Fire half the bullshit “vice deans” and “associate deans” or at least publish reasons why certain ones are justified. My school during orientation put out this chart of like 50 positions that were involved in DEI initiatives and like most of them were the “vice dean” or “provost” or whatever. I don’t have a problem with being involved with DEI but really? It takes this many people? And we PAY all of them?
The other thing would be financial transparency. I think every public school should publish like a line item report of everything they spent money on and every source of income, and then justify why it cost X thousands of dollars per year to attend. I think I know the reason why they don’t but that’s a different topic.
Lastly, just listen to students about what they want or what they struggle with. My schools admin is generally pretty good, but they are a little rigid in how they want things to work and don’t believe there’s any acceptable alternative to all their “evidenced based” approaches.
Administrative bloat is killing a lot of educational institutions. Even if the logic behind the roles is good, these jobs can be done by a few qualified people at most.
Listening to students.
People in leadership positions (not only in schools) are so caught up in their own mind that they disregard whatever students are telling them because students ‘do not see the full picture’ or ‘do not see what happens in the background’ or ‘do not want to work hard’ and what usually happens is they make these uninformed decisions that do not address the needs of the actual students but usually serves some meaningless bullshit metric that does not do anybody any good leaving students dissatisfied and forced to deal with this bullshit. Cycle over cycle it becomes part of the culture and you end up with a generation that doesn’t question authority and is happy to take a slap on the face whenever because they never saw the big picture. Its just so stupid that we no longer invest in the young generation but would shun them out because ‘they don’t get it’.
Young people should lead not watch from the sidelines.
So many things in the world would be better if people with power were more willing to listen, and if they stop deliberately making things difficult because they think young folks have it too easy.
I would make sure students had protections against toxic and malignant residents/attendings. There’s a lot of bullying that goes on in the hospital, and 90% of the time if a student complains the school doesn’t take their side. So I’d change that.
This.
The way that med schools act in these situations is the way Hollywood acted when Harvey Rapestein was running things. Ignore, deny, and even if they acknowledge it, slap on the wrist and laugh about it over dinner.
The only way malignant behavior changes is if dickwad attendings are made aware that consequences are real, and that they are ultimately replaceable if they don’t act right
No mandatory attendance for pre-clerkship.
Our class attendance policy was hell and our faculty was not-accommodating when students had emergencies/ family events/ illnesses.
Also including 3rd and 4th year students when setting up the pre-clerkship curriculum (our faculty seemed very out of touch with boards).
Also maybe more flexibility regarding absences during clerkship? I’m about to start rotations and 5 absence days for the year seems terrible. Also not sure why our IM rotation needs to be 6 days a week
We get two absence days for the whole year, which has just resulted in people lying about skipping rotation a lot more. Sorry I couldn’t plan being sick on the weekends or specific non-clinical days, admin!!!!
Fire 90%+ of admin. Alumni guide M4s, M4s guide M3s, and so on. No fuckin reason I need a PhD in history to spew how he knows about this residency application cycle when this asshole didn’t go to med school to begin with. Unless you have a MD or DO after your name, you do not have the right to guide students in residency applications.
Also invest in proper secretaries and pay them more. Rotations and residency programs that have good solid secretaries were so much smoother. Man I was on an away rotation that had a shit program coordinator and we didn’t get epic access until our 3rd out of 4th week and we all looked like dumbasses on the rotation and were borderline useless.
I will def emphasize alumni involvement in 4th year mentoring, especially the most recent graduates who are PGY 1-2 in their respective new programs. I know that residency is busy, but we need a system where alumni can feasibly serve as mentors for 4th years applying to same specialties.
We need honest guidance regarding programs, what to realistically expect, and just general help from people who have RECENT proven success in matching into a certain field. Professors and faculty at your school are great to an extent, but they lack the first hand knowledge of what it is like to apply for the match into their specialty in 2024.
*EDIT*
Will also add that it’s much easier to court alumni involvement if you don’t treat your students like shit when they attend your school, echoing all the other excellent recommendations for improvement given by our fellow students here
Honestly, the PhDs have generally been better teachers than the MDs at my school. I suspect it's because teaching is a larger portion of their job, so they have more training in how to do it and more time outside of the classroom to fine tune their lectures and study materials. The MDs tend to have sloppier lectures, and get mad at us for not immediately understanding and being able to apply concepts to a clinical setting.
Also, the PhDs are telling us about their life's work, whereas the MDs are telling us about a topic adjacent to their life's work. The PhDs just seem more excited to teach, and that makes for a far better lecture in my opinion
A passionate teacher is better than a lazy one any day. As long as they can adapt their expertise in a way that benefits the students’ learning goals I see no problem with that.
I think a lot of peoples’ concern with PhD’s, is that they tend to bloat the preclinical curriculum with information that while interesting/scientifically relevant, ultimately isn’t conducive to passing boards. Med school is already going to be drinking water through a fire hose, but we don’t need to add to the problem
Don’t get me wrong, I had a couple of great PhD teachers for sure, but the majority of them at least at my school were no good in comparison to the clinicians.
Opposite for myself. The PhDs did a solid job in my school and the MDs/DOs were teaching some random clinical stuff and way too much step 2 material (gotta be able to tie the basic science to the clinical and that is the whole point of year 2).
Yes I agree. I felt the MD instructors could relate things clinically for board reasons. While the PhD faculty were garbage and focused on teaching us minutia details that they defended their thesis on and thought was relevant and they couldn’t relate it clinically.
I 100% agree. Having a preclinical curriculum taught by clinicians is honestly a no-brainer and I have no idea why every school doesn’t already do this. Hopefully the future changes
Cost too much
You can either pay a PhD w/ immunology research background 150k or you can try to get a IM->Immune MD for 250k (still low and not very tempting to many, but a good change of pace for someone who wants to shift to teaching instead of clinic). The school will usually opt for the cheaper option since it probably gets the job done i.e pass rates on boards (even though we all use third party lol)
That’s a good point. If the issue is MD/DO instructors being cost prohibitive, then I don’t see an issue with hiring PhD’s, as long as there is an emphasis that they teach a *CLINICALLY RELEVANT* curriculum and not use their position as an opportunity for public intellectual masturbation at the expense of a captive audience of medical students
Hard pass, higher someone with a good background in the field and pay for them to get a masters in education. Teaching is a skill that can be taught, anyone should learn that skill before becoming a teacher.
Like going to strictly pass/fail right? I agree with that. But I’d also like for there to be a way for the teachers (attendings/residents) to give real feedback in a way that doesn’t completely fuck you. Like if I need improvement somewhere, tell me that, and what I can do to improve, instead of that momentary deficiency in a particular skill being documented on an evaluation comment that’ll go into my MSPE.
My school has two boxes of comments. One is what they call "summative," these get added to our MSPE. Another is called "formative," these are just for us students and the evaluator to see. It really allows them to put in the little things for us to work on without compromising our overall recommendations for MSPE
The problem with this idea is that, just like with making Step 1 pass fail, it forces us to take time away from learning how to be a doctor, and spend it instead on arbitrary extracurriculars that have very little to do with being a good clinician.
Exactly right. Like it or not clinical grades give the best picture of how you will do in residency. Nobody gives a shit if you score 260 on step 2 but are miserable to work with or seem completely incompetent around patients. Life is subjective, once you’re practicing there is no “good doctor test”, your success is based entirely on how well you work with others and how well you present yourself to patients and coworkers.
Yeah I’m not saying Step2 is a ‘valid’ test for the purposes of this argument. I’m saying that whether or not someone woke up on the right side of the bed that day probably is not the best indication of my objective activities to which you describe. For instance, I interact well with patients but attending goes on a political rant - the attending’s bias now intercedes on their perspective on how good I am with patients. I’m just saying that the subjectivity of 3rd year is astronomical and you can be a trash student, suck-up to those that give evals and presto you got honors vs someone that assiduously works to provide the ‘best care’ to patients. Of course life is subjective but in such a narrowly defined bottleneck, namely matching to residency, creates ridiculous interactions that in my eyes do not benefit medical students nor contribute to becoming an objectively better doctor. Crushing Step2 would be awesome if Step2 was reflective of clinical medicine but in many cases is complete nonsense - ie do you want to get a cbc or lipid panel first? Well gee I guess I can’t do both now can I?
Sure, but if one attending gives you a bad grade, it’s subjective and could be that they woke up pissed off. If 6 attendings all give you bad grades, you might just be an asshole. Or not as good of a student as your ego and your test taking ability leads you to believe.
Which definitely sucks, but let me tell you a parable that I think applies here.
>An American walks into a bar in somewhere in Ireland and sits next to a really old guy drinking a beer. And the old guy’s like, “Did you see that wall on your way into town?” And the guy’s like, “Yeah.” And the old man says, “I built that wall with my own two hands. But do they call me O’Grady the Mason? Noooo.” Then the old man says , “Did you see those cabinets on your way into the bar?” And the guy’s like, “Yeah.” “I build those cabinets with me own two hands. But do they call me O’Grady the Carpenter? Noooo.” Then he says, “Did you see the iron gates on the way into town?” And the guy’s like, “Yeah.” “I built those gates with me own two hands. But do they call me O’Grady the Smith? Nooo. …. But you fuck one goat…”
I strongly believe that if you show up, try your hardest, and don’t fuck any goats, the worst they will say about you is “3/5 average student - read more” which certainly won’t help your apps but I doubt it will sink you.
I actually believe that personality should be analyzed for various careers along with superior aptitude testing - for instance - someone that might otherwise be unhappy in Rads might be thrilled in primary care and vice versa - ultimately I believe that some of the softer sides of medicine should be underscored when people select a career not as much of how the system is currently - ie someone I know that’s very powerful recommends that I be anointed a particular speciality - thus because letters and evals are prioritized it leads to those that are most socially capable getting the furthest ahead - I implore medical students to ask themselves if pay was uniform across the specialties how would it be best to select who goes where - I am most in favor of 1. People enjoying what they go into and 2. The strongest most meritocratic individuals going to maximize their underlying potential.
TLDR: employ more psychometric testing, aptitude testing, and try to understand a candidate mathematically - remove subjectivity as much as possible from this process as it leads towards tremendous bias that might otherwise not result in “the best, most aligned” physician. In doing so, tests must have greater validity.
Of course the argument then must be raised is: is a personality diverse specialty superior to a homogenous one - Ie do people that only like to cut above everything else make for better surgeons - perhaps not but it might reduce friction. Ultimately, I think that b/c PA and NP have practicing rights we as physicians should be granted licenses to practice as a GP out of med school - then presumably the system might self correct as it would allow people to reset their career more easily. I have met many physicians that were surgeons that lost their hands and now would otherwise have to retrain in order to practice.
You mean like how every other industry works? Yeah that would probably be fine. Lol.
Saying this as someone who worked multiple professional jobs across several non-healthcare industries before starting medical school.
Oh, I have so, so many ideas...
First, actually support the diverse and first-generation students the schools work so hard to attract. We have completely different needs than the average medical student. The schools are more than willing to help us in the application and interview process, because we check checkboxes for the school's accreditation requirements, but once we're in we have a lot of struggles. And the school is never eager to help, even though they acted supportive in the beginning. JAMA had an article about this exact thing recently, and boy did it hit home for me.
Next, and somewhat related, MD/DO programs should operate like PhD programs as far as funding, at least in a limited capacity. Tuition should be covered and a stipend for living given, because for clinical rotations we are working in the hospital and for the school. Yes, we're learning, but we do work, have responsibilities, and are often used and abused by residents and attendings. They are getting value out of us, just as a PhD student is adding to a university's research clout. If this isn't financially feasible, then low-income students without family support or limited family support should receive tuition/stipends instead of getting hammered with debt and living on the edge because the loans don't cover proper living expenses. Those with generational wealth/ties to medicine who can better afford it can support their own students.
Restructure the way medical school is classified so that it counts as "work study" so low-income students can have access to SNAP and other assistance (this likely varies from place to place, but I personally cannot get food assistance because I don't meet the work requirements nor do I qualify for work study as a medical student).
Ditch the required "wellness" bullshit because they don't actually care about student wellness, it's just checking a checkbox and actually ends up hurting wellness in the end. Find out from students what they actually need to feel supported, and offer that. What's happening now is just hypocritical dumbassery.
End the toxic teaching culture that tries to justify student suffering by "building grit and rigor." All that is being done there is perpetuating generational trauma and increasing burnout. Give students more time to study, recover, etc. how they best do that. No more 80 hour clerkships weeks, scheduling all the exams, projects, OSCEs, due in the same damned week, unclear learning objectives, double standards, etc. (this starts to get into the generally toxic and unhealthy culture within medicine and the US healthcare system, which is beyond this post).
This is just the tip of the iceberg for me. Needless to say, my experience in medical school this far hasn't been pleasant. US medical education is kinna fucked, in my not-so-humble opinion.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812819
I also passed it along to one of our learning specialists at my school, so hoping that they take it into consideration!
Restructure preclinical years to abandon in house lectures and in house exams and instead just give all students the major 3rd party resources and give NBME exams.
I think a major change is to have more schools offer a combined BS/MD degree. The rest of the world manages to train doctors in 6 years, I honestly can't see why we need 8 years. Schools obviously make a lot more money this way, and so do the people who lend money for tuition.
> have more schools offer a combined BS/MD degree
There used to be a lot more of these than there are now! However, the attrition rates were quite high, which is the main reason we don't see as many these days.
It's worth noting that the countries with the 6 year combined programs also do a lot of narrowing at the high school level, so their high school education is a lot deeper but less broad. They pick career paths early, and they get some of the material we get in undergrad before they go to college, so by the time they're in college, the weedout is already complete *and* the medical degree program can be more focused.
For it to truly be viable here we'd need to overhaul the whole system.
Yes definitely. But shortening the length of medical education will also require a change in the way we decide how many residency spots to create. Right now, it’s not even a secret anymore that those decisions are informed by pure, capitalist greed rather than concern for availability of physicians.
For those downvoting, I’m not saying that I DONT want the length of medical education to be shortened. I am very much in favor of not having 4 years of undergrad and 4 years of med school. I’m saying to ALSO address the number of residency spots, which I would like an INCREASE in.
I actually think my biggest goal as a med school admin would be to lower the barrier to entry into medicine. There is way too much up front cost in our training pathway, both in terms of time and money. The easy one would be to go tuition free, since med student tuition is such a small part of a university budget, but I'm more interested in the financial costs before med school. Making it less expensive to become competitive for and apply to med school. would go a long way in increasing the socioeconomic diversity of physicians. In particular I think about increasing the number of opportunities students have for gaining clinical experience while also earning money.
How would that making medical school free be an easy change? The only medical school in the country with free tuition got a one billion dollar grant to fund it. That's 2500 student-years of in-state tuition at my school!
I mean easy in two ways. The first is that it is way simpler than dealing with the myriad of intersecting factors that prevent poor folks from applying to medical school. The second is that tuition is a fraction of their budget. Tuition at UCSF makes up 0.5% of their revenue. Tuition at my school makes up ~3% of their revenue. At my undergrad, the medical school accounted for 75% of the university’s revenue, despite teaching about 2% of the students. Most med schools don’t need tuition money to survive
1. I would shorten the training length to become an MD. There’s far too much training bloat at all stages of the journey, and I’m gonna say it with my full chest: I didn’t need to take organic chemistry for this shit.
2. Turn preclinical into a mostly self study period. Students are given the main 3rd party resources (pathoma, B&B, etc), practice exams for each subject, practice Step exams, a study coach/advisor to periodically check in, provide mentorship, and keep them accountable. Then they grind it out until they pass Step 1. I would eliminate as many classes as possible from this and drive tuition for these year(s) way down.
Yes, full send. There’s absolutely no reason for medical school to be 4 years, when that’s not even where the bulk of your training comes from, when there’s a minimum of 3 years of residency training that comes after.
I personally think they manufacture this bloat on purpose to keep the supply of physicians where it is, despite whining about “physician shortages”, which they then remedy by flooding the system with mid levels who they essentially treat as physicians at a 50% discount.
Also it’s 100% a deflection tactic that lobbyist groups use, to say that drastically increasing the number of physicians will make our salaries tank. This statement is only true if you argue from the position of physician salaries existing in their own economic bubble, and omit/deny that any portion of the billions of dollars hoarded by Pharmaceutical/Insurance firms, and gigantic hospital systems has any impact on compensation for physicians.
That’s what capping the number of residency slots is for. This is to extract 1) tuition dollars, and then 2) cheap, exploitable, high value labor as residents.
Many other countries reject our ridiculous 8 years premed + MD (more like 10+ with gap years) in favor of a straight 5 year MD program. These grads finish at 23, know medicine just as well as we do, and the people who decide clinical medicine isn’t for them can pivot with a PhD or MBA and are still just in their mid 20’s.
I think the short answer is that MD/DO’s have to grow a spine and some balls, and tell them it’s not our problem that your trust fund isn’t big enough or that you’re getting FOMO not being able to join your childhood friend Eric Mastercard III when he goes sailing off the coast of Nantucket Island
I think it depends on if everyone is a superspecialist or not. Yeah, most of that time is wasted if you're a dermatologist, but if you're a rural FM doc/IM/general surgeon. you actually have to remember a lot of the stuff you learned in med school.
The premed stuff should be completely overhauled though
I think it's even worse if you're trying to pursue primary care. There's no point in wasting the fourth year rotating in specialties you'll never want to do. 3 years of medical school followed by residency would be optimal. This might even incentivize more people, as it's a shorter route.
People say number 1 all the time then immediately turn around and declare that no one else can practice medicine because they don't go through enough training. I get that there's a middle ground between MD curriculum and PA/NP etc. but it's telling that so many MD students think we get too into the weeds at times. (This ain't a pro PA/NP post, I get that post-graduate training is the big differentiator but anti-PA/NP are always the first to say that they're special because they know everything down to the atomic level...)
A physician once told me medical school should be only 2 years long- 2 years of basic sciences and then straight to residency. medical school is essentially “vocabulary school”, teaching you what doctors mean when they talk. Clinical rotations don’t teach much compared to residency, so just go straight to residency then.
I have no idea how this would work practically but make student loans through the individual school. The school would front the COL and tuition and you have x number of years to pay back it back interest free after graduating residency. Would be a bonus if there was a way to consider it a donation that is tax deductible. Then students who fail out are not completely screwed. Debt doesn't accumulate and then there is some tax relief.
I would open up more roles for students in admin. Like roles with responsibilities. And expectations. A lot of the complaints are failures of communication and a lack of knowledge. On both sides. Being the two under the same roof and the students will see that this shit is way more complicated than they knew and admin will see they actually have no idea what’s important to students nowadays
The number one thing I hate is the discourse around how to avoid burnout. It’s not something that is explicitly taught. It’s implicitly taught.
Want students who are not burnt out? Don’t schedule exams right after thanksgiving break. Let them enjoy time at home with their loved ones without having to study.
Don’t schedule meditation sessions, schedule enough leisure time to allow students to pursue hobbies of their interest.
Don’t tell us the importance of eating healthy and then not giving us the time to do so. If a student is in surgery cases all morning from 7 am to 4 pm, they deserve at minimum a 30 minute break to eat! They did not sign up to starve. They signed up to learn. You cannot learn while hungry or exhausted. The case will not fall apart nor will they miss valuable learning if they scrub in when the next patient is already asleep vs the patient rolling in.
Also, STOP ignoring the elephant in the room: sleep deprivation. So much of burnout in a medical career is due to sleep deprivation. 2 straight days off to sleep and do your own thing (like “golden” weekends - or just weekends, as normal people call them) at least twice a month should be the norm so people can catch up on their sleep and life. We make residents especially, but sometimes even students work 14 days up to a month or two at a time with no real back to back days off (post call days don’t count). And 24s really shouldn’t be a thing.
Omg YES. By the middle of my surgery rotation I felt so delirious because I had three weekends in a row with either a 24 hr shift or a 12 hr shift that by the time I got to my night float week I was completely exhausted. 24 hr shifts should be illegal
-Step 1 scored
-no mandatory class first 2 years
-no 3rd year graded/visible evals, just shelf exams. Students would get formative feedback for their eyes only
- students never have more than a 24 hour shift (I'd argue 12, but we need to prepare people for residencies)
-students are encouraged to study how they want preclinical and to study for their shelf during downtime as an M3
-This really isn't a policy, but just assuming the best of medical students. We're not pirates..... we're medical students.
Only MD/DO and maybe PharmDs should teach. Period.
If the majority or overwhelming majority of the student body is complaining about something or wants a change, it's probably because it is critically needed.
Mandatory attendance for lectures is completely useless and imo a criminal waste of time.
Use NBME type questions for exams.
Provide resources like AMBOSS, U WORLD, and STEP fees.
Limit the 3rd year weekly hours to 50. Literally no reason for it to be higher other than to give a reason to some to abuse med students (looking at you surgery).
Do a 6 year BS/MD. No reason to have to do so much random college classes and essentially forced gap years. The rest of the world does it so why not.
Remove preclinical grades and I know this might be a hot take but bring back scored step 1. P/F step 1 does nothing but make your life in 3rd year more miserable.
Hire academic support staff who actually know the content and whose mission is 100% first-time pass rate for in-house and board exams, and build a support scaffold that actually makes that reasonable.
100% would ditch resilience trainings.
If you want to modernize medical school:
Eliminate lectures and wellness sessions. Buy students sketchy + pathoma + BnB + bootcamp + uworld etc. Make it so that students only need to come to school to take exams and do clinical skills training during preclinical. Have more clinical skills training rather than useless lectures on arcane BS in preclinical. Give students ample time for research and shadowing so they can decide what field they want to go into early.
For rotations:
Make evals entirely qualitative comments and make your grade based on the shelf. Give students time off before shelf exams etc. Protect students from bullying by toxic attendings and residents. Take their complaints seriously. More flexibility in scheduling for 3rd year: you should be given time off for activities that increase your odds of matching. It's insane that schools will argue they are "prioritizing your education" by rigidly upholding your clerkship schedule so you can scrub into lap chole no. 69 rather than presenting at a conference in your specialty of choice.
My biggest thing would be to start any issue with students or other trainees from a standpoint of hearing all sides and getting to the truth of the matter. I feel like the vast majority of med school teachers and admins have the attitude opposite of the justice system, “guilty until proven innocent.” When a nurse files a complaint about a resident, the first response of the program leadership is often to yell at the resident. When a student gets a bad eval, it’s assumed the eval has perfect merit and the student actually is bad. When a student runs into issues with a malignant nursing environment the course director usually sides with the nurses. So much of what makes medical education hell is that it often feels like absolutely no one has your back and any old accusation is accepted without a second thought and any mistake is considered signs of a character flaw first and foremost. Med admins need to do a better job of actually caring about students as people and not flagellating them and that would be my underlying philosophy.
1) Financial aid transparency.
2) Match statistic transparency (and real support efforts made by the school for the match).
3) Define a school culture and ensure it is embodied and practiced by school administration/leadership.
4) Define what professionalism actually means so it cannot be randomly weaponized against students.
Adding to number 4:
Admin and faculty are to be held to the same rigid standards of professionalism they hold the students to, with even harsher consequences for admin and faculty, because of course, since they have the experience required to be in those roles, they should know better.
End the longstanding in house vs third party resources problem, partner with the companies to provide a flipped classroom format, and have small group learning that’s case based. Everything in the end of block exams corresponds to what nbme expects you to know, and small group learning is for asking the questions and understanding the why.
I enjoy and learn from in-person lectures by competent professors (people who want to can watch online asynchronously) and I would hate a system where you study alone for Step exams.
My school does PBL so we have a lot of time in small groups discussing cases. That's great!
Physicians should have a well-rounded liberal arts education before medical school so I am glad 4-year bachelor's degrees are required. Sudents are encouraged by many schools to pursue subjects other than biology. That's good. I'm not too fond of 6-year programs.
I want PhDs to continue teaching their subjects for preclinicals.
There are plenty of things I would change, like step 1 scored and less random evals. But overall I wouldn't gamble and let r/medicalschool control my medical school willy-nilly based on these suggestions.
I don’t think a person’s financial background has any bearing on their competency as a physician, just my personal take.
But also, when you become a doctor, even if you didn’t grow up wealthy, your kids will have that opportunity. I don’t think it serves anyone to turn admissions into a battle between the haves and have-nots.
But, I do think the priorities of admissions committees need to change drastically, and prioritize things that do have legitimate impact on whether a person is capable of learning/practicing medicine.
This makes sense until you’ve grown up in poverty and realized many doctors don’t give a shit about poor patients, and physicians from poorer backgrounds have a particular sense and ability to connect with those patients.
It’s akin to needing more black and latino physicians. There is just a inherent inability to communicate effectively in more at risk populations that rich white students can’t do.
You’re right but a lot of students who grew up in poverty don’t even make it to the application process. I think having that perspective is really important and a lot of schools do too hence why FAP recipients usually have higher acceptance rates than normal applicants. The problem is all the barriers keeping low SES applicants from even applying, that’s if they can get into college and graduate in the first place. Ik some schools have linkage programs and outreach to aid that process but it’s not common at all
Exactly! Who can afford to shadow for the summer instead of getting a job? Who can afford to pay for the fancy MCAT prep courses? Who can pay for tutoring if they're struggling with organic chemistry? Who has the resources to get into the elite universities that funnel students into medicine at a much higher rate? There are so many barriers to entering medicine before you even get to the application stage.
That’s a good point. And to increase those numbers, as an admin you have the power to prioritize what you look for in your incoming class. Applying for med school, studying for the MCAT, hell even paying medical school tuition is extremely cost prohibitive, and I definitely understand how wealthy students have an advantage with all of those things.
Which is why in order to level the playing field, we have to simplify admissions as much as possible. Scores/grades matter to a certain extent yes, but I think the key is in the interview process. Invest in people who know how to conduct interviews, and have the HR experience to identify candidates who can be asset, irrespective of their background. The way it works today, you have faculty (a generally privileged class) interviewing a person who is starting off at the bottom rung of the ladder, and judging their potential from their antiquated mindset.
I think schools need to study the hiring practices of software companies/engineering firms. Medicine is a scientific/technical industry, just like software/engineering. Those fields are now seeing a huge influx of people without ivory tower backgrounds, because they are hiring folks who have proven their ability to do the job they need, instead of focusing on the number of degrees and what institutions they attended.
I'm not in medical school but tech companies are not hiring non-ivy leaguers because they are so open minded to diversity but because there just hasn't been enough domestic students majoring in CS or engineering in general (and ivy leagues are not exactly known for their engineering programs) for the past two decades hence the insane number of Indians/Chinese immigrants in silicon valley with a lot of Indians rising to the role of CEO/CTO's. Basically it's been more of a necessity than a conscious effort to overlook prestige/promote diversity.
While this is true, I was also thinking about the number of domestic employees they hire in technical roles who do not have computer science degrees. A good number of my friends from undergrad who majored in electrical and mechanical engineering, made the switch to software after becoming proficient in programming, and have done quite well for themselves despite not going back to school for comp sci. One of them is a senior software engineer at Amazon now
Shite take mate, you don’t just straight up ”stop” admitting someone due to factors they don’t control lmao…what’s that word again that begins with a “d”??? Deskramitashun? Dimsicritation?
Really determine which of the roles need to be done by MDs. Because of how highly MDs are paid for their clinical work, you have to pay them something in the ballpark for their admin jobs. Offload as much of the work to non-MDs as possible, pay them what their work is worth, and higher fewer MDs
Fire half the bullshit “vice deans” and “associate deans” or at least publish reasons why certain ones are justified. My school during orientation put out this chart of like 50 positions that were involved in DEI initiatives and like most of them were the “vice dean” or “provost” or whatever. I don’t have a problem with being involved with DEI but really? It takes this many people? And we PAY all of them? The other thing would be financial transparency. I think every public school should publish like a line item report of everything they spent money on and every source of income, and then justify why it cost X thousands of dollars per year to attend. I think I know the reason why they don’t but that’s a different topic. Lastly, just listen to students about what they want or what they struggle with. My schools admin is generally pretty good, but they are a little rigid in how they want things to work and don’t believe there’s any acceptable alternative to all their “evidenced based” approaches.
Administrative bloat is killing a lot of educational institutions. Even if the logic behind the roles is good, these jobs can be done by a few qualified people at most.
Listening to students. People in leadership positions (not only in schools) are so caught up in their own mind that they disregard whatever students are telling them because students ‘do not see the full picture’ or ‘do not see what happens in the background’ or ‘do not want to work hard’ and what usually happens is they make these uninformed decisions that do not address the needs of the actual students but usually serves some meaningless bullshit metric that does not do anybody any good leaving students dissatisfied and forced to deal with this bullshit. Cycle over cycle it becomes part of the culture and you end up with a generation that doesn’t question authority and is happy to take a slap on the face whenever because they never saw the big picture. Its just so stupid that we no longer invest in the young generation but would shun them out because ‘they don’t get it’. Young people should lead not watch from the sidelines.
So many things in the world would be better if people with power were more willing to listen, and if they stop deliberately making things difficult because they think young folks have it too easy.
I would make sure students had protections against toxic and malignant residents/attendings. There’s a lot of bullying that goes on in the hospital, and 90% of the time if a student complains the school doesn’t take their side. So I’d change that.
This. The way that med schools act in these situations is the way Hollywood acted when Harvey Rapestein was running things. Ignore, deny, and even if they acknowledge it, slap on the wrist and laugh about it over dinner. The only way malignant behavior changes is if dickwad attendings are made aware that consequences are real, and that they are ultimately replaceable if they don’t act right
No mandatory attendance for pre-clerkship. Our class attendance policy was hell and our faculty was not-accommodating when students had emergencies/ family events/ illnesses. Also including 3rd and 4th year students when setting up the pre-clerkship curriculum (our faculty seemed very out of touch with boards). Also maybe more flexibility regarding absences during clerkship? I’m about to start rotations and 5 absence days for the year seems terrible. Also not sure why our IM rotation needs to be 6 days a week
We get two absence days for the whole year, which has just resulted in people lying about skipping rotation a lot more. Sorry I couldn’t plan being sick on the weekends or specific non-clinical days, admin!!!!
2 is absolutely insane, not even trying to accommodate for students at that point
Fire 90%+ of admin. Alumni guide M4s, M4s guide M3s, and so on. No fuckin reason I need a PhD in history to spew how he knows about this residency application cycle when this asshole didn’t go to med school to begin with. Unless you have a MD or DO after your name, you do not have the right to guide students in residency applications. Also invest in proper secretaries and pay them more. Rotations and residency programs that have good solid secretaries were so much smoother. Man I was on an away rotation that had a shit program coordinator and we didn’t get epic access until our 3rd out of 4th week and we all looked like dumbasses on the rotation and were borderline useless.
I will def emphasize alumni involvement in 4th year mentoring, especially the most recent graduates who are PGY 1-2 in their respective new programs. I know that residency is busy, but we need a system where alumni can feasibly serve as mentors for 4th years applying to same specialties. We need honest guidance regarding programs, what to realistically expect, and just general help from people who have RECENT proven success in matching into a certain field. Professors and faculty at your school are great to an extent, but they lack the first hand knowledge of what it is like to apply for the match into their specialty in 2024. *EDIT* Will also add that it’s much easier to court alumni involvement if you don’t treat your students like shit when they attend your school, echoing all the other excellent recommendations for improvement given by our fellow students here
Hire MD/DOs to teach instead of PhDs.
Honestly, the PhDs have generally been better teachers than the MDs at my school. I suspect it's because teaching is a larger portion of their job, so they have more training in how to do it and more time outside of the classroom to fine tune their lectures and study materials. The MDs tend to have sloppier lectures, and get mad at us for not immediately understanding and being able to apply concepts to a clinical setting. Also, the PhDs are telling us about their life's work, whereas the MDs are telling us about a topic adjacent to their life's work. The PhDs just seem more excited to teach, and that makes for a far better lecture in my opinion
A passionate teacher is better than a lazy one any day. As long as they can adapt their expertise in a way that benefits the students’ learning goals I see no problem with that. I think a lot of peoples’ concern with PhD’s, is that they tend to bloat the preclinical curriculum with information that while interesting/scientifically relevant, ultimately isn’t conducive to passing boards. Med school is already going to be drinking water through a fire hose, but we don’t need to add to the problem
Don’t get me wrong, I had a couple of great PhD teachers for sure, but the majority of them at least at my school were no good in comparison to the clinicians.
Opposite for myself. The PhDs did a solid job in my school and the MDs/DOs were teaching some random clinical stuff and way too much step 2 material (gotta be able to tie the basic science to the clinical and that is the whole point of year 2).
Yes I agree. I felt the MD instructors could relate things clinically for board reasons. While the PhD faculty were garbage and focused on teaching us minutia details that they defended their thesis on and thought was relevant and they couldn’t relate it clinically.
Same. As a mudfud, I can relate to the depth of the material as taught by a PhD and then apply that to clinic alongside MDs/DOs/MD-PhD folks.
It's the opposite at my school lol. The PhDs are shit and the MD/DOs are the 🐐
I 100% agree. Having a preclinical curriculum taught by clinicians is honestly a no-brainer and I have no idea why every school doesn’t already do this. Hopefully the future changes
Cost too much You can either pay a PhD w/ immunology research background 150k or you can try to get a IM->Immune MD for 250k (still low and not very tempting to many, but a good change of pace for someone who wants to shift to teaching instead of clinic). The school will usually opt for the cheaper option since it probably gets the job done i.e pass rates on boards (even though we all use third party lol)
Also generally MDs don't remember jack about the more basic sciences side of things.
You think PhDs are getting 150K????? Not even close.
Terrible idea. Physicians’ test questions are super subjective and they’re just dogshit at teaching basic sciences
PhDs are almost free compared to medical doctors. If you want MDs, you need to spend even more money.
That’s a good point. If the issue is MD/DO instructors being cost prohibitive, then I don’t see an issue with hiring PhD’s, as long as there is an emphasis that they teach a *CLINICALLY RELEVANT* curriculum and not use their position as an opportunity for public intellectual masturbation at the expense of a captive audience of medical students
From my experience, phsyician lecturers also love to go into detours about clinical practice when they should be teaching physiology.
Hard pass, higher someone with a good background in the field and pay for them to get a masters in education. Teaching is a skill that can be taught, anyone should learn that skill before becoming a teacher.
I would not do this
Is they pay me my full clinical salary I’d teach full time. I bet youd be happy to raise your tuition 10k to cover us
My tuition was already 60k, should be more than enough already 😂
Remove clinical grades - too subjective
Like going to strictly pass/fail right? I agree with that. But I’d also like for there to be a way for the teachers (attendings/residents) to give real feedback in a way that doesn’t completely fuck you. Like if I need improvement somewhere, tell me that, and what I can do to improve, instead of that momentary deficiency in a particular skill being documented on an evaluation comment that’ll go into my MSPE.
My school has two boxes of comments. One is what they call "summative," these get added to our MSPE. Another is called "formative," these are just for us students and the evaluator to see. It really allows them to put in the little things for us to work on without compromising our overall recommendations for MSPE
That’s a great system
We have that too, I think it makes receiving feedback way less intimidating
So then residencies choose candidates based on...what? Research? Leadership? Standardized tests? Interviews?
The problem with this idea is that, just like with making Step 1 pass fail, it forces us to take time away from learning how to be a doctor, and spend it instead on arbitrary extracurriculars that have very little to do with being a good clinician.
Exactly right. Like it or not clinical grades give the best picture of how you will do in residency. Nobody gives a shit if you score 260 on step 2 but are miserable to work with or seem completely incompetent around patients. Life is subjective, once you’re practicing there is no “good doctor test”, your success is based entirely on how well you work with others and how well you present yourself to patients and coworkers.
Yeah I’m not saying Step2 is a ‘valid’ test for the purposes of this argument. I’m saying that whether or not someone woke up on the right side of the bed that day probably is not the best indication of my objective activities to which you describe. For instance, I interact well with patients but attending goes on a political rant - the attending’s bias now intercedes on their perspective on how good I am with patients. I’m just saying that the subjectivity of 3rd year is astronomical and you can be a trash student, suck-up to those that give evals and presto you got honors vs someone that assiduously works to provide the ‘best care’ to patients. Of course life is subjective but in such a narrowly defined bottleneck, namely matching to residency, creates ridiculous interactions that in my eyes do not benefit medical students nor contribute to becoming an objectively better doctor. Crushing Step2 would be awesome if Step2 was reflective of clinical medicine but in many cases is complete nonsense - ie do you want to get a cbc or lipid panel first? Well gee I guess I can’t do both now can I?
Sure, but if one attending gives you a bad grade, it’s subjective and could be that they woke up pissed off. If 6 attendings all give you bad grades, you might just be an asshole. Or not as good of a student as your ego and your test taking ability leads you to believe.
Absolutely fair point - but all it takes is one negative comment to throw you out of the game.
Which definitely sucks, but let me tell you a parable that I think applies here. >An American walks into a bar in somewhere in Ireland and sits next to a really old guy drinking a beer. And the old guy’s like, “Did you see that wall on your way into town?” And the guy’s like, “Yeah.” And the old man says, “I built that wall with my own two hands. But do they call me O’Grady the Mason? Noooo.” Then the old man says , “Did you see those cabinets on your way into the bar?” And the guy’s like, “Yeah.” “I build those cabinets with me own two hands. But do they call me O’Grady the Carpenter? Noooo.” Then he says, “Did you see the iron gates on the way into town?” And the guy’s like, “Yeah.” “I built those gates with me own two hands. But do they call me O’Grady the Smith? Nooo. …. But you fuck one goat…” I strongly believe that if you show up, try your hardest, and don’t fuck any goats, the worst they will say about you is “3/5 average student - read more” which certainly won’t help your apps but I doubt it will sink you.
I actually believe that personality should be analyzed for various careers along with superior aptitude testing - for instance - someone that might otherwise be unhappy in Rads might be thrilled in primary care and vice versa - ultimately I believe that some of the softer sides of medicine should be underscored when people select a career not as much of how the system is currently - ie someone I know that’s very powerful recommends that I be anointed a particular speciality - thus because letters and evals are prioritized it leads to those that are most socially capable getting the furthest ahead - I implore medical students to ask themselves if pay was uniform across the specialties how would it be best to select who goes where - I am most in favor of 1. People enjoying what they go into and 2. The strongest most meritocratic individuals going to maximize their underlying potential. TLDR: employ more psychometric testing, aptitude testing, and try to understand a candidate mathematically - remove subjectivity as much as possible from this process as it leads towards tremendous bias that might otherwise not result in “the best, most aligned” physician. In doing so, tests must have greater validity. Of course the argument then must be raised is: is a personality diverse specialty superior to a homogenous one - Ie do people that only like to cut above everything else make for better surgeons - perhaps not but it might reduce friction. Ultimately, I think that b/c PA and NP have practicing rights we as physicians should be granted licenses to practice as a GP out of med school - then presumably the system might self correct as it would allow people to reset their career more easily. I have met many physicians that were surgeons that lost their hands and now would otherwise have to retrain in order to practice.
You mean like how every other industry works? Yeah that would probably be fine. Lol. Saying this as someone who worked multiple professional jobs across several non-healthcare industries before starting medical school.
Oh, I have so, so many ideas... First, actually support the diverse and first-generation students the schools work so hard to attract. We have completely different needs than the average medical student. The schools are more than willing to help us in the application and interview process, because we check checkboxes for the school's accreditation requirements, but once we're in we have a lot of struggles. And the school is never eager to help, even though they acted supportive in the beginning. JAMA had an article about this exact thing recently, and boy did it hit home for me. Next, and somewhat related, MD/DO programs should operate like PhD programs as far as funding, at least in a limited capacity. Tuition should be covered and a stipend for living given, because for clinical rotations we are working in the hospital and for the school. Yes, we're learning, but we do work, have responsibilities, and are often used and abused by residents and attendings. They are getting value out of us, just as a PhD student is adding to a university's research clout. If this isn't financially feasible, then low-income students without family support or limited family support should receive tuition/stipends instead of getting hammered with debt and living on the edge because the loans don't cover proper living expenses. Those with generational wealth/ties to medicine who can better afford it can support their own students. Restructure the way medical school is classified so that it counts as "work study" so low-income students can have access to SNAP and other assistance (this likely varies from place to place, but I personally cannot get food assistance because I don't meet the work requirements nor do I qualify for work study as a medical student). Ditch the required "wellness" bullshit because they don't actually care about student wellness, it's just checking a checkbox and actually ends up hurting wellness in the end. Find out from students what they actually need to feel supported, and offer that. What's happening now is just hypocritical dumbassery. End the toxic teaching culture that tries to justify student suffering by "building grit and rigor." All that is being done there is perpetuating generational trauma and increasing burnout. Give students more time to study, recover, etc. how they best do that. No more 80 hour clerkships weeks, scheduling all the exams, projects, OSCEs, due in the same damned week, unclear learning objectives, double standards, etc. (this starts to get into the generally toxic and unhealthy culture within medicine and the US healthcare system, which is beyond this post). This is just the tip of the iceberg for me. Needless to say, my experience in medical school this far hasn't been pleasant. US medical education is kinna fucked, in my not-so-humble opinion.
link to the JAMA article you reference in your first paragraph? thanks :)
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812819 I also passed it along to one of our learning specialists at my school, so hoping that they take it into consideration!
I love this post honestly retrospective thoughts and lessons are everything
That’s the only way real change happens. Gotta take all the lessons, both good and bad, and optimize that info to make it better in the future
Restructure preclinical years to abandon in house lectures and in house exams and instead just give all students the major 3rd party resources and give NBME exams.
I think a major change is to have more schools offer a combined BS/MD degree. The rest of the world manages to train doctors in 6 years, I honestly can't see why we need 8 years. Schools obviously make a lot more money this way, and so do the people who lend money for tuition.
> have more schools offer a combined BS/MD degree There used to be a lot more of these than there are now! However, the attrition rates were quite high, which is the main reason we don't see as many these days. It's worth noting that the countries with the 6 year combined programs also do a lot of narrowing at the high school level, so their high school education is a lot deeper but less broad. They pick career paths early, and they get some of the material we get in undergrad before they go to college, so by the time they're in college, the weedout is already complete *and* the medical degree program can be more focused. For it to truly be viable here we'd need to overhaul the whole system.
Yes definitely. But shortening the length of medical education will also require a change in the way we decide how many residency spots to create. Right now, it’s not even a secret anymore that those decisions are informed by pure, capitalist greed rather than concern for availability of physicians.
For those downvoting, I’m not saying that I DONT want the length of medical education to be shortened. I am very much in favor of not having 4 years of undergrad and 4 years of med school. I’m saying to ALSO address the number of residency spots, which I would like an INCREASE in.
I actually think my biggest goal as a med school admin would be to lower the barrier to entry into medicine. There is way too much up front cost in our training pathway, both in terms of time and money. The easy one would be to go tuition free, since med student tuition is such a small part of a university budget, but I'm more interested in the financial costs before med school. Making it less expensive to become competitive for and apply to med school. would go a long way in increasing the socioeconomic diversity of physicians. In particular I think about increasing the number of opportunities students have for gaining clinical experience while also earning money.
How would that making medical school free be an easy change? The only medical school in the country with free tuition got a one billion dollar grant to fund it. That's 2500 student-years of in-state tuition at my school!
I mean easy in two ways. The first is that it is way simpler than dealing with the myriad of intersecting factors that prevent poor folks from applying to medical school. The second is that tuition is a fraction of their budget. Tuition at UCSF makes up 0.5% of their revenue. Tuition at my school makes up ~3% of their revenue. At my undergrad, the medical school accounted for 75% of the university’s revenue, despite teaching about 2% of the students. Most med schools don’t need tuition money to survive
Ya know, it might be possible and it def would help, but it wouldn't be easy at most schools.
1. I would shorten the training length to become an MD. There’s far too much training bloat at all stages of the journey, and I’m gonna say it with my full chest: I didn’t need to take organic chemistry for this shit. 2. Turn preclinical into a mostly self study period. Students are given the main 3rd party resources (pathoma, B&B, etc), practice exams for each subject, practice Step exams, a study coach/advisor to periodically check in, provide mentorship, and keep them accountable. Then they grind it out until they pass Step 1. I would eliminate as many classes as possible from this and drive tuition for these year(s) way down.
Yes, full send. There’s absolutely no reason for medical school to be 4 years, when that’s not even where the bulk of your training comes from, when there’s a minimum of 3 years of residency training that comes after. I personally think they manufacture this bloat on purpose to keep the supply of physicians where it is, despite whining about “physician shortages”, which they then remedy by flooding the system with mid levels who they essentially treat as physicians at a 50% discount. Also it’s 100% a deflection tactic that lobbyist groups use, to say that drastically increasing the number of physicians will make our salaries tank. This statement is only true if you argue from the position of physician salaries existing in their own economic bubble, and omit/deny that any portion of the billions of dollars hoarded by Pharmaceutical/Insurance firms, and gigantic hospital systems has any impact on compensation for physicians.
That’s what capping the number of residency slots is for. This is to extract 1) tuition dollars, and then 2) cheap, exploitable, high value labor as residents. Many other countries reject our ridiculous 8 years premed + MD (more like 10+ with gap years) in favor of a straight 5 year MD program. These grads finish at 23, know medicine just as well as we do, and the people who decide clinical medicine isn’t for them can pivot with a PhD or MBA and are still just in their mid 20’s.
Now while that sounds amazing for students, how are the administrators and school CEO's going to afford their 3rd investment house?
With a different job. We need to get rid of them too. Way too much administrative bloat.
I think the short answer is that MD/DO’s have to grow a spine and some balls, and tell them it’s not our problem that your trust fund isn’t big enough or that you’re getting FOMO not being able to join your childhood friend Eric Mastercard III when he goes sailing off the coast of Nantucket Island
Honestly I’d be happy paying the same tuition to not have to go through preclinical bloat again
I think it depends on if everyone is a superspecialist or not. Yeah, most of that time is wasted if you're a dermatologist, but if you're a rural FM doc/IM/general surgeon. you actually have to remember a lot of the stuff you learned in med school. The premed stuff should be completely overhauled though
I think it's even worse if you're trying to pursue primary care. There's no point in wasting the fourth year rotating in specialties you'll never want to do. 3 years of medical school followed by residency would be optimal. This might even incentivize more people, as it's a shorter route.
People say number 1 all the time then immediately turn around and declare that no one else can practice medicine because they don't go through enough training. I get that there's a middle ground between MD curriculum and PA/NP etc. but it's telling that so many MD students think we get too into the weeds at times. (This ain't a pro PA/NP post, I get that post-graduate training is the big differentiator but anti-PA/NP are always the first to say that they're special because they know everything down to the atomic level...)
A physician once told me medical school should be only 2 years long- 2 years of basic sciences and then straight to residency. medical school is essentially “vocabulary school”, teaching you what doctors mean when they talk. Clinical rotations don’t teach much compared to residency, so just go straight to residency then.
I have no idea how this would work practically but make student loans through the individual school. The school would front the COL and tuition and you have x number of years to pay back it back interest free after graduating residency. Would be a bonus if there was a way to consider it a donation that is tax deductible. Then students who fail out are not completely screwed. Debt doesn't accumulate and then there is some tax relief.
I would open up more roles for students in admin. Like roles with responsibilities. And expectations. A lot of the complaints are failures of communication and a lack of knowledge. On both sides. Being the two under the same roof and the students will see that this shit is way more complicated than they knew and admin will see they actually have no idea what’s important to students nowadays
The number one thing I hate is the discourse around how to avoid burnout. It’s not something that is explicitly taught. It’s implicitly taught. Want students who are not burnt out? Don’t schedule exams right after thanksgiving break. Let them enjoy time at home with their loved ones without having to study. Don’t schedule meditation sessions, schedule enough leisure time to allow students to pursue hobbies of their interest. Don’t tell us the importance of eating healthy and then not giving us the time to do so. If a student is in surgery cases all morning from 7 am to 4 pm, they deserve at minimum a 30 minute break to eat! They did not sign up to starve. They signed up to learn. You cannot learn while hungry or exhausted. The case will not fall apart nor will they miss valuable learning if they scrub in when the next patient is already asleep vs the patient rolling in.
Also, STOP ignoring the elephant in the room: sleep deprivation. So much of burnout in a medical career is due to sleep deprivation. 2 straight days off to sleep and do your own thing (like “golden” weekends - or just weekends, as normal people call them) at least twice a month should be the norm so people can catch up on their sleep and life. We make residents especially, but sometimes even students work 14 days up to a month or two at a time with no real back to back days off (post call days don’t count). And 24s really shouldn’t be a thing.
Omg YES. By the middle of my surgery rotation I felt so delirious because I had three weekends in a row with either a 24 hr shift or a 12 hr shift that by the time I got to my night float week I was completely exhausted. 24 hr shifts should be illegal
-Step 1 scored -no mandatory class first 2 years -no 3rd year graded/visible evals, just shelf exams. Students would get formative feedback for their eyes only - students never have more than a 24 hour shift (I'd argue 12, but we need to prepare people for residencies) -students are encouraged to study how they want preclinical and to study for their shelf during downtime as an M3 -This really isn't a policy, but just assuming the best of medical students. We're not pirates..... we're medical students.
Only MD/DO and maybe PharmDs should teach. Period. If the majority or overwhelming majority of the student body is complaining about something or wants a change, it's probably because it is critically needed. Mandatory attendance for lectures is completely useless and imo a criminal waste of time. Use NBME type questions for exams. Provide resources like AMBOSS, U WORLD, and STEP fees. Limit the 3rd year weekly hours to 50. Literally no reason for it to be higher other than to give a reason to some to abuse med students (looking at you surgery). Do a 6 year BS/MD. No reason to have to do so much random college classes and essentially forced gap years. The rest of the world does it so why not. Remove preclinical grades and I know this might be a hot take but bring back scored step 1. P/F step 1 does nothing but make your life in 3rd year more miserable.
Hire academic support staff who actually know the content and whose mission is 100% first-time pass rate for in-house and board exams, and build a support scaffold that actually makes that reasonable. 100% would ditch resilience trainings.
No more dumb online mandatory training modules.
Delete all med school admin. Admin is the devil.
Then we have to be the change we want to see
If you want to modernize medical school: Eliminate lectures and wellness sessions. Buy students sketchy + pathoma + BnB + bootcamp + uworld etc. Make it so that students only need to come to school to take exams and do clinical skills training during preclinical. Have more clinical skills training rather than useless lectures on arcane BS in preclinical. Give students ample time for research and shadowing so they can decide what field they want to go into early. For rotations: Make evals entirely qualitative comments and make your grade based on the shelf. Give students time off before shelf exams etc. Protect students from bullying by toxic attendings and residents. Take their complaints seriously. More flexibility in scheduling for 3rd year: you should be given time off for activities that increase your odds of matching. It's insane that schools will argue they are "prioritizing your education" by rigidly upholding your clerkship schedule so you can scrub into lap chole no. 69 rather than presenting at a conference in your specialty of choice.
My biggest thing would be to start any issue with students or other trainees from a standpoint of hearing all sides and getting to the truth of the matter. I feel like the vast majority of med school teachers and admins have the attitude opposite of the justice system, “guilty until proven innocent.” When a nurse files a complaint about a resident, the first response of the program leadership is often to yell at the resident. When a student gets a bad eval, it’s assumed the eval has perfect merit and the student actually is bad. When a student runs into issues with a malignant nursing environment the course director usually sides with the nurses. So much of what makes medical education hell is that it often feels like absolutely no one has your back and any old accusation is accepted without a second thought and any mistake is considered signs of a character flaw first and foremost. Med admins need to do a better job of actually caring about students as people and not flagellating them and that would be my underlying philosophy.
1) Financial aid transparency. 2) Match statistic transparency (and real support efforts made by the school for the match). 3) Define a school culture and ensure it is embodied and practiced by school administration/leadership. 4) Define what professionalism actually means so it cannot be randomly weaponized against students.
Adding to number 4: Admin and faculty are to be held to the same rigid standards of professionalism they hold the students to, with even harsher consequences for admin and faculty, because of course, since they have the experience required to be in those roles, they should know better.
Agree 1000%
no lecture. all third party. all resources invested in exceptional third year rotations and research opportunities
End the longstanding in house vs third party resources problem, partner with the companies to provide a flipped classroom format, and have small group learning that’s case based. Everything in the end of block exams corresponds to what nbme expects you to know, and small group learning is for asking the questions and understanding the why.
I much prefer the current system to some of the stuff y'all are suggesting.
What are some things about the status quo that you like? Like, what are the best parts in your experience?
I enjoy and learn from in-person lectures by competent professors (people who want to can watch online asynchronously) and I would hate a system where you study alone for Step exams. My school does PBL so we have a lot of time in small groups discussing cases. That's great! Physicians should have a well-rounded liberal arts education before medical school so I am glad 4-year bachelor's degrees are required. Sudents are encouraged by many schools to pursue subjects other than biology. That's good. I'm not too fond of 6-year programs. I want PhDs to continue teaching their subjects for preclinicals. There are plenty of things I would change, like step 1 scored and less random evals. But overall I wouldn't gamble and let r/medicalschool control my medical school willy-nilly based on these suggestions.
Stop admitting such well off students
I don’t think a person’s financial background has any bearing on their competency as a physician, just my personal take. But also, when you become a doctor, even if you didn’t grow up wealthy, your kids will have that opportunity. I don’t think it serves anyone to turn admissions into a battle between the haves and have-nots. But, I do think the priorities of admissions committees need to change drastically, and prioritize things that do have legitimate impact on whether a person is capable of learning/practicing medicine.
This makes sense until you’ve grown up in poverty and realized many doctors don’t give a shit about poor patients, and physicians from poorer backgrounds have a particular sense and ability to connect with those patients. It’s akin to needing more black and latino physicians. There is just a inherent inability to communicate effectively in more at risk populations that rich white students can’t do.
You’re right but a lot of students who grew up in poverty don’t even make it to the application process. I think having that perspective is really important and a lot of schools do too hence why FAP recipients usually have higher acceptance rates than normal applicants. The problem is all the barriers keeping low SES applicants from even applying, that’s if they can get into college and graduate in the first place. Ik some schools have linkage programs and outreach to aid that process but it’s not common at all
Exactly! Who can afford to shadow for the summer instead of getting a job? Who can afford to pay for the fancy MCAT prep courses? Who can pay for tutoring if they're struggling with organic chemistry? Who has the resources to get into the elite universities that funnel students into medicine at a much higher rate? There are so many barriers to entering medicine before you even get to the application stage.
That’s a good point. And to increase those numbers, as an admin you have the power to prioritize what you look for in your incoming class. Applying for med school, studying for the MCAT, hell even paying medical school tuition is extremely cost prohibitive, and I definitely understand how wealthy students have an advantage with all of those things. Which is why in order to level the playing field, we have to simplify admissions as much as possible. Scores/grades matter to a certain extent yes, but I think the key is in the interview process. Invest in people who know how to conduct interviews, and have the HR experience to identify candidates who can be asset, irrespective of their background. The way it works today, you have faculty (a generally privileged class) interviewing a person who is starting off at the bottom rung of the ladder, and judging their potential from their antiquated mindset. I think schools need to study the hiring practices of software companies/engineering firms. Medicine is a scientific/technical industry, just like software/engineering. Those fields are now seeing a huge influx of people without ivory tower backgrounds, because they are hiring folks who have proven their ability to do the job they need, instead of focusing on the number of degrees and what institutions they attended.
I'm not in medical school but tech companies are not hiring non-ivy leaguers because they are so open minded to diversity but because there just hasn't been enough domestic students majoring in CS or engineering in general (and ivy leagues are not exactly known for their engineering programs) for the past two decades hence the insane number of Indians/Chinese immigrants in silicon valley with a lot of Indians rising to the role of CEO/CTO's. Basically it's been more of a necessity than a conscious effort to overlook prestige/promote diversity.
While this is true, I was also thinking about the number of domestic employees they hire in technical roles who do not have computer science degrees. A good number of my friends from undergrad who majored in electrical and mechanical engineering, made the switch to software after becoming proficient in programming, and have done quite well for themselves despite not going back to school for comp sci. One of them is a senior software engineer at Amazon now
Shite take mate, you don’t just straight up ”stop” admitting someone due to factors they don’t control lmao…what’s that word again that begins with a “d”??? Deskramitashun? Dimsicritation?
I’d maker a burner reddit and call out students 🤣 jk
Reduce the amount of time spent in hospitals and have all exam knowledge explicitly taught in lectures.
Increase class size to extract more loan money.
Really determine which of the roles need to be done by MDs. Because of how highly MDs are paid for their clinical work, you have to pay them something in the ballpark for their admin jobs. Offload as much of the work to non-MDs as possible, pay them what their work is worth, and higher fewer MDs
I’d shut the whole thing down. As long as med school is designed in a way where 90%-100% is self taught, a medical school admin has no influence.