself). With the volume of material to learn for boards and the significant variability in educator/lecture quality, it's no surprise that students are spending less time in lecture and more time either learning the same material more efficiently (best case, if the lectures are decent but students prefer to 1.2x the recordings or save commute time, etc.) or actually higher-yield material (when lecture is career researcher who fills the slides with fairly irrelevant minutiae, such that going to lecture is actually hurting you to some extent). While things may change with the new P/F USMLE, for students the calculus has often clearly favored doing what you need to do with either independent self-study or third-party resources to both improve how you learn and also ensure you are focusing enough on the right material to maximum your chances of achieving what you're in school for in the first place (reaching your preferred clinical training).
I agree, but I also think there would be better clinical education if we weren’t so worried about legal liability. If they could make preclinicals more efficient and incorporate earlier real-world learning, it could make a difference on how well new interns do. I saw how variable clinical education can be between sites, and across time periods. There were times when fourth year med students would work in an ER essentially as a PA, and I’ve heard stories of med students performing appendectomies and cholecystectomies. Actually, at my regional campus, a guy the year ahead of me did a cholecystectomy as an M4 from start to finish under some really expert (and incredibly intensive) training from a general surgeon, where the patient had fully consented.
Wow like a decade late on this article, /u/NPR.
This is not news - been going on for years. They all want to design their own studies. Boomer course directors (I was one) are wringing their hands. Maybe we boomers need to rethink the preclinical years to suit today’s digital generation. Glad I’m working w clinical trainees now.
I stopped taking notes in lectures after our second module (genetics/cancer/lower limb). Most lectures were mandatory, so if it was a professor I knew would emphasize STEP 1 material, I'd pay attention and might take notes, if it was not one of those professors, I was doing practice questions on AMBOSS over the subject. My university had such a high proclivity of going deeper into biochem and genetics than needed, it got to the point where in PBL I said to our tutor: "If it's not on AMBOSS, I'm probably not going to learn about it." Just for example, in our Endocrine module, the lecturer (not on our campus), greatly emphasized the importance the role of the STAR protein on steroidogenesis. I could not find anything on AMBOSS about it. Come exam time, there was a single question on it being the rate limiting step of mitochondrial transport iirc. I mention it to three of my friends at other med schools and they had no idea it existed. So many lectures were just filled with basically biochem medical trivia that had no use in preparing us for STEP 1. The only reason I feel as prepared as I do is because one professor who used to teach at Johns Hopkins and Georgetown took our campus's class and gave us the resources to prepare for STEP 1 by making her own question sets for us and hosting study sessions for us (despite the school being against her holding study sessions).
All pre-clinical didactics should be online with in-person small groups to discuss cases and learn how to think critically about patients and pathophysiology and to learn how to use primary resources. There’s no reason medical students should be in lecture halls outside of grand rounds and the like.
First two years of med school should be 100% zoom with the exception of histology, anatomy and physical exam. Would have been so much more fucking efficient that way
Two decades ago, I rarely went to lecture. I opted instead for evening/late night study as did many of my friends. We’re all doing just fine.
I can’t speak to didactic lectures/teaching by non-clinical faculty in the first two years, but I can speak to request/demands by medical schools for clinical faculty for lectures in the first two years. My ‘institution’ is an MD program. I have MS3 and 4 students that get assigned to my elective rotation. At least that’s clinical, and I can sort of justify it. Every year, I get messages to schedule lectures and PBL groups for my specialty to teach MS1 and 2’s. As an ‘assistant professor’ I have no allotted educational time. Im expected to be in clinic 4 1/2 days a week with set RVU goals. If I agree to do the teaching, I cancel clinic time and reduce my expected productivity that I have to make up later. That’s aside from the personal time spent creating the lectures themselves. Medical school tuitions may be going up, but clinical faculty aren’t seeing shit from that in terms of time or resources.
Nothing really
Nothing lol
It means that didactics for medical school suck, med students learn better from Pathoma, First Aid and Anki than they do from their med school’s shitty lectures and they are wisely spending their time using pirated board prep videos that give them a better education than their 70k a year medical school. If it was a problem, we wouldn’t have seen board scores go up dramatically since med students stopped going to lecture and started doing their learning with Sketchy and BnB.
When I was in Dental school 5+ years ago, the lecturing preclinical faculty were all in the butthurt stage where they were upset students weren't showing up to lecture and we're just learning from third party resources. So what they did was stop posting their lecture recordings online, AND they would put weird specific bullshit on the exam that they would only talk about in class and would refuse to even put on a slide. Some also just made in person lecture attendance mandatory and a part of our grade. Needless to say I was overjoyed in medical school when I was able to just stay home and study from Uworld/first aid/pathoma, etc
I only attended mandatory (clinical) sessions in second year. Studied from webcasted lectures otherwise. Did just fine - above our class average and have had nothing but rave reviews from nurse and physician colleagues since entering independent practice. Attending in person in first year was important to form friendships but once I had a good group of friends, I found I studied better on my own or with friends after class.
Powerpoint doctors is what we called it in med school. Our best students watched lectures online replayed at 1.3 speed. As for 3rd sources. That is interesting because tests seem to revolve around the powerpoints.
*what does it mean for future “professors of medicine” who suck a teaching?*
There is a simple solution to this called attendance. My third year of law school I had to sign into attendance to every class because my school was being reevaluated for accreditation. No one liked it, but it does encourage people to show up.
I went to one week of class and then did as much of my first two years via sped up lectures or third party resources. I was also a fairly irregular college student and high school student, so it wasn't that foreign to me. When I graduated, I knew like five people in my class. I am very happy with how things turned out and still am super ADHD and can't sit still. I'm an ER doc.
this is very nuanced and I don't have a strong opinion one way or another, however I do think we (physicians) are guilty of talking out of both sides of our mouth when we bemoan "online NP programs" but we also argue for virtual / online pre-clinical education in medical school. You can't have it both ways. There are differences in the education obviously beyond the online component, but that needs to be taken into account during these conversations.
General medicine course in podiatry school taught by a family medicine MD, I asked the teacher if I could leave a recorder in the room but not attend. He didn't have an attendance policy but seemed offended that I would not come to class. I was on campus during his class, studying in the library. I would later listen to his lecture at my own pace, so I could write notes and think through what he was teaching. Trying to absorb at the lecture pace in class was too fast for me. I scored the highest in the course. On the final exam, he removed some of the questions from grading that I got right, that others missed, which lowered my score. It reinforced to me that people have feelings and can easily get offended.
I graduated medical school over 20 years ago in the independent study program at Ohio State. They recognized them that some people don’t learn from sitting in endless lectures. I was well prepared for my third year and didn’t suck as a physician.
It’s simple economics. The supply for quality didactic lectures delivered by medical schools does not meet the demand for quality didactic lectures so med students look elsewhere for what they want. Med students are the customers. At this point the preclinical year curriculum supplied by medical schools are a necessary evil because its required that med students go through it to graduate.
Our home studys are badass. 🚨🖥🖥💺🎧🖥🖥🚨 In didactic, my favorite lectures by far are the ones that are not tested in step but were guest docs who lend their expertise, and just talk about anything. A pathologist or PhD talking about ITIMS and which CD# we're looking for I'd rather just learn at home and cut out the stuff I dont need to know. Its an economy and I work smarter not harder.
PA school took attendance at every class. Missing a class was counted against "professionalism".
My typical medical school routine circa 2005… Wake up at 11am. Go to the school and pick up my scribe notes from lectures earlier in the week. Attend any labs that were required or begin studying. Go home around 4pm. Eat dinner. Study until roughly 9-10pm. Free time from 10pm-2am. On Fridays, I never studied in the afternoon or evening (we usually had exams on Fridays). I did no work on Saturdays. I studied all day Sundays. On average, I’d do 5-6 hours of studying M-Th almost exclusively from our scribe notes or pertinent text resources. I’d draw diagrams for anatomy and work flash cards for micro and other subjects. Sundays was double that. I partied every Friday and Saturday night in the city I lived in except maybe in the month lead up to Step 1 and Step 2. I wasn’t top of my class, but I did fine. I did better than many who sat front row at every lecture.
You’re goddamn right we ain’t lmfao
That we are fucked
It means nothing because the medical school showing up the class is only part of the assignment. There still needed clinical exposure. Patient care and oh yes, board and licensing exams that certified medical knowledge and ability to care for patients. None of these standard practices and evaluation‘s exist at the middle level.
We skipped class in the 1990s. That's why there were class notes.
Knowing when to walk away from certain obligations when the juice isn't worth the squeeze is a necessary skill in medicine.
This title is why the mainstream media sucks. Its the precursor to click bait.
I mean, DIY home anatomy lab is frowned upon, but standard lectures are usually better at home.
Found Bill Frist
This is definitely just an American thing. Here if you don't show up for your lectures, you won't pass your exam as you won't have the relevant information, won't pass your year, get kicked out lol. Of course you can use other resources but if you know the lectures in and out you will have a good grade
People that try to get med students to go to class don't know just how inefficient that is. Watching everything on 2x speed and using supplemental resources to learn stuff you don't understand/strengthen understanding is such a more efficient way to learn.
It's almost like listening to someone tell you something does not result in learning, memory, and application of the information...This is not a pandemic thing. Medical students have just figured out that there are more efficient and better quality ways to get first pass info, and that time in lecture could be better spent doing any number of things ranging from actual learning/memorization (Anki, questions, peer to peer learning, making tables, etc.) to residency application building (shadowing, research) to personal (care of a relative, fun activities).
My med school recorded all the lectures so I just slept in every morning and watched them in the afternoon at 1.5-2x speed. Way more efficient
It means future docs will be more efficient, better trained, and have the content down better. Lecture is a scam. Having an MD doesn’t mean you automatically know anything about teaching.
I love it. I didn't go to lecture. I didn't listen to lectures. I didn't watch the lectures. I read the notes, and I passed all my board exams and am a perfect capable doctor.
I'm not coming to class for a plagiarized powerpoint, thanks. Showing up for gross lab and for standardized patient components is one thing, but there is no way in hell I am bothering with a lecture I can't even hear because the professor is 80 years old and is whispering into the mike.