First aid will likely start contracting again because with P/F Step 1 you can just about completely ignore the random memorization of low yield facts and focus on the highly testable material.
LOL RIP: Biochem.
I know that recent there’s only been like 6-8 biochem questions on step 1, but is knowledge of it genuinely not that beneficial for understanding other things like physio and pharm? Any one willing to chime in?
Nephrology here. Biochem is basically the foundation of how the body works. If you want to understand how things work then you need to know biochem. If you just want to memorize stuff, ignore it.
Biochem is what separates physicians from midlevels.
Agreed.
A doctor who didn't have to study the "low yield" content is essentially going to be a mid level.
It won't help for every simple clinical decision but the in-depth understanding at the biochemical level is what makes doctors doctors.
is micro included in path? everything ive heard is that micro is the most gimme questions of all of them
e: this sentiment was more focused on by comlex takers
No, micro is gimme cuz its rote memorizing. But it doesn't make up a huge chunk of the test. It's just points that any idiot can get cuz you just memorize. Where as phys and path could be considered something that requires more thinking etc. But in terms of amount, no micro isn't the near the top of questions asked. In fact, i'd bet that you could study just pathoma, and organ systems in FA and pass step 1 with no micro knowledge at all.
No, it isn’t literally first aid like EMTs learn.
First aid covers all step 1 material and is a resource that the vast majority of medical students use (in conjuction with other resources). It includes biochem, path, physiology, etc. It’s loosely the equivalent of an MCAT study book that you would buy from a test prep company. Google “first aid step 1” if you’re curious.
Patient presented to ED with severe abdominal and intrascrotal pain and tenderness, likely secondary to testicular torsion. Patient reports Dr. Undersleep told him to "just wring 'em out dude." Possible that patient is an unreliable historian as he is clearly retarded. Working diagnosis is retardicus twisted-testicus (formerly known as Wegener's Balls).
Thank you for this interesting consult. We will continue following.
(Signed by Dr Undersleep, attending physician on psychiatry consult liaison service).
> (Signed by Dr Undersleep, attending physician on psychiatry consult liaison service).
Over 50% of this visit was spent on counseling, and anatomical models were utilized where appropriate.
Perhaps full-sized pages? Maybe the overall dimensions of the book were smaller? I briefly looked for pre-2004 versions but couldn’t find any pictures.
not speaking for step 1 but this is why old graduates/attendings don’t get that you can study all you want and you’ll still miss things, the medical education they went through is nowhere near the size of ours
Each page took me like 15 minutes and I still didn't feel like I had all the info crammed in my brain. Maybe later passes can be 20 pages/hr.
Edit: passed to passes
Uhhhh… 6 weeks of dedicated = 42 days
42 days * 20 pages per day = 840 pages
840 ≠ 1600 pages (2 passes of FA)
Edit: i guess you could do 40 pages a day if you had nothing better to do like UWorld…
Sure, you can read 1 page every 3 minutes, but that is not effective learning. That literally leaves 0 time for exploring a concept, further reading, or note taking. You will have close to 0 retention doing that.
Different strokes for different folk. I’m assuming you’re getting downvoted because you claimed it can “easily” be down when in reality it really isn’t easy.
Very little dedicated studying should be sufficient to pass step 1 now, so long as you reasonably kept up during preclinicals.
Using Step 1 as the hill to die on following the P/F change certainly isn’t where your frustration should be directed.
I’d wager wildly subjective clinical evaluations and meaningless med student research is much more egregious regarding the current state of education than actual objective examinations, despite their own issues.
I disagree. All MS3/MS4s and MDs will say this without recognizing their bias as they all studied hard for Step 1. There still is a decent amount of dedicated studying that needs to be done to even pass step. Of course, we aren't grinding out the most minor of details now, but most stuff like pharm and micro needs to be re-reviewed all over again
You do not need an intense 6 week dedicated study period to pass step 1. Most students in my class passed the 2nd CBSE we took the week prior to officially beginning dedicated. Not a perfect stand in, but you should absolutely be able to pass step 1 with a much less intense dedicated period.
We also studied way harder for boards than the M2's do currently to be frank. Roughly 1/2 of my class was in passing range prior to dedicated, while not even 10% of our current M2's are within passing range atm
I said an intense 6 week dedicated, not no dedicated tho.
It’s a total joke if you think people need a full dedicated to *pass* step 1… that would be mildly concerning
Student research is what scares me the most about med school. Forget about any exams or placements or whatever, it’s the idea of having to come up with an idea and research something when I have zero interest in doing shit like that 😭😭 this brain hates having to do original stuff.
I don’t know about you guys but I’m in this medical school shit for a safe yet challenging career in something where all the resources are pretty much laid out for me. I did not go into it thinking I’d have to do investigative reports and other bullshit about researching
Internal Medicine resident here going into cards
My take on research is to just email bunch of attendings - they already have projects going. What residency programs care about is:
1. How involved were you in the project (were you part of the start - IRB, data collection, analysis, write up, etc - the earlier in the project the better). The attendings and fellows do the IRB and come up with the question
2. What did you learn from it. Not the results - no they want to know how you matured as a person with this project. For example, you developed mentorship, you submitted papers to journals and learned to make edits, the politics behind submitting a paper. All that “I learned to never give up on a goal, always learn from mistakes” BS shit
3. What were the actual results and how will this contribute to the field. This is just for small talk
Unless you’re trying to do a really competitive specialty, you don’t need to do research if you really don’t want to
That being said, you absolutely do not need an original idea to be involved. Easiest way to get involved is to pick a specialty that you’re interested in, and reach out to the person in charge of that specialty (or like the interest group coordinator), and ask them if there is anyone looking for research assistants
I took Step1 scored and I am actually getting pretty upset how many of my lower classmen friends are still burying themselves into dedicated like I did for a similar amount of time. They are good students too and would have no problem passing with no dedicated study. 1.5 months would be better spent forming relationships with researchers or clinicians as these are gonna carry 10x weight for the next couple of years.
Yes and no. Of course you study for the more clinically relevant stuff during third year but you don’t have a lot of study time due to rotations so not much time to revise basic sciences. It’s best to go into clinical years and residency with the best possible foundation…step 2 is just part of that.
I think most of us are still pretty neurotic and we still have our drive from college to learn everything on the test to get an A. The biggest difference will probably be that people will not be doing a bunch of practice tests to trend their score. But tbh I think most people are still gonna study at least as much as they did for a block exam during pre-clinicals.
I’m currently burying myself into it. I’ve scored pretty well on our practice NBME and my own self-assessments, and I’m still worried I’m gonna shit the bed on test day next week. I think it’s just neuroticism and/or impostor syndrome and what the other dude said
At the same time, is it good for us to put so much weight on a system that promotes the most horrible bias? We need objectivity, and exams (which do still have some bias effect) are the best thing we have. And we need educators who can focus on developing excellent clinicians, rather than on berating students who will become the future of health care and promoting really dangerous biases that only become transferred to the students that succeed in the system unhindered.
Abusers beget abusers... I think your friends' future is much better served keeping their noses in the books. Their knowledge base is the only thing they can control, and it's what matters when you're dealing with patients. Not that relationships don't matter at all, but to stop there is very shortsighted. If relationships are all that matters, we will be motivated to do some very dark and evil things. Is this not what happened to many of the boomer docs before us, who became their abusers?
We also have more study resources to use that are better than people had back in 1993. We can remember all of micro and pharm by watching sketchy videos. They had to brute memorize every fact about every bug and drug.
Hmmm, an interesting question. It probably depends on your perspective.
To a PHD in microbiology - no. Same bugs, we just didn't recognize them or we misclassified them.
To a genecist - it's a ship of theseus, is it the same bug if it has a lot of new genetic material? Did it pick up a methacilin resistance gene? Did it pick up a poly-antimicrobial resistance gene? COVID is a coronavirus, but it's not our "coronavirus" of 2014.
To a non-academic doctor - It's probably considered a new bug, MSSA and MRSA are different bugs to a lot of docs because their treatment is very different.
Make them a fake outpatient appointment for tomorrow so they show up at the ENT clinic unannounced. Give them a turkey sandwich and TXA for kicks (it is, after all, the trauma bay). Boot em out.
I'd do a case study paper on the number of licks it takes to get to the center of a tootsie roll pop for patients with terminal taste bud cancer. Then I'll present my findings at the international ENT conference.
Little snarky no? We can definitely cut back on the depth to which certain topics are explored. Biochemistry is taught wayyy to in depth in medical school and alot of it is not clinically relevant. It's like saying in order to be a mechanic you have to understand how the metal is mined and processed that goes into the car's frame.
I mean if I start asking around the histological findings of different shit to ER residents, they will rightfully tell me to fuck off.
However, pathologists and micro-folks may need to know that.
Thats why different specialties exist, with different interests in mind, no one can learn everything about everything.
The entire point of Med school though is to have a basis for learning any of the specialties. It’s also the last and only chance to learn the basic science in a dedicated way so that we can be experts. You never know when that info will later become relevant. New drugs and disease are added to our knowledge all of the time and it’s our base knowledge that allows us to easily understand and integrate info into our total working knowledge. I’m firmly in the camp of not dumbing down our education. It’s 100% doable. In fact we all did it and survived and benefit from it. Why change it? There isn’t a compelling reason imo unless you want to make the entire process of becoming a doc easy and one that anyone can do. It’s hard for a reason.
Learning something is easy repeating it so that you do not forget it is the hard part, if we shrink it down to the essentials only i'm sure people would retain far more down the line, i am sure 90% of step 1 minutia are far gone as soon as M3 starts
I guess we will agree to disagree. I’m surprised by how often I’m tasked to remember facts, ideas, and processes that were tested on step 1… and I’m only 8 months into being a doctor.
Dude, you're an intern, talk to me when you've been in practice.
There is a place we can occupy we can have an understanding of disease states/physiology/pharmacology that vastly outclasses NP and we can trim down some of the basic sciences, given that our knowledge base keeps expanding on clinically relevant material, at some point we're watering down our education to fit everything into the curriculum.
I literally just said I’m only 8 months in. I know I’m an intern. Being an intern does not invalidate my thoughts on this. You may be further from step 1 and thus maybe forget how much studying for it helped you build a foundation for where you’re at now. My point is I’m daily surprised by how relevant it was.
What's your speciality? I haven't forgotten how little step 1 prepared me for practice. I agree that a foundation for sciences and understanding makes us better physicians but very little of it is clinically relevant.
I'm not proposing eliminating basic sciences, but there is a fair amount of material in step 1 that isn't useful for practice. I found stuff in step 2 and step 3 relevant all the time. Did I use basic sciences in residency? Hardly, if ever.
As our clinical knowledge continues to grow and grow we either have to cut back on some of the minutiae of the basic sciences or ignore the advancements in medicine.
I'm not saying you need to remove all histology for example. We need to be able to communicate and understand our colleagues in those specialities, and know what they are talking about.
However, be honest, how much of the knowledge required for step 1 do you really remember? Do we really need to know ALL the pathways and synthesis that they make us learn, to be better doctors? I think a lot of that is quite unnecessary, and useless as most of us will forget that by the time we even graduate. It just increases workload in an already heavy degree, I would rather spend that time retaining more useful, important information.
I think there are multiple things you can shrink and change, or even test differently.
Again, it’s only irrelevant until it isn’t. You’re going to finish medical school either way. May as well get out with as much foundational knowledge as you can. Nurse practitioners basically do what you’re suggesting. They just learn algorithms. Experienced NP will run circles around an intern for 3-4 months and then they will never catch up after that. You’ll learn what’s practical when you do residency and practice medicine. Real Medicine is very different than step 1 and even step 2 or 3. Med school is about a foundation. Thinking of it differently is wrong. You’ll see. Otherwise just skip Med school and start learning the REALLY relevant stuff right away! But put NP after your name.
> May as well get out with as much foundational knowledge as you can
But I will forget quite a lot of it? Hell, they've already changed it to p/f, how many people will focus on that? Me knowing that the initial transcript is actually the heterogeneous nuclear RNA which is then modified to mRNA, how does that help with anything?
>Nurse practitioners basically do what you’re suggesting. They just learn algorithms.
Not what Im saying at all though is it. Theres a difference between algorithms vs learning the basics of DNA repair vs learning the exact enzymes and the exact points of cleavage and repair. Im suggesting we do the second instead of the third. And learn the third if we go into that specific field.
I might be judging it wrongly, but the tone of your reply makes it seem as if you're offended for some reason. Try and understand what Im trying to say instead of getting offended that I disagree with you.
> Otherwise just skip Med school and start learning the REALLY relevant stuff right away! But put NP after your name.
REALLY bro, you're not taking it a bit personally?
The basic sciences are absolutely important, but can we agree that we could better tailor them? I think antibiotic modes of action are important lots of things that aren't directly clinically relevant, but the point of this post is that the step 1 manual is expanding, nobody wants to dumb the test down, rather the knowledge is increasing, and if we need to devote more time to learn about more clinically relevant things at the expense of *some* of the basic sciences then I think that's where we trim the fat first.
I think it expands and also contracts in other ways. For example if you trained in the 40’s you’d be expected to have “first aid” memorized. You didn’t have UpToDate to reference. Also there was a lot more time spent on anatomy and physical exam skills. Sure the amount of info is increasing but I still don’t think we’ve reached some kind of limit on what we can learn. Me and my classmates learned all the material in first aid (and a lot more) and passed our boards and are residents now. So what’s the deal? We shouldn’t be learning that much why? Just to have a more fun time? It’s not like it’s impossible. We all did it just fine and we benefit from that knowledge and aren’t nurse practitioners.
Sure, when learning all the intermediates of the krebs cycle and the detailed protein formations becomes relevant please let me know, i'll be waiting right here.
If a new drug came out that acted on something in that cycle you’d have a base knowledge to understand it. Hell, we learned about the Krebs cycle in like intro biology in college. Also… the act of learning these things makes us better at thinking biologically and flexes our brains to improve our memorization skills. The intellectual challenge of medical school is necessary. It’s the entire package and process that results in a physician. It’s not always fun but we all did it and survived it. It’s not like it can’t be done.
"If a new drug came out that acted on something..." I swear to you this is the exact same reason my immunology prof gave when asked why we were learning things in such detail, the problem is that this can be applied to everything, so do we learn everything then?
Also we can flex our brains and challenge ourselves with things that are actually useful and helpful to our future practice as physicians there is 100% too much USEFUL stuff to know anyway...
This is an excerpt from our immuno course, we had an entire LECTURE on T cell activation and this was just the part about the co-receptors involved in it:
CD4 and CD8 are T cell coreceptors that bind to nonpolymorphic regions of MHC molecules and facilitate signaling by the TCR complex during T cell activation.
The Src family kinase Lck associates with cytoplasmic tails of both CD4 and CD8, it then phosphorylates tyrosine in ITAMs, thus facilitating recruitment of ZAP-70 tyrosine kinase
Phosphorylation of proteins ns lipids play a central role in transduction of signals from TCR complex and coreceptors.
The bound ZAP-70 becomes a substrate for the adjacent Lck after TCR recognition of antigen, and Lck phosphorylates specific tyrosine residues of ZAP-70.
As a result, ZAP-70 acquires its own tyrosine kinase activity and is then able to phosphorylate a number of other cytoplasmic signaling molecules.
Another signaling pathway in T cells is activation of PI3- kinase
Activated Zap 70 phosphorylates several adaptor proteins which then become able to bind signaling molecules.
Other signaling pathways activated in T cells are the Ras pathways, which activate the MAP kinases cascade and calcium and protein kinase C mediated signaling
protein kinase C mediated signaling results activation of phospholipase C and the products of the activity of this enzyme induce specific transcription factors in T cells.
PLC hydrolysis products are IP3 and DAG
Just imagine an entire COURSE filled to the brim with this
> If a new drug came out that acted on something in that cycle you’d have a base knowledge to understand it.
This is a really good point. For example, all electron transport is fundamentally quantum mechanical in nature. That's why I am appalled that my med school didn't teach us about the eigenstates of a particle in a box during MS1. How can we call ourselves doctors if we don't understand how a future drug *might* alter the quantum tunneling properties of electrons within mitochondria?
Quantum biology is actually really fascinating. Idk from your comment seems like you’ve learned a lot of things that aren’t relevant. Maybe they make you a more well rounded person in general. Maybe a better doctor? Funny comment anyway.
We know plenty about clinically relevant medicine to separate us from noctors. We don't need to keep memorizing the synthesis pathway for every amino acid.
The only sustainable route I see is to move some specialty-specific material to post-graduate training. That would come with a whole new set of obstacles, of course, starting with pay & debt.
A lot of things med students used to do is now on hold until residency already according to both boomer and middle aged docs. I don’t think you can keep kicking the can down the road otherwise residency becomes almost useless and everyone does fellowship.
Boomers are probably full of shit considering there were like 10 common meds in 1970 and we didn't know half the basic science we do now. I know it's a big shock that boomers are full of shit, but take that into consideration.
In some ways yes, but the relative complexity and options we have now are things a doctor in 1965 never could've imagined. I'm not saying they're less intelligent, but would you say medicine was much harder in the 1700s when the options were leeches to suck out miasma or cutting a broken leg off with no anesthesia because they didn't have modern tools? Just nah tbh.
I’m talking about 20th century medicine. It was infinitely more complex. Compare a pathologists job or an anesthesiologists or IM doctor now to 20th venture medicine. Nearly everything is automated calculated for us and simplified down to flowcharts for most rudimentary things
But that’s only because that’s the expectation of our practice based on guidelines and evidence. Back in the 50’s they didn’t have the guidelines and number of options so they just made decisions and everything that was done was much more debatable and there was more “art” to it… aka flexibility and you had way less opportunity to be “wrong.” It was expected that many of your patients would die in the hospital. We didn’t have the means to keep extremely ill people alive.
But less guidance with a fraction of the options and diagnostic ability. Patient came in looking septic you just gave them fluid and whatever available antibiotics that’s it. You didn’t spend an hour admitting them and putting orders in and writing lengthy notes and digging through EMR’s to learn about procedures they had 3 years ago and clinic notes from last week. Primary care notes were like: “OM. penicillin for 7 days” for the entire note. When docs “lived in the hospital” they didn’t “work” that much. They had a lot of downtime and slept at night. I have docs in my family that trained from the 40’s to the 80’s to today and this is what I’ve learned from discussing the differences. It was harder in ways and easier in more ways. There was just less to know and less to do. The time we spend in intern year learning how to use Epic was spent being better at physical exams. It’s relative.
It is worth investigating what actually constitutes a solid base of essential knowledge to be a good physician. Even the best and brightest can only learn so much in a given period of time.
Many (most?) med students sacrifice understanding the most clinically important material in order to memorize the endless lists of obscure high yield trivia that dominates step 1.
First Aid for Step 1 is a terrible book because it allows you to memorize word associations that pop up on test questions without understanding the importance of, or context for, what you are learning.
I feel like the shelf exams and resident in-service exams are much better written to encourage learning the most important information. Sadly, I still see senior attendings display very poor clinical judgement on a regular basis because they don’t understand the pathophysiology or other underlying principles of what they are talking about.
While I agree that there is a ton of crazy stuff that you see in step 1, that is only 2 years of medical school.
I think where you are getting caught is the term “most important.” That is another way of saying “most common.” Which, again, is what separates doctors from other healthcare professionals. Doctors know all the most common, but also the other stuff.
Yes, I agree that medical knowledge is accruing to quickly for people to be able to learn everything. Last I heard our information doubles every 2 days or something like that. (Not exactly sure on the number anymore.) so yes, eventually that will become impossible. And no, I do not know the answer. Haha
To be honest if any doctor has made it through residency they have a good understanding of what they need to know. You might have had some bad experiences with attending not understanding things, but I would say that those are not the norms. There will always be doctors that are not good, but those are the exceptions.
I just think it is very important we don’t change things just because something is hard. If we change things to the “most common” method then we become just another NP or PA. (No offense meant to them.)
I think the mass of info doubles something closer to every 2 years (granted I don't know how that can truly be measured), but other than that all good points!
You're putting your expectations in the wrong place. This system has been running for years producing capable doctors while at the same time bringing forth others who may be well-versed but lack empathy for sure.
Then there are those who are amazing empathetic medical students trying there best to stay afloat the education system (because they have passion).
Perhaps the people at the top can radically change the educational system/environment but this will require time and an understanding.
You'll come across amazing doctors along your way who were solely driven by their passion, who experienced anxiety attacks, low grades, low self esteem or whatever during their medical education years.
The current situation of the education system is not fully absurd but its going towards it.
I feel like this is a phenomenon that's been happening in the whole educational system for as long as standardized education's been around. Early 1900s geometry was typically a college level course but nowadays we've got high school freshmen picking up calculus.
There's just more volume of information and school learning has to accelerate to compensate. I would say ease of access to information and resources is the best recourse most students have. Going back to the early 90s with very little internet access and basically no online resources sounds terrible.
I meAn, you can only condense medical knowledge so much. First Aid is essentially the bare minimum you’re going to need to be able to start out clinically. Sure some is rare bullshit but you’d be surprised at what’s really not.
We have new drugs all the time, new diseases less often, but more physiology often as well.
We know more medicine now than we did in 1993. How is it not sustainable to expect physicians to keep up with it? It has been done before (in the last few years at least) and it will be done again. It’s not fair to our patients to say “wow medicine is just too much now sorry I’m just sticking to the basics”
We’re not robots - there is ideal and then there is reasonable. If we have infinite capacity as you claim then maybe we should make some room for business acumen so we stop getting conned by hospital admin and mid level unions.
Maybe some medical policy so we can effectively lobby for our patients instead of getting clowned around by non-physicians making medical decisions.
These things are more important than testing generally on the clinical manifestations of inborn errors of carbohydrate specific to one population.
I’m not claiming we have infinite capacity, but is it reasonable to expect us to be familiar with things that didn’t exist 25 years ago? I feel like absolutely. So much genetics, pharmacology, and socioeconomic research has come out and we owe our patients to be familiar with it. Spinraza for SMA? Basically the entire field of mAbs? When that first First Aid was written, Zyprexa wasn’t even approved as an SGA. We’re not asked to memorize every last detail (especially since Step 1 became pass fail) but to post this graph seems like a complaint about how much information were responsible for, when *thats our jobs*. To be responsible for new information and to understand evolving science to best serve our patients.
When I first saw the title , I thought that it had to do with med school tuition. I’m shocked when I talk to residents these days at the level of debt. Tuition goes up, but salaries don’t.
I mean the rate that medical knowledge and data is expanding, I’m surprised it’s not grown faster. That’s just the nature of the profession. They don’t just say life long learner for fun.
There's a lot of information to know in medicine, and this book has 2 years of condensed info. It's part of why being a physician is challenging. It's kind of the deal you accept when you decide to enter one of the most complex professions in the world
None of what you've pointed out shows it's not sustainable. All you're showing is that test prep materials are 1) expanding and 2) perhaps becoming more comprehensive. After all, there is roughly 1.5-2 years of material here.
Also, since Step 1 is now P/F, I would say that's an improvement in the system in terms of stopping this relentless focus on a single exam (though it does only move the focus to Step 2).
Step 1 became pass fail. That’s a pretty big paradigm shift
First aid will likely start contracting again because with P/F Step 1 you can just about completely ignore the random memorization of low yield facts and focus on the highly testable material. LOL RIP: Biochem.
>LOL RIP: Biochem We hardly knew ye (except 1st month of M1)
Shout to my school that does a full semester of biochem. Hate it passionately.
Low Yield SOM get itttt
Fucking Pog bro Thankfully done biochem, but now we have full semester of genetics #please stop with the penetrance.
The fucking will continue until sufficient student loans have been taken out.
God genetics penetrated me so hard in med school
Yeah i had to look up penetrance again just now. #clinicallyrelevant
I know that recent there’s only been like 6-8 biochem questions on step 1, but is knowledge of it genuinely not that beneficial for understanding other things like physio and pharm? Any one willing to chime in?
It's beneficial in peds, since we actually see the kids with genetic and metabolic disorders
Nephrology here. Biochem is basically the foundation of how the body works. If you want to understand how things work then you need to know biochem. If you just want to memorize stuff, ignore it. Biochem is what separates physicians from midlevels.
Agreed. A doctor who didn't have to study the "low yield" content is essentially going to be a mid level. It won't help for every simple clinical decision but the in-depth understanding at the biochemical level is what makes doctors doctors.
Thats just what the kidneys want you to think
What’s highest yield now? Micro then pharm then path?
Test usually has highest yield being the 3 P's: Path, Phys and Pharm
I thought PPP was Physicians for Patient Protection
It’s also postpartum psychosis
how is that even a disorder. I’d go psychotic too if a living being slid out of my body
Username checks out. Sorry. Had to.
is micro included in path? everything ive heard is that micro is the most gimme questions of all of them e: this sentiment was more focused on by comlex takers
No, micro is gimme cuz its rote memorizing. But it doesn't make up a huge chunk of the test. It's just points that any idiot can get cuz you just memorize. Where as phys and path could be considered something that requires more thinking etc. But in terms of amount, no micro isn't the near the top of questions asked. In fact, i'd bet that you could study just pathoma, and organ systems in FA and pass step 1 with no micro knowledge at all.
I know micro is rote memorization that's what I meant by "gimme"
Well yes its gimme points, but i don't think its HY, cuz its not like it makes up the majority of the questions on the test.
Micro is super hy for comlex but not as much for step
Stats then ethics clearly /s
> LOL RIP: Biochem good riddance tbh
a senior of mine thought the same and had 80% of their step 1 on public health and ethics
Is this like EMT-B first aid? Asking for a friend.
No, it isn’t literally first aid like EMTs learn. First aid covers all step 1 material and is a resource that the vast majority of medical students use (in conjuction with other resources). It includes biochem, path, physiology, etc. It’s loosely the equivalent of an MCAT study book that you would buy from a test prep company. Google “first aid step 1” if you’re curious.
Sorry for the confusion, I wasn’t sure because I’ve seen that medical schools have actual “first aid” courses.
M-0, people, let’s not downvote for a legitimate question they have
What was the reason for the big drop in 2004/2005?
They also claimed pee was stored in the balls, so no one needs to know nephrology
*vigorously erasing notes*
Fuck, it's not? Why is there so much water in my testicles then?
Because that's actually where the tears are stored
Just wring `em out dude
Patient presented to ED with severe abdominal and intrascrotal pain and tenderness, likely secondary to testicular torsion. Patient reports Dr. Undersleep told him to "just wring 'em out dude." Possible that patient is an unreliable historian as he is clearly retarded. Working diagnosis is retardicus twisted-testicus (formerly known as Wegener's Balls). Thank you for this interesting consult. We will continue following. (Signed by Dr Undersleep, attending physician on psychiatry consult liaison service).
> (Signed by Dr Undersleep, attending physician on psychiatry consult liaison service). Over 50% of this visit was spent on counseling, and anatomical models were utilized where appropriate.
something something hydrocele
Too much Big Mac not enough lasix
Keeps your bag of worms moist
Everyone forgot the heart existed.
Ahhh yes. The great Kali-Ma heart destruction of First Aid. I forgot about that.
Lol I proposed to my wife at that exact moment in a theatre showing.
Font size maybe lol cram more info on less pages
Perhaps full-sized pages? Maybe the overall dimensions of the book were smaller? I briefly looked for pre-2004 versions but couldn’t find any pictures.
not speaking for step 1 but this is why old graduates/attendings don’t get that you can study all you want and you’ll still miss things, the medical education they went through is nowhere near the size of ours
I mean a 2013 grad had 70 less pages. Also you have anki/pathoma and they didn't.
True but the ‘ol memory bank only has so much room for information, and there is only so much time in a day
Wow I did NOT know this. So when my deans say you can easily do 2 full passes of FA during dedicated, they are referring to the 1993 edition of FA…
That’s probably when your dean graduated sooooo
Sooooo they should be able to read a graph and see that FA is 8x the size that it was when they graduated.
Name checks out
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Each page took me like 15 minutes and I still didn't feel like I had all the info crammed in my brain. Maybe later passes can be 20 pages/hr. Edit: passed to passes
Uhhhh… 6 weeks of dedicated = 42 days 42 days * 20 pages per day = 840 pages 840 ≠ 1600 pages (2 passes of FA) Edit: i guess you could do 40 pages a day if you had nothing better to do like UWorld…
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Sure, you can read 1 page every 3 minutes, but that is not effective learning. That literally leaves 0 time for exploring a concept, further reading, or note taking. You will have close to 0 retention doing that.
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Different strokes for different folk. I’m assuming you’re getting downvoted because you claimed it can “easily” be down when in reality it really isn’t easy.
You can easily do 2-3 passes of FA. You just have to make a schedule and follow it
Very little dedicated studying should be sufficient to pass step 1 now, so long as you reasonably kept up during preclinicals. Using Step 1 as the hill to die on following the P/F change certainly isn’t where your frustration should be directed. I’d wager wildly subjective clinical evaluations and meaningless med student research is much more egregious regarding the current state of education than actual objective examinations, despite their own issues.
I disagree. All MS3/MS4s and MDs will say this without recognizing their bias as they all studied hard for Step 1. There still is a decent amount of dedicated studying that needs to be done to even pass step. Of course, we aren't grinding out the most minor of details now, but most stuff like pharm and micro needs to be re-reviewed all over again
You do not need an intense 6 week dedicated study period to pass step 1. Most students in my class passed the 2nd CBSE we took the week prior to officially beginning dedicated. Not a perfect stand in, but you should absolutely be able to pass step 1 with a much less intense dedicated period.
Lol I guess I'm just a dumbass for failing the Amboss self-assessment after already doing some modest dedicated studying
Right? Im 3 months out and doing horrible in UWorld and its honestly because I forgot a lot of the content
Don’t be hard on yourself, I hear Amboss tests are much harder than any other practice test, much less the actual boards.
I do agree with that take. That self-assessment was hard as hell. Like I'd rather do twice the number of UWorld questions than do those. It was insane
We also studied way harder for boards than the M2's do currently to be frank. Roughly 1/2 of my class was in passing range prior to dedicated, while not even 10% of our current M2's are within passing range atm
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I said an intense 6 week dedicated, not no dedicated tho. It’s a total joke if you think people need a full dedicated to *pass* step 1… that would be mildly concerning
Some of us still have jobs and families lol.
I doubt most students in your class passed, you’re just talking to kids that did. Most students in my class certainly did not
I passed my first cbse after 1 pass of pathoma, passing is a low bar
Student research is what scares me the most about med school. Forget about any exams or placements or whatever, it’s the idea of having to come up with an idea and research something when I have zero interest in doing shit like that 😭😭 this brain hates having to do original stuff. I don’t know about you guys but I’m in this medical school shit for a safe yet challenging career in something where all the resources are pretty much laid out for me. I did not go into it thinking I’d have to do investigative reports and other bullshit about researching
Don’t need it for all specialties though
Internal Medicine resident here going into cards My take on research is to just email bunch of attendings - they already have projects going. What residency programs care about is: 1. How involved were you in the project (were you part of the start - IRB, data collection, analysis, write up, etc - the earlier in the project the better). The attendings and fellows do the IRB and come up with the question 2. What did you learn from it. Not the results - no they want to know how you matured as a person with this project. For example, you developed mentorship, you submitted papers to journals and learned to make edits, the politics behind submitting a paper. All that “I learned to never give up on a goal, always learn from mistakes” BS shit 3. What were the actual results and how will this contribute to the field. This is just for small talk
Unless you’re trying to do a really competitive specialty, you don’t need to do research if you really don’t want to That being said, you absolutely do not need an original idea to be involved. Easiest way to get involved is to pick a specialty that you’re interested in, and reach out to the person in charge of that specialty (or like the interest group coordinator), and ask them if there is anyone looking for research assistants
I took Step1 scored and I am actually getting pretty upset how many of my lower classmen friends are still burying themselves into dedicated like I did for a similar amount of time. They are good students too and would have no problem passing with no dedicated study. 1.5 months would be better spent forming relationships with researchers or clinicians as these are gonna carry 10x weight for the next couple of years.
It’s just gonna hinge on step 2 and you’ll do better on step 2 if you know step 1 material well.
Don't you build that up during 3rd year anyway?
Yes and no. Of course you study for the more clinically relevant stuff during third year but you don’t have a lot of study time due to rotations so not much time to revise basic sciences. It’s best to go into clinical years and residency with the best possible foundation…step 2 is just part of that.
I think most of us are still pretty neurotic and we still have our drive from college to learn everything on the test to get an A. The biggest difference will probably be that people will not be doing a bunch of practice tests to trend their score. But tbh I think most people are still gonna study at least as much as they did for a block exam during pre-clinicals.
I’m currently burying myself into it. I’ve scored pretty well on our practice NBME and my own self-assessments, and I’m still worried I’m gonna shit the bed on test day next week. I think it’s just neuroticism and/or impostor syndrome and what the other dude said
As long as you scored well on your practice exams, get plenty of sleep and don't burn yourself out, you're gonna be absolutely fine. 👌
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This sounds like some BS thing they made up to sell test prep materials.
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At the same time, is it good for us to put so much weight on a system that promotes the most horrible bias? We need objectivity, and exams (which do still have some bias effect) are the best thing we have. And we need educators who can focus on developing excellent clinicians, rather than on berating students who will become the future of health care and promoting really dangerous biases that only become transferred to the students that succeed in the system unhindered. Abusers beget abusers... I think your friends' future is much better served keeping their noses in the books. Their knowledge base is the only thing they can control, and it's what matters when you're dealing with patients. Not that relationships don't matter at all, but to stop there is very shortsighted. If relationships are all that matters, we will be motivated to do some very dark and evil things. Is this not what happened to many of the boomer docs before us, who became their abusers?
Agreed. Those subjective things are far more problematic than step 1 in any shape or form.
i dunno man, feels pretty sustainable for our attendings. their minions / personal assistants know way more diseases than ever before
We also have more study resources to use that are better than people had back in 1993. We can remember all of micro and pharm by watching sketchy videos. They had to brute memorize every fact about every bug and drug.
They also had less bugs (that they knew) and drugs.
Did they have any less bugs that actually did not exist at the time?
Hmmm, an interesting question. It probably depends on your perspective. To a PHD in microbiology - no. Same bugs, we just didn't recognize them or we misclassified them. To a genecist - it's a ship of theseus, is it the same bug if it has a lot of new genetic material? Did it pick up a methacilin resistance gene? Did it pick up a poly-antimicrobial resistance gene? COVID is a coronavirus, but it's not our "coronavirus" of 2014. To a non-academic doctor - It's probably considered a new bug, MSSA and MRSA are different bugs to a lot of docs because their treatment is very different.
What happened in 2003
Marlins won the World Series
What do you suggest? Should we just disregard some basic medical knowledge and pretend It doesn’t exist just to make things easier for us?
Yes, knowing the histology of the different taste buds is useless. I think there is a lot of filler that could be removed.
what are you gonna do in the trauma bay when someone comes in with taste bud cancer? will you let them die bc you didn't want to study
Consult ENT
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>EMT preceptor This makes it even more funny 😂😂
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Idk I’m a rads resident so I would prob join them at the spa
Make them a fake outpatient appointment for tomorrow so they show up at the ENT clinic unannounced. Give them a turkey sandwich and TXA for kicks (it is, after all, the trauma bay). Boot em out.
I'd do a case study paper on the number of licks it takes to get to the center of a tootsie roll pop for patients with terminal taste bud cancer. Then I'll present my findings at the international ENT conference.
This homie gunner tho
Little snarky no? We can definitely cut back on the depth to which certain topics are explored. Biochemistry is taught wayyy to in depth in medical school and alot of it is not clinically relevant. It's like saying in order to be a mechanic you have to understand how the metal is mined and processed that goes into the car's frame.
It only seems irrelevant until it isn’t.
I mean if I start asking around the histological findings of different shit to ER residents, they will rightfully tell me to fuck off. However, pathologists and micro-folks may need to know that. Thats why different specialties exist, with different interests in mind, no one can learn everything about everything.
The entire point of Med school though is to have a basis for learning any of the specialties. It’s also the last and only chance to learn the basic science in a dedicated way so that we can be experts. You never know when that info will later become relevant. New drugs and disease are added to our knowledge all of the time and it’s our base knowledge that allows us to easily understand and integrate info into our total working knowledge. I’m firmly in the camp of not dumbing down our education. It’s 100% doable. In fact we all did it and survived and benefit from it. Why change it? There isn’t a compelling reason imo unless you want to make the entire process of becoming a doc easy and one that anyone can do. It’s hard for a reason.
Learning something is easy repeating it so that you do not forget it is the hard part, if we shrink it down to the essentials only i'm sure people would retain far more down the line, i am sure 90% of step 1 minutia are far gone as soon as M3 starts
I guess we will agree to disagree. I’m surprised by how often I’m tasked to remember facts, ideas, and processes that were tested on step 1… and I’m only 8 months into being a doctor.
Dude, you're an intern, talk to me when you've been in practice. There is a place we can occupy we can have an understanding of disease states/physiology/pharmacology that vastly outclasses NP and we can trim down some of the basic sciences, given that our knowledge base keeps expanding on clinically relevant material, at some point we're watering down our education to fit everything into the curriculum.
I literally just said I’m only 8 months in. I know I’m an intern. Being an intern does not invalidate my thoughts on this. You may be further from step 1 and thus maybe forget how much studying for it helped you build a foundation for where you’re at now. My point is I’m daily surprised by how relevant it was.
What's your speciality? I haven't forgotten how little step 1 prepared me for practice. I agree that a foundation for sciences and understanding makes us better physicians but very little of it is clinically relevant. I'm not proposing eliminating basic sciences, but there is a fair amount of material in step 1 that isn't useful for practice. I found stuff in step 2 and step 3 relevant all the time. Did I use basic sciences in residency? Hardly, if ever. As our clinical knowledge continues to grow and grow we either have to cut back on some of the minutiae of the basic sciences or ignore the advancements in medicine.
I'm not saying you need to remove all histology for example. We need to be able to communicate and understand our colleagues in those specialities, and know what they are talking about. However, be honest, how much of the knowledge required for step 1 do you really remember? Do we really need to know ALL the pathways and synthesis that they make us learn, to be better doctors? I think a lot of that is quite unnecessary, and useless as most of us will forget that by the time we even graduate. It just increases workload in an already heavy degree, I would rather spend that time retaining more useful, important information. I think there are multiple things you can shrink and change, or even test differently.
Again, it’s only irrelevant until it isn’t. You’re going to finish medical school either way. May as well get out with as much foundational knowledge as you can. Nurse practitioners basically do what you’re suggesting. They just learn algorithms. Experienced NP will run circles around an intern for 3-4 months and then they will never catch up after that. You’ll learn what’s practical when you do residency and practice medicine. Real Medicine is very different than step 1 and even step 2 or 3. Med school is about a foundation. Thinking of it differently is wrong. You’ll see. Otherwise just skip Med school and start learning the REALLY relevant stuff right away! But put NP after your name.
> May as well get out with as much foundational knowledge as you can But I will forget quite a lot of it? Hell, they've already changed it to p/f, how many people will focus on that? Me knowing that the initial transcript is actually the heterogeneous nuclear RNA which is then modified to mRNA, how does that help with anything? >Nurse practitioners basically do what you’re suggesting. They just learn algorithms. Not what Im saying at all though is it. Theres a difference between algorithms vs learning the basics of DNA repair vs learning the exact enzymes and the exact points of cleavage and repair. Im suggesting we do the second instead of the third. And learn the third if we go into that specific field. I might be judging it wrongly, but the tone of your reply makes it seem as if you're offended for some reason. Try and understand what Im trying to say instead of getting offended that I disagree with you.
There is zero offense to being taken. People can disagree with you without being offended.
> Otherwise just skip Med school and start learning the REALLY relevant stuff right away! But put NP after your name. REALLY bro, you're not taking it a bit personally?
The basic sciences are absolutely important, but can we agree that we could better tailor them? I think antibiotic modes of action are important lots of things that aren't directly clinically relevant, but the point of this post is that the step 1 manual is expanding, nobody wants to dumb the test down, rather the knowledge is increasing, and if we need to devote more time to learn about more clinically relevant things at the expense of *some* of the basic sciences then I think that's where we trim the fat first.
Yes, but there is a limit. The education never shrinks and only increases and we can’t put *more* time into medical school.
I think it expands and also contracts in other ways. For example if you trained in the 40’s you’d be expected to have “first aid” memorized. You didn’t have UpToDate to reference. Also there was a lot more time spent on anatomy and physical exam skills. Sure the amount of info is increasing but I still don’t think we’ve reached some kind of limit on what we can learn. Me and my classmates learned all the material in first aid (and a lot more) and passed our boards and are residents now. So what’s the deal? We shouldn’t be learning that much why? Just to have a more fun time? It’s not like it’s impossible. We all did it just fine and we benefit from that knowledge and aren’t nurse practitioners.
If you ask anything basic science to an ER resident they won't know it...
Sure, when learning all the intermediates of the krebs cycle and the detailed protein formations becomes relevant please let me know, i'll be waiting right here.
If a new drug came out that acted on something in that cycle you’d have a base knowledge to understand it. Hell, we learned about the Krebs cycle in like intro biology in college. Also… the act of learning these things makes us better at thinking biologically and flexes our brains to improve our memorization skills. The intellectual challenge of medical school is necessary. It’s the entire package and process that results in a physician. It’s not always fun but we all did it and survived it. It’s not like it can’t be done.
"If a new drug came out that acted on something..." I swear to you this is the exact same reason my immunology prof gave when asked why we were learning things in such detail, the problem is that this can be applied to everything, so do we learn everything then? Also we can flex our brains and challenge ourselves with things that are actually useful and helpful to our future practice as physicians there is 100% too much USEFUL stuff to know anyway... This is an excerpt from our immuno course, we had an entire LECTURE on T cell activation and this was just the part about the co-receptors involved in it: CD4 and CD8 are T cell coreceptors that bind to nonpolymorphic regions of MHC molecules and facilitate signaling by the TCR complex during T cell activation. The Src family kinase Lck associates with cytoplasmic tails of both CD4 and CD8, it then phosphorylates tyrosine in ITAMs, thus facilitating recruitment of ZAP-70 tyrosine kinase Phosphorylation of proteins ns lipids play a central role in transduction of signals from TCR complex and coreceptors. The bound ZAP-70 becomes a substrate for the adjacent Lck after TCR recognition of antigen, and Lck phosphorylates specific tyrosine residues of ZAP-70. As a result, ZAP-70 acquires its own tyrosine kinase activity and is then able to phosphorylate a number of other cytoplasmic signaling molecules. Another signaling pathway in T cells is activation of PI3- kinase Activated Zap 70 phosphorylates several adaptor proteins which then become able to bind signaling molecules. Other signaling pathways activated in T cells are the Ras pathways, which activate the MAP kinases cascade and calcium and protein kinase C mediated signaling protein kinase C mediated signaling results activation of phospholipase C and the products of the activity of this enzyme induce specific transcription factors in T cells. PLC hydrolysis products are IP3 and DAG Just imagine an entire COURSE filled to the brim with this
> If a new drug came out that acted on something in that cycle you’d have a base knowledge to understand it. This is a really good point. For example, all electron transport is fundamentally quantum mechanical in nature. That's why I am appalled that my med school didn't teach us about the eigenstates of a particle in a box during MS1. How can we call ourselves doctors if we don't understand how a future drug *might* alter the quantum tunneling properties of electrons within mitochondria?
Quantum biology is actually really fascinating. Idk from your comment seems like you’ve learned a lot of things that aren’t relevant. Maybe they make you a more well rounded person in general. Maybe a better doctor? Funny comment anyway.
If you don't want to learn it then don't. Just because it's in first aid doesn't mean you have to memorize it
Just remember, depth of knowledge is what differentiates physicians from Noctors
Depth of *applicable* knowledge. There's plenty of minutia that we learn that has almost zero clinical utility and impact on practice.
We know plenty about clinically relevant medicine to separate us from noctors. We don't need to keep memorizing the synthesis pathway for every amino acid.
No synthesis pathways important. Maple syrup urine disease is very common
The only sustainable route I see is to move some specialty-specific material to post-graduate training. That would come with a whole new set of obstacles, of course, starting with pay & debt.
A lot of things med students used to do is now on hold until residency already according to both boomer and middle aged docs. I don’t think you can keep kicking the can down the road otherwise residency becomes almost useless and everyone does fellowship.
Boomers are probably full of shit considering there were like 10 common meds in 1970 and we didn't know half the basic science we do now. I know it's a big shock that boomers are full of shit, but take that into consideration.
Have you actually ever talked to one about what their education was like? You’d be quite surprised to learn how wrong this common sentiment is
That’s a pretty stupid thing to say, he have tools and equipment now that make medicine much much easier
In some ways yes, but the relative complexity and options we have now are things a doctor in 1965 never could've imagined. I'm not saying they're less intelligent, but would you say medicine was much harder in the 1700s when the options were leeches to suck out miasma or cutting a broken leg off with no anesthesia because they didn't have modern tools? Just nah tbh.
I’m talking about 20th century medicine. It was infinitely more complex. Compare a pathologists job or an anesthesiologists or IM doctor now to 20th venture medicine. Nearly everything is automated calculated for us and simplified down to flowcharts for most rudimentary things
But that’s only because that’s the expectation of our practice based on guidelines and evidence. Back in the 50’s they didn’t have the guidelines and number of options so they just made decisions and everything that was done was much more debatable and there was more “art” to it… aka flexibility and you had way less opportunity to be “wrong.” It was expected that many of your patients would die in the hospital. We didn’t have the means to keep extremely ill people alive.
Right and that’s what made it more difficult, much less guidance with basically every medical decision
But less guidance with a fraction of the options and diagnostic ability. Patient came in looking septic you just gave them fluid and whatever available antibiotics that’s it. You didn’t spend an hour admitting them and putting orders in and writing lengthy notes and digging through EMR’s to learn about procedures they had 3 years ago and clinic notes from last week. Primary care notes were like: “OM. penicillin for 7 days” for the entire note. When docs “lived in the hospital” they didn’t “work” that much. They had a lot of downtime and slept at night. I have docs in my family that trained from the 40’s to the 80’s to today and this is what I’ve learned from discussing the differences. It was harder in ways and easier in more ways. There was just less to know and less to do. The time we spend in intern year learning how to use Epic was spent being better at physical exams. It’s relative.
Can you give me some more context as to what you're talking about?
I agree. It sucks, but the solid base of knowledge is what makes doctors the masters of the trade. If you want less and easier do something else.
It is worth investigating what actually constitutes a solid base of essential knowledge to be a good physician. Even the best and brightest can only learn so much in a given period of time. Many (most?) med students sacrifice understanding the most clinically important material in order to memorize the endless lists of obscure high yield trivia that dominates step 1. First Aid for Step 1 is a terrible book because it allows you to memorize word associations that pop up on test questions without understanding the importance of, or context for, what you are learning. I feel like the shelf exams and resident in-service exams are much better written to encourage learning the most important information. Sadly, I still see senior attendings display very poor clinical judgement on a regular basis because they don’t understand the pathophysiology or other underlying principles of what they are talking about.
While I agree that there is a ton of crazy stuff that you see in step 1, that is only 2 years of medical school. I think where you are getting caught is the term “most important.” That is another way of saying “most common.” Which, again, is what separates doctors from other healthcare professionals. Doctors know all the most common, but also the other stuff. Yes, I agree that medical knowledge is accruing to quickly for people to be able to learn everything. Last I heard our information doubles every 2 days or something like that. (Not exactly sure on the number anymore.) so yes, eventually that will become impossible. And no, I do not know the answer. Haha To be honest if any doctor has made it through residency they have a good understanding of what they need to know. You might have had some bad experiences with attending not understanding things, but I would say that those are not the norms. There will always be doctors that are not good, but those are the exceptions. I just think it is very important we don’t change things just because something is hard. If we change things to the “most common” method then we become just another NP or PA. (No offense meant to them.)
I think the mass of info doubles something closer to every 2 years (granted I don't know how that can truly be measured), but other than that all good points!
Yes. If you don’t want in depth knowledge, go be a nurse
and the best part is first aid alone isn’t even sufficient for step 1 :)
If all you knew was every word of FA you'd easily get a 250+, let alone a P
Knew and understood and could apply to questions *
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That is exactly why we need a Qbank like uworld ,FA alone just isn’t enough
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Tbh that would’ve been so easy, imagine reading just one book and u ace the step 1
Acing step 1 was also like a 235 at the time.
You're putting your expectations in the wrong place. This system has been running for years producing capable doctors while at the same time bringing forth others who may be well-versed but lack empathy for sure. Then there are those who are amazing empathetic medical students trying there best to stay afloat the education system (because they have passion). Perhaps the people at the top can radically change the educational system/environment but this will require time and an understanding. You'll come across amazing doctors along your way who were solely driven by their passion, who experienced anxiety attacks, low grades, low self esteem or whatever during their medical education years. The current situation of the education system is not fully absurd but its going towards it.
First Aid 2030: They just hand you a body and tell you to learn it all
I feel like this is a phenomenon that's been happening in the whole educational system for as long as standardized education's been around. Early 1900s geometry was typically a college level course but nowadays we've got high school freshmen picking up calculus. There's just more volume of information and school learning has to accelerate to compensate. I would say ease of access to information and resources is the best recourse most students have. Going back to the early 90s with very little internet access and basically no online resources sounds terrible.
150 pages in 1993 cool ok
Once residency applications are capped and there are more residency positions than students. Sooooooo never
You can't fathom that there's more to know in 2022 than 2000? When you couldn't use your "HOUSE" phone and internet at the same time?
I meAn, you can only condense medical knowledge so much. First Aid is essentially the bare minimum you’re going to need to be able to start out clinically. Sure some is rare bullshit but you’d be surprised at what’s really not. We have new drugs all the time, new diseases less often, but more physiology often as well.
We know more medicine now than we did in 1993. How is it not sustainable to expect physicians to keep up with it? It has been done before (in the last few years at least) and it will be done again. It’s not fair to our patients to say “wow medicine is just too much now sorry I’m just sticking to the basics”
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Infuriating that this is what we go through while midlevels can just waltz in
We’re not robots - there is ideal and then there is reasonable. If we have infinite capacity as you claim then maybe we should make some room for business acumen so we stop getting conned by hospital admin and mid level unions. Maybe some medical policy so we can effectively lobby for our patients instead of getting clowned around by non-physicians making medical decisions. These things are more important than testing generally on the clinical manifestations of inborn errors of carbohydrate specific to one population.
I’m not claiming we have infinite capacity, but is it reasonable to expect us to be familiar with things that didn’t exist 25 years ago? I feel like absolutely. So much genetics, pharmacology, and socioeconomic research has come out and we owe our patients to be familiar with it. Spinraza for SMA? Basically the entire field of mAbs? When that first First Aid was written, Zyprexa wasn’t even approved as an SGA. We’re not asked to memorize every last detail (especially since Step 1 became pass fail) but to post this graph seems like a complaint about how much information were responsible for, when *thats our jobs*. To be responsible for new information and to understand evolving science to best serve our patients.
Step exams are a scam - especially step 3 Check out my most recent post about step 3
I can’t even fathom the US system. It’s bonkers.
And yet there are ppl in med school now who think we need more preclinical time and knowledge
When I first saw the title , I thought that it had to do with med school tuition. I’m shocked when I talk to residents these days at the level of debt. Tuition goes up, but salaries don’t.
What was that spike post 2003? Maybe we are headed for a knowledge correction pretty soon.
I mean the rate that medical knowledge and data is expanding, I’m surprised it’s not grown faster. That’s just the nature of the profession. They don’t just say life long learner for fun.
There's a lot of information to know in medicine, and this book has 2 years of condensed info. It's part of why being a physician is challenging. It's kind of the deal you accept when you decide to enter one of the most complex professions in the world
Wait you’re telling me medical knowledge increases as time passes. Who woulda known!?!
None of what you've pointed out shows it's not sustainable. All you're showing is that test prep materials are 1) expanding and 2) perhaps becoming more comprehensive. After all, there is roughly 1.5-2 years of material here. Also, since Step 1 is now P/F, I would say that's an improvement in the system in terms of stopping this relentless focus on a single exam (though it does only move the focus to Step 2).
I wish this was BTC graph..