From the New York Times to Fox television, medicine and medical education seems to be a recurring subject of fair interest.
I come from a background of biochemistry and working in a primary care medical office.
I am a first year medical student at a fairly traditional medical school. So far we’ve finished a cadaver based anatomy course and we’re a third of the way through the combined biochemical/molecular biology/genetics course. We also have an ongoing course in doctoring that covers skills such as physical examination and interviewing.
In the interest of offering some Straight Dope, I’d be happy to share my observations and opinions or answer any questions about the process to date.
Among your colleagues, what would you say is the ratio of students who will become competent, trustworthy doctors to boneheads who’ll make it through by the skin of their teeth?
I’m interested in how your program is structured. How is the first year schedule laid out? Is there a strong emphasis on PBL, or is it mostly didactic? Is the curriculum strongly integrated, or does each course flow separately? Are courses taught by one professor, or a group?
(The anatomy course is a single semester? Did everyone live in the anatomy lab for the whole semester?)
What, if anything, are you taught about defense against lawsuits? For example, are you encouraged to get into the habit of sleeping with cloves of garlic around your neck now, or do you merely stick to the cross?
What do you mean by fairly traditional?
Do you have classes that teach you interpersonal communication skills? Like how best to break bad news to patients, deal with difficult people, etc.
I don’t want to be overly glib about this, but as of yet the ratio is undefined (as in 181 over 0). The admissions process is competitive and selective enough that there’s no reason that any one admitted shouldn’t be capable of becoming a competent physician in some capacity. That’s not to say anyone can do anything. From anatomy lab, I probably though, “okay, you *definitely * should *not * specialize in surgery” for about 20% of the people that I spent a significant amount of time with. Around 10% of the class hold attitudes about learning, medicine, or the role of physicians in society that are antithetical to mine, but I suppose that I’m not the final authority on such opinions. For example, there has been one person that’s expressed a view that, “I’m just doing this because of my family and because I’ll make good money,” and while I think that’s an attitude doomed for burn-out and resentment, they might have been kidding and doing a profession for the money doesn’t preclude one from also being competent. I guess my biggest complaint would be about people that whine about having to learn stuff that, “won’t be on the test,” either on the school tests or the USMLE Step-I which is a large, standardized test that comes at the end of the second year to make sure that everyone knows enough to go into their clinical years. To inappropriately stretch an analogy from Office Space, to be a good doctor, I really think you have to be someone that, “wears a few extra pieces of flair,” instead of learning only what you get fed on and tested on, and this difference in attitude only grows in importance with the number of years in practice.
Perhaps 2-3% are so painfully shy that I have trouble imagining them effectively communicating with patients, but again, there are specialties and career tracks that would make full utility of their training even with that characteristic, and further training might make them fully capable of successfully interacting with anyone. So, again, I haven’t had reason to believe that a single member of my class isn’t capable of becoming a good doctor, but I’m not so naive as to claim that every person will live up to that capability. I guess I’ll have to defer the question.
Our school is overwhelmingly didactic in the first year. Supposedly we’ll have some PBL stuff next year. For people that aren’t in medical education, PBL stands for, “Problem Based Learning,” where, instead of just being taught information, you’re presented with problems, usually cases, and assigned to a small group of around six student and one facilitator. The idea is that one, “learns how to learn,” better via PBL. Students are expected to independently research some aspect of that problem (such as, what is the biochemical pathophysiology that underlies this disease) and present it to the rest of the group. The downside that I’ve heard from students at other schools is that of course this instruction will be weaker than instruction from someone that’s laid out a clear lesson plan. Like all group work, if you get assigned to a group of slackers (relative term I suppose), then you’ll suffer unfairly for it. So, from comparing notes with students at other schools, I think we actually learn the material much more efficiently, but we really aren’t gaining anything in terms of how to research problems, organize the information, or present it, which might actually be a much more important skill. Again, we’ll get more PBL during the second year.
It’s supposed to be an integrated clinical curriculum, but that’s a bit of a lie or marketing hype from the administration. The “integration” was just covering embryology and anatomy at the same time and slapping the doctoring course on top of the previously existing block schedules. Although those classes were co-occurring, they weren’t really integrated in any meaningful sense.
Our biochem/molec bio course is taught by a rotating gallery of about 25 scientists from the school’s research programs. It’s a little bit disorganized in some sense because of that, but it’s worth it for the diversity of research emphasis and seeing different ways of presenting material. I think faculty are much more energized to come do two days worth of lecture than have to completely change their schedule for three months, so I think it’s a good thing.
We have a block schedule and did anatomy in a whirlwind seven weeks. I would guess that between coming in after school and the scheduled lab time, students spent an average of about four hours a day with the cadavers plus lecture and independent book-based or online studying.
Correct me if I’m wrong, but you are doing an MD/PhD program yourself, aren’t you, Crescend?
We really haven’t had any significant discussion of legal liability at all so far beyond mandatory reporting requirements for abuse or threats. It is mentioned in passing a great deal, from almost like the Boogey man; “study your brachial plexus, kids, or the lawyers will come get you,” to explaining the high cost of medical education. As I understand it, our tuition payments are virtually a wash with the liability insurance costs. Everything else (faculty salaries, facilities, etc.) comes from public funding, alumni donations, endowment, patient care revenue, etc.
Traditional in this context refers to the use of didactic lectures rather than PBL, etc. Our doctoring course does cover the communication skills that you discussed. We haven’t gotten to those, “advanced topics,” yet, but we will. I’ve found the class very interesting so far and will probably find it pretty invaluable in the future for starting out with a good patient repoir. I had no idea just how hard it was to organize an interview for something like the, “History of Present Illness,” for a cough until we started that class, and I’m learning a great deal from it.
Yup. My school structures MD/PhD programs a bit differently from the standard 2+4+2; I take a few first-year courses every year while doing my PhD. If everything goes according to plan, I’ll be done with my first year classes at the same time as I’m done with the PhD.
That’s why I was curious about how you guys have it set up - the only reason I can do this is because we schedule by semester/course, not block. This allows us to somewhat sync our progress in med school with our progress in the PhD program. That actually reminds me - does your school have an MD/PhD program? If so, is it a standard MSTP or something different? How do my fellow intellectual masochists integrate into the class?
I sort of came straight out of undergrad, and I’m 22 right now. I finished my fourth year of undergrad in May, but I could have graduated about 18 months earlier. I did not get into a school the first two times that I applied, so I went around for a couple extra degrees and worked about 30 hours a week while doing 12 hours of classes during my last year to try to improve my application.
The average age of my class was about 23.4 (I think) at matriculation, about 18 months lower than the average AFAIK for all US allopathic schools.
It’s hard to quanitfy the studying specifically, but between going to class, shadowing (mostly optional but I feel a very important part of what I’ve gained so far), studying, volunteering, and doing the administrative stuff, perhaps 60-65 hours a week of total “work” for medical school. Which, I suppose, really isn’t bad at all. I think I’m pretty familiar with the biochem stuff, so someone that didn’t come from a science background might have to work a lot more, and do more pure studying, and I know that there are definitely some individuals more, “under the yolk” than I.
I’m considering so many specialties that at this point it isn’t really worth mentioning any particular interests. Basically, everything I’ve seen from radiology to critical care to primary care all seems like something I could see myself doing so I won’t expound too much on why I’m interested in each.
My best advice would just be to keep working hard, apply early, apply widely, and make sure it’s something you really want to do. Clinical experience, especially paid clinical experience, is critical in my view. I think I’ve decided that the admissions process on the school side is complete BS, but the self-selection process for applicants might be the most important aspect.
Good luck with the process.
Because you asked, I took the occasion today to beat up one of the MD/PhD’s for their lunch money.
As I had him in a headlock and was positioning him into the restroom for a swirlie, I asked him about our program and learned that it’s not an MSTP program, but a “fully funded” MD/PhD program from the school. Details about the stipend, etc. weren’t forthcoming, but I’m sure they don’t all drive brand new C-Classes for nothing. Apparently the school is angling to try to gain MSTP funding. Apparently the organization is 2+3+2, plus of course all break blocks and one one hour lecture a week during the MD course obligations. Frankly, 3 years sounds ambitious to me, and if it takes longer, apparently you can opt to “self fund” until it is finished or pay some back-tuition and stipend.
They integrate fairly well into the class, from my informal survey half the class doesn’t even know that there are MD/PhD’s in the class and the other half can only identify one person who is in the program, max. Before today, I didn’t know all of the MD/PhD’s either. Basically, because they complete the courses on the same schedule etc. there’s no reason for us to necessarily know and they’re completely integrated.
What’s it like being an MD/PhD where you’re at? Are you at an MSTP program?
How are you taught to deal with having to tell family members the bad news? As a doctor, I’d hate to be the one to have to say, “I’m sorry, Mrs. Jones, but your husband has terminal cancer and he only has six months to live.”
It’s not an MSTP. The program is what I’d call ‘mostly’ funded; the difference between the PhD years and the MD years is a difference in standard stipend, not in tuition wavers. We have a pretty good record of applying for NIH F31 fellowships, so the stipend drop doesn’t affect us badly (it also convinces people to TA at the med school; that neuroscience TA might have a PhD in the discipline).
Students can structure their program in a number of ways, but the MD/PhDs typically start their PhD program first. They add some medical classes over time, and by the time they’re done with the PhD, they’re also done with the first year of med school. MD/JDs (there are a bunch), usually compress their law school into two years, which they do first, then do the four years of med school like a traditional student. We have one MD/JD/PhD student. They plugged the loophole after he elected to follow that course of study. He’s a madman. God bless him.
The MD/PhDs mostly take similar classes for a given year, so we keep track of the MD/PhD students of our incoming class more than we do the traditional first-years; they come and go, while we stay around. We’re also a bit elusive, in that we pop in for a class or two a day, then vanish. Most students know we’re around (this site is built around the MD/PhD program, so it’s hard to miss its presence), but we’re a bit hard to get a hold of.
We have decided to not standardize on the C-class. Certain individuals have complained that there was not enough room in the back for the hot tub.
Again, this is not a topic that we’ve given full coverage to yet, but largely it revolves around communicating what you know clearly and without judgement to allow the patients and their family to make informed decisions about their care. To start with, I can’t imagine ever saying, “has six months to live,” rather they should know what percent of individuals with that stage of disease typically survive to certain points. Beacuse it’s never just, “you’re dead in six months, deal,” there are always more imporant decisions to be made, from treatment options to options in palliative care.
If you don’t mind me asking, where do you go to school? I’m a 3rd year student in an MSTP, and I was unaware of any school that deviated that significantly from the standard 2-4-2 scheduling. If you’d rather not divulge where you go to school, do you know of any other programs that are scheduled similarly?
Does stretching your basic science curriculum over four years create any concern about recall for Step 1? I just took it in July and it was hard enough trying to relearn subjects from 2 years previous.
Yeah, I would be curious about this as well? Not specifically how it relates to other MD/PhD programs, but how do USMLE scores or matches compare for people in the regular MD track at a school vs. the MD/PhD?
Also, what exactly are you expected to do post graduation? Obviously, if you want to go into clinical practice, then you’ll have to do three to six years of residency? Are MD/PhD’s expected to go into residency programs that specifically allow opportunities for large amounts of basic research time? And then when you get into your career, are there positions specifically designed for MD/PhD’s or do you simply do two more-than-fulltime jobs at once if you want to continue to do both research and clinical medicine? What’s the actual breakdown of career outcomes? Do people tend to end up in one or the other instead?
Sorry, I realize that was a lot of questions. Perhaps you should have been the OP instead.
I don’t get the impression that, at least at my school, MD/PhD students do any better on Step 1 than the MD students. We take Step 1 the summer before starting graduate school, which is pretty standard for MD/PhD programs.
MD/PhD’s do tend to match better than MD’s in general. This is mostly due to the several years of intensive research and usually some first-author publications making for an application which is more attractive to many of the big-name residencies
The goal of the MD/PhD programs is to train physician-scientists who will take positions in academic medicine. The often-quoted “ideal” career for a physician-scientist is 80% research, 20% clinical medicine. This of course varies widely–some do only research, while some go into private practice. My impression is that about 2/3rds of MD/PhDs actually end up in academic positions. It is up to the MD/PhD and the department to negotiate how much time will be spent doing research. Basically any academic physician has to justify his postion financially to the school; the more money you bring in grants, the less they will ask you to bring in by seeing patients.
The majority of MD/PhD’s do a residency–probably around 95% from what I have seen. There are residencies with research pathways but I don’t personally know anybody who has done one of those.
There are definitely specialties that MD/PhDs gravitate to. Over 20% of students matching into radiation oncology are MD/PhD’s (see Chart 7 here). Other common specialties are Pathology, Internal Medicine, and Neurology; these have traditionally been more amenable to protecting time for research.
Hmm…how interesting. I hadn’t expected something like this to come up, and I’m not sure of the etiquette of butting in on someone else’s thread, but what the hell. I’m halfway through my third year of school and beginning to look at residency programs.
After hanging around with the same group of people for so long, I’m going to have to say it’s frightening. There are a number of people in my class who are outright alcoholics. A number have anger issues. Really…you’re better off not knowing. Threemae - you would be surprised at some of the shy people once they hit third year. I’ve found many of them are quite good professionally. They just aren’t great with social situations. I would argue that people with strong opinions actually have more trouble once they hit third year, since so much of it is putting aside your own opinions to do what is right for the patient and the team. Attitudes won’t take you far third year.
eh. We did basic sciences for a year, organ systems for a year, ended for boards in Feburary-ish. Sat for boards in April, reported for clinical duties in may. It’s really not very thrilling in retrospect. Group professors, mixed didatic/PBL.
PS - PBL is the biggest load of @*@)! ever. Seriously. I hated that crap. You will too. Give it time.
Yes, a little. One of our ethics classes in second year had a lawyer come in and lecture about the realities of lawsuits in medical practice. It was very, very interesting. The take home lesson was good communication = no lawsuits. People don’t sue doctors who they feel tried their best for them and laid out the reasons why they did what they did. At least, that’s what the statistics say.
Yep. Second year “advanced interviewing techniques.” In which a bunch of actors come in and “role play” different scenerios. This is also how I ended up discussing someone’s anal warts for 45 minutes with an audience. Oh, the pain.
The realities of the situation is that all the rollplaying in the world isn’t enough. There is no way to really learn how to break bad news except to do it and see it done. I’ve been ‘lucky’ enough to be in the ER in a couple of serious medical situations. I was actually just discussing this with one of my colleages. It’s awful…but the best way to learn these things is to sit in on an actual conversation with a physician you respect. But this is very, very awkward. I have no purpose in these conversations. I am there to witness the private grief of a family and it is terrible. Absolutely terrible and intrusive. I feel like I shouldn’t be there…but there’s no other way to learn. I am very fortunate to have witnessed two of these conversations with doctors I respect. It’s far more than many of my classmates get.
Straight through. Many of my classmates took a year or more. My school is fairly unique in that 1/3 of the class is “returning” students. Our oldest member is 46, I believe. Youngest had just turned 21 when he entered school.
Me? Very little.
I am probably going into peds.
I have a ton of advice about medical school admissions. I’ve interviewed potential applicants, I’ve advised undergrads, I know stats and where all the official documents are. If you have any particular questions, I’d be willing to tackle them.
Medical school is such a twisted environment…I got actual jealosy over being in the ER to witness the guy who got shot in the face. “Bilateral Traumatic Globe Rupture?” apparently equals AWESOME*.
Sigh.
Okay, the CT scan was pretty damn cool. Still…so sad.
I’m a student at the University of Illinois at Urbana-Champaign. Our MD/PhD program is called the “MSP” (Medical Scholars Program). We don’t stretch the entire basic science curriculum over four years; rather, we stretch just the first year. The second year is typically done traditionally. The U of I College of Medicine is made up of, I believe, five sites. The UIUC site is really focused on the MD/PhD program; after the first year, the only people who remain here are students in the MD/PhD program, for the most part. I think that the traditional second year helps to review, though I can’t compare - I’ve never been in a typical MSTP. I do think that the way we do our program is helpful in keeping us linked to the medical side while doing our PhDs. There’s no ‘break’ like you see in 2-4-2s.
Hirundo82 pretty much covered the latter questions, so let me take a stab at the former: I think we’re pretty good at matching. Some years are better than others, but I think it’s strong overall. (Match results here.)