1-800-IDEA-MAN: Eliminating the first two years

November 20, 2007 at 6:20 pm (1-800-IDEA-MAN, 1st and 2nd year)

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.



  1. wealthandtaste said,

    I’ve had similar thoughts about University education in general. Being an autodidact, it appalls me to pay someone to read off powerpoint slides ad nauseum.

    Great Post!

  2. REO SpeedDealer said,

    I think the vast majority of us feel/felt this way. From the get go, I had it in my mind that I was paying for the opportunity to take the USMLE. Since it is essentially a closed exam, I had to pay for admission in the form of the first 2 years of med school tuition. Going to class just isn’t an efficient method of learning the basic sciences. If you are pursuing a pre-med course, you should do the basic medical sciences in the last 2 years of undergrad, take the test, get in, and voila!, start clinical rotations and graduate med school 2 years later. However, getting academicians to change (and consequently having their universities make less money) is a frighteningly difficult prospect.

  3. Zagreus Ammon said,

    Go ahead, be a PA.

  4. MSG said,

    Just wanted to say that this sounds an awful lot like the healthcare system a German med student told me about. She was doing an elective month in the US, but they have 6 years of undergrad and medical school training all lumped together. It shortens the course 2 years, but teaches everything you need before wards. Good idea, I say.

  5. halfmd said,

    That’s how MOST of the world is. Europe, Australia, China, take your pick. Students go from high school directly to medical school and spend six years learning the medical trade. The bad news is that there is a higher physician burnout rate in the UK versus the US. I’m sure that a variety of factors play a role in drop out rate, but immaturity might be a big one. I’m not advocating graduating younger physicians; I just want much of the B.S. to get cut out.

  6. Y. S. said,

    Though you put it in a very funny way it is so true. I can’t believe its the same in the US. When i encounter BS over here I say to my self I wish I studied in the US instead! But it looks like it is almost the same everywhere. I stopped attending classes last year. I read on my own and study for the boards. I know it seems crazy but its better than having 60 year old professors read me the book. Most of the professors at my school forgot what teaching is all about 20 years ago! Ahhh, what can I say, you opened up the wounds. I hope clinical years will be more satisfying.

  7. halfmd said,

    Clinical years are indeed better, but you still have lots of asinine activities.

  8. M.S. said,

    Ah, you Kaplan comments, really make me think back to when I was studying for Step I one year ago…

    I realized how poorly taught/organized many of my classes had been, and how much emphasis had been placed on stupid stuff the professors were particularly interested in, taking our time away from studying the IMPORTANT stuff that we really needed to know. There was so much I hadn’t learned / hadn’t assimilated.

    It doesn’t help that you get these lecture handouts that look like they were thrown together by a committee; nothing is designed for easy assimilation of knowledge. It is possible to organize things in such a way (and present them visually in such a way) that they are quickly and easily comprehended and assimilated into knowledge. Unfortunately, most of the professors know very little about the theory behind LEARNING and TEACHING. (Plus, it is time-consuming to organize things to maximize learning – even those who know the theory might not have the time [or interest] to so organize their content.) Also – you get different lecturers contradicting each other, etc. It’s all a huge mess for the student to sort out / organize in their own mind. (We have ONE prof who DOES do a great job with organizing stuff for easy learning… Kudos to him…)

    Anyway, I remember as I was studying for Step I (trying to learn all the IMPORTANT stuff I’d MISSED the first time around) I was thinking back to the MCAT test-prep I took from Kaplan & I thought to myself “Kaplan knows how to organize content for efficient learning” and “KAPLAN seems to have a grasp on what the IMPORTANT points are” [vs. someone’s arcane research interests, etc.] I remembered thinking to myself – why don’t they just let KAPLAN teach the first two years of medical school – at least it would be organized properly & we’d learn something!

    (Honestly – my tuition is enough to pay an administrative assistant’s salary; maybe 1/2 of a person’s salary if you wanted to give them a decent salary they could live comfortably off of, with a nice lifestlye. You would think that if I am paying enough to provide 1/2 of someone’s salary, that things could be a little better organized!)

    OK, enough ranting! Thanks for letting me vent.

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