Via Reddit
Simplified
In a perfect medical school the basic science education would be cut down. What I mean is that the focus on minute ‘physiologic’ biological processes would be limited. The basic sciences, especially in the first year, have become too complex and unnecessary. Too often what students are introduced to is influenced by the research of the faculty of the school. At the perfect medical school such would be limited with strict curriculum oversight. Further cutting of the basic science years would be limited by the National Board of Medical Examiners and their continued insistence that memorizing a host of biochemical pathways is somehow imperative for a single test day, somehow is imperative to becoming a physician. If that obstacle was removed the perfect medical school would significantly cut down on the traditional ‘first year’ material.
Early Clinical Exposure
The perfect medical school would also compress the basic science years. Already there are schools which do the first “two years” in eighteen months. An applause to such schools. The perfect medical school would do the same. The key is to get the medical student out of the classroom as soon as possible.
As I’ll discuss in the clinical sciences post, clinical exposure would be early in the first year and often. The 18 months at the beginning of the perfect medical school could hardly be called ‘basic science,’ despite the title of this post.
Integrated Curriculum
The perfect medical school would have a truly integrated curriculum. There would be no distinction between ‘first’ and ’second’ year. You would progress through the 18 months of basic science in modules focusing on various topics (i.e. cellular metabolism, cardiovascular system, GI system, etc.) in which you would cover the physiology, anatomy, pathology, related pharmacology, etc. The basics, which are hard to integrate, would be covered in the first two months in the classroom and then it would be off.
Despite the abandonment of the anatomy lab by some schools, gross anatomy and human dissection would remain a strong component of the perfect medical school.
Technology
The perfect medical school would be the most integrated school in the country, technology wise. The obvious things, done in most schools nowadays, would include virtual microscopy (no student should ever have to fix a path or histo slide), online lectures, online grades, online syllabi, computerized test taking.
Summary
Pre-Requisites
Pre-requisites for medical school admission should be extremely limited. Indeed, I think in the perfect school, they would not exist at all. Completion of say an undergraduate biochemistry has absolutely no independent predictive value of medical school success. A reliance on standardized tests to assess the pre-medical school basic science knowledge base in appropriate and required pre-requisite classes are simply redundant. Indeed the MCAT is an excellent predictor of medical school success; probably the best single predictor.
As many medical schools there would be no specific requirement for an undergraduate degree. Indeed, I would propose allowing mature high school students sure of their future to study for and take the MCAT without any college preparation and to enter medical school immediately following high school. And I’m not talking about an extended course here (like the 6 year European programs).
Admissions Criteria
As above, great emphasis would be placed on standardized measures (i.e. the MCAT). True, there are anecdotes of those who are merely poor standardized test takers and otherwise excellent students and perform as excellent physicians but in general the MCAT is an excellent predictor, not only of future standardized test performance, but of performance in medical school in general.
Very little weight would be put on prior GPA, which is entirely impossible to standardize versus other applicants. Such would probably help the pre-med attitude a bit.
More than lip service would be given to the intangibles that make a good physician and a demonstration of the right motives for going into medicine, a commitment to research, etc. would be elicited in part through self reporting, letters of recommendation and the unique interview process.
Interview Process
The admissions committee interview team would be entirely limited to physicians and current medical students and basic science faculty would be barred. The idea is that the interview process should solely serve in trying to determine the intangibles which make a good clinician. Hopefully things like a dedication to research can be derived from the applicants’ previous activities.
The interview process would be given a huge amount of weight, as a measuring tool of applicants’ intangibles as mentioned above. I imagine a full day ‘interview’ or perhaps two half day ‘interviews’ to standardize the rankings the admission committee members give to the applicants they interview.
What I mean, is that the admissions committee members would give an entire half day to interact with the applicant. Your a clinician in clinic then the applicant comes along or he scrubs into that surgery. The applicant and interviewer sit down for lunch together and then perhaps dinner with a second interviewer.
Summary
[Return To The Perfect Medical School]
——-
Photo: Laffy4k/CC License
If I was creating a medical school from scratch there are some specific things I would incorporate. Many of these ideas exist at various medical schools here or across the world. Some of these ideas are wholly new. This is essentially just a random collection of thoughts and not exactly an outline of how to start a school (no duh). For obvious reasons these ideas ignore current accreditation standards.
This series was inspired by a lengthy conversation I participated in (admittedly over drinks) concerning the perfect medical school. It was a group discussion amongst second and third year medical students from schools all across the country. It obviously focuses largely on ‘undergraduate’ medical education, which should be the primary focus of any medical school (many medical schools lose sight of this).
1. Pre-requisites & Admissions
2. Basic Science Education
3. Clinical Education
4. Special Topics
If you have any ideas on the perfect medical school please leave them in the comments.
This is a drawing from a lecture today. Actually a very good lecture and not just because we got a kick out of the drawing. Any guesses as to what condition is being…crudely…illustrated?
I was at a fundraiser recently for a program to send several first years over to Ethiopia for 4-6 weeks. They had this interactive drumming group come in who are actually a lot of fun. And while I’ve been on some international mission trips, hearing the kids who did it last year talk it made me really wish I had gotten to do this in between my first and second year.
It is becoming a trend to get students far more involved in clinical experiences during their first two years. Indeed, my school may be a little slow to the party. But if you can find the funding for it, it seems very important to send first and second years on international experiences. Listening to the second years who had been last year, they were getting to operate with an incredible level of autonomy, see incredible things, in a small way help a lot of people. I’m sure all of them are better medical students and eventually better physicians, for their experience over there.
For the first years going this year, good luck and do some good over there guys.
There’s a weird for profit “allopathic” medical school which has apparently opened up in California. The New Scotland International School of Medicine.
2 years and ten months total program length
3 starting classes per year: January, May, September
No MCAT - NOT required for MD licensure
No Bachelor’s Degree - NOT required for MD licensure
No Minimum Undergrad Credit Hrs -NOT required for MD licensure
No AMCAS Application, Apply Directly via School Website
No Age Limit
The school apparently has no clinical partners (no hospitals or clinics for students to do rotations at) but instead says that you can go find your own rotations at various Veterans Affairs hospitals and clinics around the country. And I say: What?
The school isn’t accredited by the LCME, but claims a loophole in that it will be listed in a World Health Organization Directory. It is true that for foreign medical school graduates most states use the WHO directory as a starting point for accreditation. But this almost certainly only applies to foreign graduates. For U.S. graduates you have to be a graduate of an LCME or AOA accredited school.
The school has been roundly mocked on the web and rightly so. Over My Med Body! (side note: congratulations to Graham for his great match in Emergency Medicine), on Student Doctor Network, and on other blogs throughout the web. Over My Med Body! in particular did some actual detective work and uncovered something far sketchier than even Stewart Unviersity’s crappy website might imply.
In response, defenders of the school have made some biazzare claims. Over My Med Body! reports a conversation with someone at the school,
I just spoke to a man who answered the phone, who was very confrontational when I asked “Where is the school located?” He started rambling about how ValueMD and StudentDoctor have been harassing and stalking people from the school. He admitted the address on the website is a PO Box, and said the school does not release the address or location of the school until an applicant has been accepted. (”Fine by me,” I said, “But it seems a little weird that a medical school wouldn’t be visitable or even map-able.”) He then noted that “members of Al Queda have been in contact” with the school, and the school had to file a “400 page document with the FBI” because of this. Yowsers.
Such claims of being targeted by terrorists are echoed elsewhere. Check out this comment on Wikipedia,
We have experienced a flood of stalking behavior from students concentrated at a small number of schools (particularly Wayne State University) who have created a fictitious group on Facebook, and stolen copyrighted material from our website repeatedly at www.stewartmed.org and posted it illegally on other websites including www.studentdoctor.net. I suspect that these same individuals, some likely related to Al Qaida, have misled you regarding our school because it seeks to give US military veterans admissions preference to the school.
I seriously laughed out loud while reading that. The entire idea of Stewart University New Scotland International School of Medicine is just too stupid to take seriously, otherwise I might be concerned about the school’s encroachment onto the turf of legitimate medical education.
How cool is MIT for putting 1800 course syllabi, written notes, even a helluva lotta video and audio lectures all online for free.
A Very Introductory Lecture On Biochem
Go visit MIT’s OpenCourseWare page and learn something today.
I’m done with USMLE Step 1! Maybe I should leave off the exclamation point. The entire ordeal has been kind’ve anticlimactic.
It’s a giant relief to have that behind me and yet, disappointing that it is over. Mostly because the only things I can remember are the questions I had trouble with…so I sat there Wednesday after the test frustrated over things I could’ve done better.
It’s annoying when you get halfway to a question. For instance, the best case scenario would for me to have a memorized list in my head of vaccines contraindicated in HIV…but I don’t. Instead, trying to reason it out, I can call up the fact that MMR is a live attenuated vaccine. Seems a reasonable thing to figure not to give to someone facing immunocompromise.
Last night, as I did my after the fact research (with a beer in my hand) I couldn’t help but be a little annoyed. Of course, that question is just an example of many that are tugging at me.
Oh well, you only remember the iffy/tough questions. Not exactly a balanced way to estimate your performance.
Third year didactics are less than five days away. I plan to get back to regular posting before then.
I’ve been done with my basic science classes for a little over a week.
It certainly was an incredible feeling. But short lived since I’ve started my study time for the biggest test of my life to date - the Step 1.
What, personally, I think is even more exciting however is I’ve finally got my third year rotation schedule. I admit, I didn’t have really strong preferences about what I was hoping to rotate through this year. I had some things I didn’t want (uh, sorry PM&R) but besides that I think I could be happy with just about anything. But it is still very exciting.
My school breaks the rotations up into six weeks, except for medicine and surgery which are twelve weeks each. Surgery gives you more the most choice. For the others your selection is mostly limited to what order you want to do your rotations in and where you hope to do them.
And then…done with third year. Yeah, that shouldn’t be too hard or anything. *rolls eyes*
The directive interview is beaten into your head when you’re first learning to do a patient history. You ask pointed, direct questions in a pretty standard order.
That is lovely until you get to the patient who doesn’t feel like elaborating.
I shouldn’t be so hard. I’m pretty tight lipped myself.
So I probably have more sympathy for the “non-elaborators” than for those on the other end of the spectrum. This is the patient with just crazy tangential thought. He starts off talking about his back pain and the next thing you know the stats from his junior year in high school playing tailback or about the time he bit into a piece of rotten fruit when he was nine years old.
For those who stumble across this post: which do you think is the most difficult to deal with for an inexperienced medical student?
Third year is so close you can feel it. Not that I’m looking past the Step 1, but it can’t hurt to keep the exciting milestone of starting your first rotation in sight.
With that said, it does provide a little stress on the nerves. I wish I had seen more on the clinical side. I’m pretty involved in some national organizations and from the many interesting medical students I meet it is my impression that one of the things that varies the most amongst school’s pre-clinical curriculum is how they treat the introduction to patient contact.
I’ve seen a lot of standardized patients, I’ve seen a lot of patients being presented in physical exam labs as examples of specific findings. After this week however I will have performed an H&P on exactly four real patients as a medical student.
It has been enough to get me over my fear of invading a patient’s personal space and privacy. That early fear to lay hands on a stranger so intimately. And I suppose I have pretty good confidence in my physical exam skills. But I wish I had seen more.
Maybe it is just some innate social awkwardness of my own but I wish I had a better handle and sense of the provider-patient relationship.
No…that’s overstating it.
I wish I felt like I belonged there when I walk into a patients room; like it seemed like I belonged there, that I played the role of an actual health care provider better. If that makes the least of sense.
That comes with experience, no doubt. Another reason to look forward to getting into the hospitals. That brings us full circle to my original point: actual patient contact during the basic science years varies wildly between medical schools and I wish I had had more of it.
Hot off the heels of my rant comes this from Clinical Management of Poisoning & Drug Overdose (via Caffeine Web):
Caffeine-induced psychosis, whether it be delirium, manic depression, schizophrenia, or merely an anxiety syndrome, in most cases will be hard to differentiate from organic or non-organic psychoses.
[…]
The treatment for caffeine-induced psychosis is to withhold further caffeine.
I think this is terribly offensive and sad. A three year investigation finally leads to indictments in a cadaver trafficking ring out of the UCLA School of Medicine.
Henry Reid, 57, an embalmer who was director of the willed-body program from 1997 to 2004, was charged with conspiracy and grand theft for allegedly funneling donated bodies to a middleman, who then sold them to others for profit.
The middleman, Ernest Nelson, 49, was charged with conspiracy, grand theft and tax evasion. He has acknowledged cutting up about 800 cadavers and selling them to large medical research companies, including Johnson & Johnson; Nelson says the school authorized the sales, but UCLA officials say he was acting on his own.
Traditionally, at least from my psychopathology course, the cognitive deficits of depression have been excused as concentration failures or lack of motivation. Indeed, on a test on Monday I’m going to need to be able to distinguish between dementia and the “pseudodementia” of depression, wherein the latter you see lack of effort in memory testing, like immediately answering “I don’t know,” rather than true deficits.
A write up on a study of the relationship between depression and memory, using virtual reality, tries to contradict the above notion..
