As a second year medical student, every time I hear someone mention The Boards, I see this in my head:
http://www.youtube.com/watch#!v=HqqQ-3tTZig&feature=related
I believe that creeptastic music plays in the minds of every 2nd year whenever we hear the words "USMLE" or "The Boards." You can't help but flinch.
So what is this "boards" business? It's Step 1 of the US Medical Licensing Exam (USMLE), aka Step 1 of "The Boards." USMLE Step 1 is a standardized multiple-choice exam that all medical students around the country take. Step 1 covers basically everything that you learn during the first two years of medical school (or everything you should have learned), including biochemistry, microbiology, physiology, pathophysiology, pharmacology, behavioral science, and anatomy. It is the gateway to the second half of medical school (the clinical years), and it can be a major component of your residency applications down the line. Depending on what you want to go into, your Step 1 score can profoundly influence your decisions about what specialty to pursue and which programs you can apply to. In other words, it's a Big F#*%!ing Deal.
People have a tendency to freak out about it. Which is understandable, but probably not helpful. It's an important test, but it's still just a test. Multiple choice, just like the SAT, and the MCAT. No written portion. And sure, it covers more material than probably any other test you've ever taken, and the questions probably demand a more advanced level of reasoning and synthesizing information than you're used to, and OK so it could potentially have a major effect on the rest of your life, but... I'm sorry. I forgot where I was going with that thought. I know it was going to end on some hopeful, inspiring thought, but I'm having trouble thinking of one right now.
If you want to be a plastic surgeon, then you really need to rock out on the Boards and score well above the national average. If you want to be a pediatrician or a psychiatrist, you really just need to pass. And most people pass. The Boards are hardest for people who went to medical school outside of the US and are taking the exam so they can do a residency and/or get licensed to practice in America. The vast majority of American medical students who don't have some horrific breakdown the day before their exam date do just fine. And if you fail, you can take it again. It will suck, and you may have to take a year off to study and do research or something while all your classmates continue on through 3rd year rotations, but it does not necessarily mean the end of your medical career.
Oh, and, yes, there is a USMLE Step 2 exam. That tests knowledge about medical treatment and management of illness; basically it tests everything you should have learned during your 3rd year rotations. There is also Step 2 CS which is a practical exam assessing your clinical skills, such as your ability to wash your hands before touching a patient, your facility with an H&P (medical history and physical exam), and whether or not you can interact with patients like a normal human being.
Here's some info on the basics of The Boards (duh duhhhh):
http://www.usmle.org/examinations/step1/step1.html
http://en.wikipedia.org/wiki/USMLE_Step_1
What I want to do over the next couple of posts is provide some insight into the boards preparation process, and hopefully give some insightful reflection on things that you can do throughout the first two years of medical school in order to reduce stress and anxiety about The Boards (duh duhhhh) and be ready to completely kick ass when it comes time to take the test. Any advice I might dole out will probably come from the department of, "Dear God, why oh why didn't I do __blank__ last year?!" I've noticed I'm pretty good at knowing what I should do, and really bad at actually doing it. So, I'm going to write down all my brilliant thoughts here, and maybe someone else who's good at that kind of thing can actually put my plans into action.
To recap: USMLE Step 1 -->
http://www.youtube.com/watch#!v=HqqQ-3tTZig&feature=related
Thursday, April 22, 2010
Curriculum Issues
There are several major types of med school curricula. I found this article on "How Becoming A Doctor Works" which purports to speak for all medical schools as to what kinds of courses you take during the first and second years of med school: http://money.howstuffworks.com/becoming-a-doctor9.htm.
That article is wrong.
Ok, well, it's on the right track. The most "traditional" academic calendar is: first two years in the classroom, second two years on the wards, doing doctory shit (well, med student scut work shit). Year 1: physiology; how everything in the body is supposed to work. Year 2: pathophysiology; how it all goes wrong in disease. Year 3: head out into the hospital for your first year of clinical experience. Year 4: more clinical experience in the hospital, with the opportunity to do "away rotations" at other schools/hospitals, plus apply for residency. And some school's probably do it that way, but a lot of schools have evolved past that rather antiquated system. My school integrates coursework on clinical skills and arranges for on-site hands-on experiences throughout the first two years, for example. That way, we don't pee our pants the first time we're asked to touch a patient as 3rd years.
The major curricular advances of the 20th century were the systems-based approach and problem-based learning. I've never experienced PBL-style, but what I understand is that you spend a lot less time in lecture and a lot more time in small groups of students who work through clinically-based problems. You look everything up, check on the latest research in the field, work through the clinical reasoning, figure out what tests you'd need to order and how to interpret the results, etc. The one comment I've heard from a student at a top school that had recently switched to PBL was that you "live or die" by your group. When y'all are teaching each other and yourselves, it's critical that you guys can match up your learning styles and work together well enough to really get it done - without wanting to kill each other or yourselves. But, like I said, I've never really done school that way, and it was just one student's evaluation. I have to admit I don't know much about it, and I don't really have an opinion on PBL as a pedagogical model.
Recently, however, I have decided that a systems-based approach makes the most sense. We do not do it that way here, but I wish we did. Instead of learning all of gross anatomy, and then having a course on cardiovascular physiology, and later having a class cardiovascular pathophysiology, and at some point during your pharmacology course learning alllll of the drugs that treat the heart (and, oh boy, it's a lot of them), you have one all-encompassing Cardio class in which you learn the functional anatomy of the heart, it's physiology and pathophys, the cardio drugs, how it all fits together. That sounds much preferable to me than learning it all in bits and pieces and trying to reach way back into your memory to recall basic physiology when you're attempting to learn all the new, complicated pathophys a year later, and even later learn the drugs in a different class, out of context.
Like I said, at my school we don't do a systems-based approach. As such, I'm not familiar with its possible shortcomings and pitfalls. But throughout 2nd year, I've become increasingly convinced that it is a more logical and seamless approach, and that it's a better way to really learn all of this stuff, instead of just memorizing things and then forgetting them 5 minutes after the exam. When it comes to studying for The Boards (duh duhhhhh), I will be using a systems-based approach as I organize my 5 weeks of self-directed study.
I should point out that PBL is a way to structure course time and systems-based is a way to structure the overarching curriculum. They are not mutually exclusive, and there may be med schools that teach a systems-based approach in a PBL format.
Finally, a few schools have switched to a totally different calendar. They've shrunk the first two years of book learnin' down to about 18 months. That means that students at those schools take The Boards (duh duhhhh) earlier, and start rotations earlier. They have more time gaining clinical experience, can do more electives, and they can feel cool cause they're all different and special. It sounds like it's also a bit more of an intense approach. UVM and UPenn both have different versions of this type of curriculum.
One more thing to consider when it comes to judging a school by its curriculum: what does it say about the general approach of the administration? Is this a school that considers itself a vanguard of tradition, and which is confident that its model has worked for 50+ years and so will continue to work? Does that mean that that school will probably also foster more of the old-school strict hierarchy and intense competition? On the other hand, are schools that adopt new curricula or develop their own novel approach more progressive in general? Will they be more modern, flexible places with a more responsive administration? Or are they just trying to find some way to distinguish their school from the rest in order to improve rankings and admissions yield?
On a day-to-day basis, the grading system your school employs probably makes more of a difference in your quality of life. The classes you're taking are the classes you're taking, what you really care about is how you're doing in them and whether/where you're ranked in the class. You probably won't spend much time pondering the possibilities of a different curricular schedule. But as a 2nd year with The Boards (duh duhhhh) looming over me, inspiring me to reflect on the totality of my medical education thus far, I wonder how I might have learned more or learned better had my school organized the basic curriculum differently.
That article is wrong.
Ok, well, it's on the right track. The most "traditional" academic calendar is: first two years in the classroom, second two years on the wards, doing doctory shit (well, med student scut work shit). Year 1: physiology; how everything in the body is supposed to work. Year 2: pathophysiology; how it all goes wrong in disease. Year 3: head out into the hospital for your first year of clinical experience. Year 4: more clinical experience in the hospital, with the opportunity to do "away rotations" at other schools/hospitals, plus apply for residency. And some school's probably do it that way, but a lot of schools have evolved past that rather antiquated system. My school integrates coursework on clinical skills and arranges for on-site hands-on experiences throughout the first two years, for example. That way, we don't pee our pants the first time we're asked to touch a patient as 3rd years.
The major curricular advances of the 20th century were the systems-based approach and problem-based learning. I've never experienced PBL-style, but what I understand is that you spend a lot less time in lecture and a lot more time in small groups of students who work through clinically-based problems. You look everything up, check on the latest research in the field, work through the clinical reasoning, figure out what tests you'd need to order and how to interpret the results, etc. The one comment I've heard from a student at a top school that had recently switched to PBL was that you "live or die" by your group. When y'all are teaching each other and yourselves, it's critical that you guys can match up your learning styles and work together well enough to really get it done - without wanting to kill each other or yourselves. But, like I said, I've never really done school that way, and it was just one student's evaluation. I have to admit I don't know much about it, and I don't really have an opinion on PBL as a pedagogical model.
Recently, however, I have decided that a systems-based approach makes the most sense. We do not do it that way here, but I wish we did. Instead of learning all of gross anatomy, and then having a course on cardiovascular physiology, and later having a class cardiovascular pathophysiology, and at some point during your pharmacology course learning alllll of the drugs that treat the heart (and, oh boy, it's a lot of them), you have one all-encompassing Cardio class in which you learn the functional anatomy of the heart, it's physiology and pathophys, the cardio drugs, how it all fits together. That sounds much preferable to me than learning it all in bits and pieces and trying to reach way back into your memory to recall basic physiology when you're attempting to learn all the new, complicated pathophys a year later, and even later learn the drugs in a different class, out of context.
Like I said, at my school we don't do a systems-based approach. As such, I'm not familiar with its possible shortcomings and pitfalls. But throughout 2nd year, I've become increasingly convinced that it is a more logical and seamless approach, and that it's a better way to really learn all of this stuff, instead of just memorizing things and then forgetting them 5 minutes after the exam. When it comes to studying for The Boards (duh duhhhhh), I will be using a systems-based approach as I organize my 5 weeks of self-directed study.
I should point out that PBL is a way to structure course time and systems-based is a way to structure the overarching curriculum. They are not mutually exclusive, and there may be med schools that teach a systems-based approach in a PBL format.
Finally, a few schools have switched to a totally different calendar. They've shrunk the first two years of book learnin' down to about 18 months. That means that students at those schools take The Boards (duh duhhhh) earlier, and start rotations earlier. They have more time gaining clinical experience, can do more electives, and they can feel cool cause they're all different and special. It sounds like it's also a bit more of an intense approach. UVM and UPenn both have different versions of this type of curriculum.
One more thing to consider when it comes to judging a school by its curriculum: what does it say about the general approach of the administration? Is this a school that considers itself a vanguard of tradition, and which is confident that its model has worked for 50+ years and so will continue to work? Does that mean that that school will probably also foster more of the old-school strict hierarchy and intense competition? On the other hand, are schools that adopt new curricula or develop their own novel approach more progressive in general? Will they be more modern, flexible places with a more responsive administration? Or are they just trying to find some way to distinguish their school from the rest in order to improve rankings and admissions yield?
On a day-to-day basis, the grading system your school employs probably makes more of a difference in your quality of life. The classes you're taking are the classes you're taking, what you really care about is how you're doing in them and whether/where you're ranked in the class. You probably won't spend much time pondering the possibilities of a different curricular schedule. But as a 2nd year with The Boards (duh duhhhh) looming over me, inspiring me to reflect on the totality of my medical education thus far, I wonder how I might have learned more or learned better had my school organized the basic curriculum differently.
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