After having been on the wards for a while now, I’ve seen the importance of having a strong background in the basic sciences before moving on to seeing patients. While many students and physicians alike bemoan learning the mechanisms of action and half-lives of medications, this information is important in creating a useful drug regiment for treating disease.
The traditional med school curriculum uses two years of lectures and classwork to teach the basic sciences, followed by two additional years of clinical experience. The thought is that students need a firm foundation in book knowledge before applying that information to patients. Occasionally, universities get students into the hospital to practice on patients. At my school, we have a course called Physicianship Training that teaches students necessary skills for clinical encounters. The school throws us this bone to keep us interested in continuing the lectures that drag on for those first two years. The only problem is that medical school costs about $30,000 a year for those lectures.
I’ve come to realize that the first two years of med school were largely a combination of wasted time in lecture and physicianship training exercises. I’ve noticed that my school charged $60,000 for students to teach themselves from textbooks for two years. Many of my readers who are already in medical school or are doctors are all too familiar with the self-teaching that occurs. Professors are notoriously bad at teaching about mitochondria and the brachial plexus, leaving the student with the task of clarifying the material later.
Given that the students are already self-teaching, I propose that we eliminate the first two years and leave the basic sciences up to the textbook authors. We’ll make the Shelf and Step exams the determining factor of who gets into medical school. The top 17,000 scores get in, while everyone else has to re-take Step I. Naturally, research experience and rec letters will play a role in admissions, but this method will bring in a steady supply of doctors with a strong basic science background.
Some critics will claim that Step I’s 350 questions do not cover enough information to fully assess a person’s ability to become a doctor. My first response is to point out that Step I is already used as the primary indicator of knowledge from the first years. Second, we can extend the exam to cover two days and double the number of questions if there is any concern that the test is not an adequate measure of science comprehension.
Companies such as Kaplan will emerge with their own medical schools to prepare people for these exams. Critics will claim that test prep groups teach to the test and not to the material. While there is some credibility to this argument, I certainly won’t miss out on all of the surgery lectures I saw where the surgeon shows before and after pictures of his work. Further, I am sure that Kaplan would hire better lecturers, would be more efficient at teaching, and would be cheaper. Similar to a cell phone contract, at $30,000 a year I’m currently locked into my school where the professors have a monopoly on my education. Under my plan, when universities are forced to compete against each other, the quality of lectures would improve drastically. Then, after Step I, future doctors could move onto the wards—and the real two years of medical school.