Applications for Psych

[notdeadyet]

By contrast, you will get a medical residency based on your step 1 score (which is entirely regurgitation), a few but not all of your clerkship grades (6 weeks - 3 months and very subjective) and maybe some other small aspects of your application, along with your LORs and PS.

Step I score = standardization. You need this to see how one person's knowledge level compares to another. The same reason you have the MCAT. You need something on an application so that you can compare oranges to oranges.

I also disagree with the idea that it's "entirely regurgitation". Most of the Step I questions are secondary and tertiary, requiring pretty good synthesis.

Clerkship grades = subjective. Agreed. But while Step I is supposed to measure your academic knowledge, clerkship grades are supposed to measure how you apply that knowledge and work in a clinical environment. It's subjective by nature.

So basically you have an objective and subjective measurement used on your application and then LORs and all the rest. Combine that with an inteview, in which directors can try to get a feeling for who you are (as is with every interview in the world) and you have a pretty diverse judgment criteria.

What else are you looking for here?

These are smaller and more trivial measures of what a person has to offer, I would argue, than what my physics friends are judged on when they are offered or not offered jobs.

Yeah, there's a big difference between your physics friends and a medical student: your physics friends have done something. As a medical student, you haven't. You essentially took a bunch of classes and did an apprenticeship of sorts.

Your application does not rest on a discovery or book or anything else used in academia because you are not being selected for based on your ability to discover anything or write anything. You are being selected to be trained as a physician, and the best judgment for that is how you performed in medical school.

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[notdeadyet]

I am happy for how it has worked out for myself as well. But it is not a deep or "fair" system, no, I would not say that.

I'm curious what exactly you would change. I like the fact that in four years of medical school, everyone has a chance to shine via their particular strength.

If you're a great bookworm, you have the preclinical stuff to strut yourself and the Step I. If you're more the roll-up-the-sleeves type and excel via work ethic, interpersonal skills, and grunt force, you have clinical rotations. If you're the research type, you have that aspect of your application you can point to.

It's along and hard haul. I won't argue with that. But I scratch my head trying to figure out what I'd really change assuming I couldn't drop any book learning or cut back any work hours at the hospital.

 

[notdeadyet]

Anyway, you didn't answer my question about what happens if someone gets sick while carrying substantial medical student debt.

Take time off and get well. If you're talking injury/short-term disability and it's a concern for you, there is medical disability insurance that you can get as a medical student (I know AMA offers a plan for one).

If you are talking death or permanent disability, either will make your federal loans disappear. Not the best way to get debt free, but there you go.

What if they flunk out? That will happen to a percentage of people.

You're better off becoming disabled. Joking...

Flunking out is very bad juju. But have you seen the stats on it? The vast majority of med students flunk out the first semester and it drops off quickly after that. So most students who flunk out do so with "minimal" debt.

And the number of students who actually flunk out is very, very small. Many more leave for personal reasons ("Wow, I guess just because Dad's a doctor doesn't mean I should follow in his footsteps...").

From what I've seen, literally almost all of the people who have what it takes to get in to medical school have what it takes to graduate (albeit, some limping). The few cases I'm familiar with of people who actually flunked out had issues with priorities, mental health, or substance abuse. There may be people out there who were smart enough to get in to med school but just not smart enough to pass, but I don't think there are many. Every school I've heard of has bent of backwards to toss folks over the bar. Frankly, it's in their best interest on many levels.

 

[nancysinatra]

Well, this probably belongs in the Allo forum now... By the way, I'm sure we would find much to agree upon in person--what you're saying sounds very reasonable but I think we have different outlooks!

Step I score = standardization. You need this to see how one person's knowledge level compares to another. The same reason you have the MCAT. You need something on an application so that you can compare oranges to oranges.

I also disagree with the idea that it's "entirely regurgitation". Most of the Step I questions are secondary and tertiary, requiring pretty good synthesis.

Well, there I disagree. I don't see what in the first two years of medical school was anything other than memorization. Step 1 is entirely multiple choice. Where else in the "sciences" does so MUCH of the evaluation occur through multiple choice?? As for Step 2, that functions, if you ask me, on a level of association of terminology. You don't have to understand anything in depth.

Just because a test is administered to thousands of students, and just because high scores are revered, does not even make it A standardized test, let alone a great one. It's just a common test. Step 1 was not designed as a "standardized" test. It was meant as an assessment of passing competence, I believe. It's certainly no IQ test. It's not an MCAT or a GRE or an LSAT or SAT even.

So basically you have an objective and subjective measurement used on your application and then LORs and all the rest. Combine that with an inteview, in which directors can try to get a feeling for who you are (as is with every interview in the world) and you have a pretty diverse judgment criteria.

I was wondering if you are an MSIII or MSIV? I'm curious because I think even some psych programs will not rank applicants at any realistic level if they don't honor medicine. Period. At least that's the rumor. Without that "subjective" honors your application is nothing to them. What you're describing sounds more like med school applications, although even there there are cutoffs. No one in med school admissions (besides a few people maybe) cares whether the cutoffs are arbitrary. It's a system and the system keeps going. A few people will always get run over by it.

Take time off and get well. If you're talking injury/short-term disability and it's a concern for you, there is medical disability insurance that you can get as a medical student (I know AMA offers a plan for one).

If you are talking death or permanent disability, either will make your federal loans disappear. Not the best way to get debt free, but there you go.

I'm not sure about disability erasing loans. My point was that residencies will wash their hands of an application with a GAP in it. A formerly sick medical student, in addition, is a medical student who didn't get honors. This person's career is potentially done, and medicine does not care. That is what I'm trying to say. And not all medical students can just "take time off and get well." Do you assume that everyone has a nice family they can live with and backup health insurance?

I honestly don't think we disagree about all that much, but I do not think things are as rosy as maybe you do?

 

[notdeadyet]

By the way, I'm sure we would find much to agree upon in person--what you're saying sounds very reasonable but I think we have different outlooks!

I agree. I don't think you're posting anything factually untrue, we are just taking different spins on it.

Just because a test is administered to thousands of students, and just because high scores are revered, does not even make it A standardized test, let alone a great one.

So (again) I'd ask you what you'd propose. We need something to compare apples to apples. I'm not a fan of standardized tests. In fact, I'm one of those people who do pretty poorly on them. But I see the need. If not the Step I, I'd wonder what you suggest using.

It's certainly no IQ test.

Perish the thought.

I'm curious because I think even some psych programs will not rank applicants at any realistic level if they don't honor medicine. Period. At least that's the rumor.

Hmmm. I'd be interested in finding out how true this is.

I've heard this same rumor for most specialties. I've heard that many programs won't rank you if you don't get honors in medicine for Emergency Medicine, Neurology, Anesthesia, and PM&R. And those are just specialties I'm familiar with.

I'll be curious to see. The medicine clerkship at our school is notorious for giving out very few Honors, yet we have a great match list, including for psychiatry.

Maybe MGH won't take you with a pass in Medicine (don't know), but thankfully for me, they're far from the only game in town.

Without that "subjective" honors your application is nothing to them.

Are you saying you don't think the honors is subjective? The quotes are confusing me. And I'll be curious to see if anyone can post a list of more than a small handful of actual programs who have verified that a pass in medicine is a deal killer.

It's a system and the system keeps going. A few people will always get run over by it.

True of anything in life. Again, I'm asking what you think a better alternative would be.

 

[notdeadyet]

I'm not sure about disability erasing loans.

I am. You can do a quick hunt. If you are totally disabled (i.e.: can not work), they will be erased. You can get them erased with some bankruptcy proceedings as well, though I'd bet it's messy.

I researched this pretty heavily. My wife is a teacher and doesn't roll around on beds of money, so I wanted to look at what would happen were I to die or be disabled.

My point was that residencies will wash their hands of an application with a GAP in it. A formerly sick medical student, in addition, is a medical student who didn't get honors. This person's career is potentially done, and medicine does not care.

I don't know if you've seen lots of cases of this. I haven't. But I've seen cases to the contrary. I know personally of folks who've had gaps in their education due to illness, children, and one other for personal reasons who ended up in what look to be good residency programs. I don't think things are as vindictive as you seem to see them. Maybe this is true at the top 10% of programs, but who needs to be in the top 10% of programs?

But you have to go with experience. If you've seen otherwise, I can see where these feelings are coming form. I just haven't had this experience.

And not all medical students can just "take time off and get well." Do you assume that everyone has a nice family they can live with and backup health insurance?

Every med school I've seen requires health insurance, so sick med students are much better off than your average American. As for the "nice family", it ain't a requirement for wellness, thankfully, or the world would be a whole lot sicker.

I think this might be the crux of why we disagree. Most of your objections seem to be less about the specifics of medical school/residency and more objections with how life in general sort of works, no?

Is it fair that you can be declined housing because a potential landlord didn't like you? Or declined a job because you once sought substance abuse treatment? Or have that (insert black mark) come back to haunt you when you try to (achieve goal)? Or that your plans get derailed when you get sick, hurt, etc.?

You are 100% entitled to your opinions, but I personally find that things become a lot more palatable when I look at something I don't care for and say "Well, what's the alternative?" If I can't come up with anything better, I shrug and get on with life.

If you have alternatives that make the medical school/residency thing more just (again, without sacrificing the quantity/quality of education or hours required), I'd love to hear them. And if they sound reasonable, I'll help you fight for them.

I honestly don't think we disagree about all that much, but I do not think things are as rosy as maybe you do?

This would be quite funny if you actually knew me. I'm the last person someone would think had a rosy viewpoint. Much of my youthful rosy idealism ended with my, well, rosy youth.

My apologies if I am giving the impression that I think med school/residency is this wonderful utopia. It isn't. I just find it refreshingly fair compared to most of the alternatives I've seen.

I've seen medical students get a "do-over" when they fail a complete course or the Step I, as opposed to quietly being shown the door as they would in many jobs. I've seen residents get verbal dressing-downs for professionalism infractions that would have had them on the street in some private industry. I've seen folks get great residencies with personalities that would not have gotten them past the first interview at a lot of companies. And most of all, I've seen much of this experience as something that rewards those who are willing to work hard, which to me is the great equalizer but then I've always considered myself more stubborn than smart.

So I don't see med school/residency as rosy, but it's a lot more tolerant a process than most I've seen. If your personal experiences have seen things a lot more fair in other industries or walks of life, I can see where your viewpoint comes from. I haven't.

And take care. This too shall pass.

 

[VMSmith]

I'm not sure about disability erasing loans. My point was that residencies will wash their hands of an application with a GAP in it. A formerly sick medical student, in addition, is a medical student who didn't get honors. This person's career is potentially done, and medicine does not care. That is what I'm trying to say. And not all medical students can just "take time off and get well." Do you assume that everyone has a nice family they can live with and backup health insurance?

Death or disability are 2 of the few ways that your student loans are 100% cancelled (discharged). Other ways include your school fraudulently certifying your loan without your signature, your school closing, or if you declare bankrupcy. There are some other ways too but I think those are the main ones.

Not totally true that residencies will "wash their hands" of an applicant with gaps in their training. I had 2 med school friends with gaps in their training - one due to family illness and one due to personal illness. One got a residency in a non-competitive specialty at an Ivy, the other got into a very competitive specialty at a state university program.

That's not to say that everyone with gaps will succeed. One guy didn't match in a non-competitive specialty and scrambled into something else. Another one failed to match into gen surg and is doing a prelim surgery year. They had other red flags besides the gaps though - one had multiple course failures and the other failed Step 1 once.

Anecdotal evidence to be sure, but program directors are humans too, and some (if not all) understand human needs and uncontrollable circumstances.

 

[nancysinatra]

Are you saying you don't think the honors is subjective? The quotes are confusing me. And I'll be curious to see if anyone can post a list of more than a small handful of actual programs who have verified that a pass in medicine is a deal killer.

I do think the honors, as well as high pass, and pass, are for the most part subjective and meaningless. I got two totally meaningless report cards in the mail just this week. I got a pass in one class and an honors in the other, where they should have been reversed. What am I supposed to make of that?

I recall a similar thing when I applied to medical school. People drooled over things in my application that I knew were ridiculous. Meanwhile they'd overlook true achievements of mine just because they didn't have the right cache.

I don't have info on specific programs, but I think you could search for that or ask around. Probably it's a minority that "demand" honors in medicine, and yes, these would be snooty programs. Medicine, not psych. I can understand requiring honors in psych to go into psych.

True of anything in life. Again, I'm asking what you think a better alternative would be.

A kinder, more caring world?? I'd be happy to discuss that but in the Allo forum. I don't want to go on and on in the psych forum.

 

[nancysinatra]

I don't know if you've seen lots of cases of this. I haven't. But I've seen cases to the contrary. I know personally of folks who've had gaps in their education due to illness, children, and one other for personal reasons who ended up in what look to be good residency programs. I don't think things are as vindictive as you seem to see them. Maybe this is true at the top 10% of programs, but who needs to be in the top 10% of programs?

But in medicine there seems to be no legal recourse if you are an applicant, a student, a resident, or any other form of underling. The top 10% of programs count too, in any case. Though I'd expect less malignancy at the top 10% of places...

I think this might be the crux of why we disagree. Most of your objections seem to be less about the specifics of medical school/residency and more objections with how life in general sort of works, no?

No. Medicine is unique because it charges us $250,000 for the privilege of joining a Darwinian system when we are not even sure our health and sanity will survive so that we can later pay off that $250,000 plus interest. The world is already Darwinian. I did not need to PAY to be exposed to a even higher level of ruthlessness and unfairness than I am likely to find in the world at large. That makes no sense as a way to live at all. (I was saying above how I got two mixed up grades so you can understand why I find the system baffling and unfair.)

I've seen medical students get a "do-over" when they fail a complete course or the Step I, as opposed to quietly being shown the door as they would in many jobs. I've seen residents get verbal dressing-downs for professionalism infractions that would have had them on the street in some private industry. I've seen folks get great residencies with personalities that would not have gotten them past the first interview at a lot of companies. And most of all, I've seen much of this experience as something that rewards those who are willing to work hard, which to me is the great equalizer but then I've always considered myself more stubborn than smart.

This I totally agree with. It is a forgiving profession in that sense.

And take care. This too shall pass.

No it won't! It's the system! All that will happen is that the fittest will survive.

 

[nancysinatra]

Death or disability are 2 of the few ways that your student loans are 100% cancelled (discharged). Other ways include your school fraudulently certifying your loan without your signature, your school closing, or if you declare bankrupcy. There are some other ways too but I think those are the main ones.

Student loan debt is extremely hard to cancel. A person I know tried it. I could be mistaken but I believe bankruptcy will not cancel the debt.

 

[OldPsychDoc]

Student loan debt is extremely hard to cancel. A person I know tried it. I could be mistaken but I believe bankruptcy will not cancel the debt.

I'll second that--I've been trying to support a couple of loan cancellation applications for patients who really are too mentally ill to perform in the professions they trained for, and it is a long process with a LOT of letters to write!

 

[notdeadyet]

But in medicine there seems to be no legal recourse if you are an applicant, a student, a resident, or any other form of underling.

Really? Don't residencies have greviance boards and protocols to follow if you want to fight a policy or make a report of harrassment and whatnot? The ones I've looked at seem to. For residents and rotating med students, hospitals seem to have more explicit channels for gripes than most environments I know. For med students, at least at my school, there is almost too much request for input/feedback and whistleblowers of any kind seem to get very good protection.

Does substantial change actually come from it? I'm dubious, but I'll bet its at least as effective as "suggestions boxes" and the alternative you see in non-medical companies.

Medicine is unique because it charges us $250,000 for the privilege of joining a Darwinian system when we are not even sure our health and sanity will survive so that we can later pay off that $250,000 plus interest.

This is not unique, nancysinatra. Replace "medicine" above with "law" or "business" or any other form of professional education. It's true for all. The only issue with medical school is that it's more expensive. Say $220K for med vs. $160K for law vs. $150K for business school. And again, your salary and job stability in medicine make that a more attractive investment for many.

I think this is why we may disagree. You see the situation as this unique entity. The numbers are a bit different from law and business school and the like, but it's just a different flavor of the same dish.

The world is already Darwinian. I did not need to PAY to be exposed to a even higher level of ruthlessness and unfairness than I am likely to find in the world at large. That makes no sense as a way to live at all.

Thank, you, this is a good example: this is exactly the sentiment I hear from friends in law school. Not so much from friends in business school. I think the difference is probably because the majority of folks in business school attend after years of working experience rather than straight in from undergrad like medicine and law.

 

[notdeadyet]

I do think the honors, as well as high pass, and pass, are for the most part subjective and meaningless.

You think that the Step I is just rote memorization and regurgitation. So it's objective and meaningless. And you think that clerkship evals are subjective and worthless.

Short of having your career determined by height, you're not allowing for much wiggle room here.

 

[notdeadyet]

I'll second that--I've been trying to support a couple of loan cancellation applications for patients who really are too mentally ill to perform in the professions they trained for, and it is a long process with a LOT of letters to write!

Agreed.

And I don't want folks to get the wrong idea: your med student debt does not go away if you become too injured/disabled to practice medicine. Your med student debt goes away if you become to disabled to work at all.

So if you are a surgeon who injures his hand to the point of no longer being able to operate, you can't kiss your loans goodbye, because you are still able to hold some kind of job. Your student loans only go away if whatever injury you had makes disabled.

 

[notdeadyet]

No it won't! It's the system! All that will happen is that the fittest will survive.

What you're seeing as unfair and unjust will go away with time, because you will be out of training. If you don't like a job, you can pick up and leave. The nice thing about medicine is that it's a wide open world with an almost limitless number of work environments. The fishbowl effect of med school and residency will go down dramatically if you choose to get out of the fishbowl.

Ask non-academic attendings. I have a hunch that for the most part they are not quietly raging, gnashing their teeth and shaking their fists every day. And if they are, they just made a bad career choice.

Anyway, nancysinatra, though you might think that things won't get better, they really and truly will. One thing you haven't been raging about is the patients and the work. As long as you like that aspect of medicine, you can tailor a career to one that suits your tastes, style, and tolerance for bull$hit. You'll find a happy home. No law that med school angst is a permanent fixture.

 

[nancysinatra]

What you're seeing as unfair and unjust will go away with time, because you will be out of training. If you don't like a job, you can pick up and leave. The nice thing about medicine is that it's a wide open world with an almost limitless number of work environments. The fishbowl effect of med school and residency will go down dramatically if you choose to get out of the fishbowl.

Ask non-academic attendings. I have a hunch that for the most part they are not quietly raging, gnashing their teeth and shaking their fists every day. And if they are, they just made a bad career choice.

Anyway, nancysinatra, though you might think that things won't get better, they really and truly will. One thing you haven't been raging about is the patients and the work. As long as you like that aspect of medicine, you can tailor a career to one that suits your tastes, style, and tolerance for bull$hit. You'll find a happy home. No law that med school angst is a permanent fixture.

But I want to stay in the fishbowl and do academic medicine. I also want to work a million hours a week like people did in times of yore, but no one will let me...

It is nice of you to try to console me but when I have decided to take the cynical road in a debate, there is no beating me! I take pride in always winning.

 

[nancysinatra]

Really? Don't residencies have greviance boards and protocols to follow if you want to fight a policy or make a report of harrassment and whatnot? The ones I've looked at seem to. For residents and rotating med students, hospitals seem to have more explicit channels for gripes than most environments I know. For med students, at least at my school, there is almost too much request for input/feedback and whistleblowers of any kind seem to get very good protection.

Does substantial change actually come from it? I'm dubious, but I'll bet its at least as effective as "suggestions boxes" and the alternative you see in non-medical companies.

This is not unique, nancysinatra. Replace "medicine" above with "law" or "business" or any other form of professional education. It's true for all. The only issue with medical school is that it's more expensive. Say $220K for med vs. $160K for law vs. $150K for business school. And again, your salary and job stability in medicine make that a more attractive investment for many.

I think this is why we may disagree. You see the situation as this unique entity. The numbers are a bit different from law and business school and the like, but it's just a different flavor of the same dish.

Thank, you, this is a good example: this is exactly the sentiment I hear from friends in law school. Not so much from friends in business school. I think the difference is probably because the majority of folks in business school attend after years of working experience rather than straight in from undergrad like medicine and law.

I'm not trying to say that medicine in unique in having to pay tuition; just that the selection process happens twice--at med school and AGAIN, at residency selection. Residency selection is not like going out and finding a law or business job. In law or business you can be yourself. In residency selection they are scrutinizing your whole life, trying to find red flags. You missed a week of kindergarten? You're SO unreliable...

I am halfway kidding, I do hope you realize.

 

[notdeadyet]

But I want to stay in the fishbowl and do academic medicine.

Oh. Then you're probably hosed.

Someone once said that never has there been so much time spent fighting so hard over so little as is seen in academia. It can get positively Kafka. I wish you the best.

I also want to work a million hours a week like people did in times of yore, but no one will let me...

Well, you can have your whole career to do that, right? And better you than I....

It is nice of you to try to console me but when I have decided to take the cynical road in a debate, there is no beating me!

Oh, it wasn't the cynicism that was bothering me, it was the outrage over the injustices of it all. At the end of the day, med school/residency is a whole lot more even keeled and fair than the big bad world out there. We actually have it pretty good.

There are med students that put on the victim coat and take on the "woe is me" attitude (not that you are). They are almost always young and straight from undergrad. Med school only looks cruel and unfair if it's compared to four years on an undergrad campus.

But cynicism itself is fine. Whether your glass is half full or half empty, we're all drinking the same water. Bottoms up.

 

[nancysinatra]

Oh, it wasn't the cynicism that was bothering me, it was the outrage over the injustices of it all. At the end of the day, med school/residency is a whole lot more even keeled and fair than the big bad world out there. We actually have it pretty good.

I'm not outraged. Without going back over the thread, I don't remember using the word injustice either. However, I would not want to minimize the problem by saying that 250,000 in debt is trivial, or that because other fields are doing it, it's somehow ok. Also, if you have seen someone's life in ruins because they cannot work but cannot pay off their now $300,000 in student loans, you might feel differently.

If a war were going on in one country, and in 3 other countries as well, would you say, let's not try to stop it HERE because it's going on elsewhere as well? If anything, I think in medicine we have opportunities to set better examples than are being set in law, business, etc.

Also I do not share your view, exactly, that those who complain should offer an alternative. What's wrong with just complaining? A lot of things are wrong in this world and there just might not be a better alternative. Does that mean we should offer false praise?? Also we might think of alternatives somewhere down the road, after dwelling on our current miseries for awhile... Who knows?

Now can we end this or move it out of the psych forum??? I'd hate to have it be psychoanalyzed by the all wrong people...

 

[nancysinatra]

There are med students that put on the victim coat and take on the "woe is me" attitude (not that you are). They are almost always young and straight from undergrad. Med school only looks cruel and unfair if it's compared to four years on an undergrad campus.

But cynicism itself is fine. Whether your glass is half full or half empty, we're all drinking the same water. Bottoms up.

I am not straight out of undergrad.

Anyway, I do not think medicine is comparable to law, business, or undergrad or anything, because in medicine people are trapped. It's more like being in the KGB. Once you're in, you can do nothing but hope to god you finish. That part is similar to law or business, but in addition, we MUST get a residency position, and again, hope to god we finish that as well. (You can read in other threads about how people are fired from residencies at the whims of PDs. I'm not saying it's common, but it definitely puts at least some pressure on the system.) That is why I'm saying, this is a Darwinian system unlike no other. Harvey Weinberg laws would not apply here. There's just no predicting who will win. It's survival of the fittest but we don't know going in, what the selection pressure will be! For example, in SOME classes, to get honors you must do "passing" work, and in others, to get a "pass" you must do honors work. It's like being on a continent that has drifted away from where it used to be and now is in some bizarre new climate. You just never know. That's why I fear for my life every day...

This is not so true in law, though I would grant, in business there is unpredictability of the markets, but that is a different kind of unpredictability...

 

[notdeadyet]

I'm not outraged. Without going back over the thread, I don't remember using the word injustice either.

My apologies. The word "fair" was thrown around a lot, which I use synonymously with "just". And I detected a lot of frustration/anger in what you had to say (obviously justifiably). If I read that wrong, my bad.

However, I would not want to minimize the problem by saying that 250,000 in debt is trivial, or that because other fields are doing it, it's somehow ok.

I wouldn't call it trivial and the fact that other fields do it too doesn't make it more trivial. But because other fields are doing it, it means it's far from unique. So any opposition to big education debt is not a med school thing, it's an education thing. That's all.

I'm sure not looking at $250K with soft eyes either. It's a pretty scary number.

Also, if you have seen someone's life in ruins because they cannot work but cannot pay off their now $300,000 in student loans, you might feel differently.

I'm sure. I don't know anyone who failed out/dropped out of med school in fourth year after accumulating that much debt, but if I did, I'm sure I'd feel for them.

Fortunately, it's an extremely rare situation. The last stat I heard was 97% of med students finish. Of the other 3%, many more leave by choice than are asked to leave. Of the few asked to leave, every case I know it is because of outside issues (mental health/substance/etc) that impacted their ability to perform. The number that just can't handle it academically because they don't have what it takes is the tiniest sliver of a fraction.

Of course, that doesn't make it any better for that slive. I feel for them. But I don't see it as a trend.

 

[notdeadyet]

If a war were going on in one country, and in 3 other countries as well, would you say, let's not try to stop it HERE because it's going on elsewhere as well? If anything, I think in medicine we have opportunities to set better examples than are being set in law, business, etc.

No, but protesting the war on the Northern front while folks are dying on the Southern front makes those fighting question your viewpoint. Your protest is about ALL of the wars, which is cool. Your gripe is about education debt, not med school debt.

Also I do not share your view, exactly, that those who complain should offer an alternative. What's wrong with just complaining? A lot of things are wrong in this world and there just might not be a better alternative.

True, but complaining without offering an alternatives comes dangerously close to stomping of feet and saying "It's not fair!" It's probably a personal thing, but any ex-teacher will tell you that is absolute nails on a chalkboard.

Now can we end this or move it out of the psych forum??? I'd hate to have it be psychoanalyzed by the all wrong people...

We can just drop it. I don't go to Allo. I used to but there are just way too many stressed out med students with tunnel vision. I find it draining.

 

[notdeadyet]

I am not straight out of undergrad.

Sorry, I tried to explicitly exclude you from that by saying "(not that you are)".

Once you're in, you can do nothing but hope to god you finish.

Luckily, most people who don't finish are smart enough to quit in the first year. I'm saddened when folks are miserable in med school and plod along anyway until they get to the point that it's too expensive to leave and end up bitter physicians. I'd rather folks didn't take the "mafia" viewpoint that you can't quit. They'd have much happier lives if they bit the bullet and walked away with $60K in debt and went into a field they found satisfying.

That is why I'm saying, this is a Darwinian system unlike no other.

You keep saying this. If you think this is uniquely Darwinian, I keep asking "compared to what"? Any workplace is "survival of the fittest" (though I think that's a bit dramatic).

The only difference between med school and other work environments is that medical school is filled with type-A personalities (again, not including you in this) who are unused to failure and for the first time in their life find themselves compared to a group of students of a similar callibre. It's the first time they're called average because it's the first time they've been average. That's a hard pill to swallow.

But I can't get too worked up over it: it's a struggle of the incredibly bright, ambitious, and educated, in which almost all people walk out with a job whose income is in the top 4% of this country and top 1% in the world. This is a much sweeter gig than anything Darwin ever envisioned.

As for referencing the students who flunk out, I'd be more concerned about the system if I saw these folks as something other than, frankly, outliers. Of the very small percentage of those who fail, it's almost always for causes other than intellectual capability. For the tiny handful that really aren't mentally capable of getting through med school, it's probably more the fault of admissions than The System.

 

[nancysinatra]

My apologies.

Ha ha ha, notdeadyet, this conversation is pretty silly. I wonder if anyone besides us is following it?

You needn't apologize. I have been drifting in my chain of logic here. Foolish consistency is the hobgoblin of little minds, is it not?

My reason for wanting to move this to the allo forum is that I don't really want my crazy views aired in the psych forum is all, but oh well. I'm sure I've incriminated myself enough previously in this forum as it is.

Fortunately, it's an extremely rare situation. The last stat I heard was 97% of med students finish. Of the other 3%, many more leave by choice than are asked to leave. Of the few asked to leave, every case I know it is because of outside issues (mental health/substance/etc) that impacted their ability to perform. The number that just can't handle it academically because they don't have what it takes is the tiniest sliver of a fraction.

So this is the crux of our disagreement. You see the glass as 97% full, and I see it as 3% empty. Anyway, so what if it is an "outside issue?" Are those not people with lives to live too? I imagine having to sort out debt along with a substance abuse or mental health problem is daunting, to say the least.

You keep saying this. If you think this is uniquely Darwinian, I keep asking "compared to what"? Any workplace is "survival of the fittest" (though I think that's a bit dramatic).

Well, I was being dramatic on purpose. But what I'm trying to say is that you can have your Harvey Weinberg system which is in equilibrium. Then you can have your Darwinian system which is not in equilibrium, in which there are selection pressures (such as chronic food shortage, or grade competition). THEN, you can add to that perpetual CHANGE, in which the selection pressures themselves are ever in flux (such as climate change, the earth being hit by a meteorite, the sun dying, or, in this case, utterly arbitrary grading by course directors). Medicine, like I imagine the mafia or the KGB to be, is in that latter category, based on my personal experience. Law is in the middle category. So indeed they are different. In medicine, you can't simply aim for good grades. Sometimes you need to aim for a bad grade in order to GET a good grade. That's how medicine WORKS. Nice people who follow the rules will be run over and sometimes even relegated to that 3%. Again, that's how it works. Going to medical school suddenly puts you in the position the dinosaurs must have found themselves in millions of years ago; in a situation of great risk and uncertainty, a big and unwelcome change for such previously dominant creatures.

True, but complaining without offering an alternatives comes dangerously close to stomping of feet and saying "It's not fair!" It's probably a personal thing, but any ex-teacher will tell you that is absolute nails on a chalkboard.

Not if it's done artfully. Have you read Kierkegaard? All he did was complain. Over thousands and thousands of pages.

 

[notdeadyet]

Ha ha ha, notdeadyet, this conversation is pretty silly. I wonder if anyone besides us is following it?

Not at this point.

Anyway, so what if it is an "outside issue?" Are those not people with lives to live too? I imagine having to sort out debt along with a substance abuse or mental health problem is daunting, to say the least.

I'm pretty far along the left of the political spectrum. I don't mind paying higher taxes for my fellow man.

That said, I have zero interest in paying off the medical student loans of a rich college kid because he went on a coke bender in Vegas.

The reason "outside issues" are important is because by definition they are not issues with the medical education system. When people take out loans, they agree to pay them back. If there is something flawed with medical school and huge numbers of people were failing out, we'd have a big problem. But when most students who leave med school do by choice, and the few that don't fail out largely because of things that have nothing to do with medical school (change in career plans, said gambling/coke habit), this is not something that med schools have to deal with. If a student takes out a loan to buy a home, car, education, trip to Europe, it's his responsibility to pay it back and make alternate arrangements if he changes his mind/gets ill/etc. It's not up to Visa.

There are a lot of safety nets I'd put up before one to catch med students. Bright/ambitious/well-born kids have a much better chance of landing on their feet than folks from other walks of life who have comparable bad luck.

 

[notdeadyet]

In medicine, you can't simply aim for good grades. Sometimes you need to aim for a bad grade in order to GET a good grade. That's how medicine WORKS.

No. Some (though far from all) of med school is subjective grading. Advising people to aim for a bad grade is just foolish.

Nice people who follow the rules will be run over and sometimes even relegated to that 3%.

Nonsense. People may miss an Honors here and there for being nice and following the rules, but no one has failed out because of it. People fail out for NOT following the rules (studying for tests, showing up to rotations, etc.).

If I believed your medical school is actually as you describe, you'd be doing folks a public service to identify it.

To wrap up here:

The impression you give is that at your school, large numbers of students are failing in spite of their best intentions, grades are given out largely arbitrarily, folks don't have a good shot at getting into decent residencies, and the best way to succeed is to try to fail.

If the above is all true and you're not taking dramatic license, no offense, but your medical school sucks. Take comfort in the fact that for most of us out there, medical school is not the Kafka-esque pit of the absurd. For almost every med student I've talked to at dozens of schools, it's a long/hard/stressful slog of four years of hard work and occassional humility lessons. But that's it.

 

[nancysinatra]

If I believed your medical school is actually as you describe, you'd be doing folks a public service to identify it.

Ha! You think I want to do myself the disservice of ending up in the East River one night later this week? No thanks.

The impression you give is that at your school, large numbers of students are failing in spite of their best intentions, grades are given out largely arbitrarily, folks don't have a good shot at getting into decent residencies, and the best way to succeed is to try to fail.

If the above is all true and you're not taking dramatic license, no offense, but your medical school sucks. Take comfort in the fact that for most of us out there, medical school is not the Kafka-esque pit of the absurd. For almost every med student I've talked to at dozens of schools, it's a long/hard/stressful slog of four years of hard work and occassional humility lessons. But that's it.

I'll have to look this Kafka guy up.

 

[FireCloud9]

Ha ha ha, notdeadyet, this conversation is pretty silly. I wonder if anyone besides us is following it?

Ha ha ha, notdeadyet, this conversation is pretty silly. I wonder if anyone besides us is following it?

This is the Internet... someone is always following...

I thought I'd do a little research about medical school, specialties, etc. and ended up here.

For a different perspective, I completed an MBA with a triple major from a top 15 school in 2000 which I did in the evenings while working full-time during the day, and I did my undergrad the same way.

Until recently, I worked at IBM for over 10yrs. During my time at IBM I was witness to 33 'reorganizations' (mass layoffs) and personally avoided a dozen or so during that time by moving to different units and/or job functions.

Aside from layoffs from which noone is safe, there is a simple ranking system - 1,2,3 - in recent years they added a 2+ and 4. In the IT world you find similar ranking systems at top tech companies.

It's simple really, 1 = top 10% of all employees, 3 = bottom 10% of all employees, everyone else is a 2 - the recent change to include 2+, and 4 means 10% of employees in each of those rankings.

While the companies don't admit as much, 4 = eligible for immediate dismissal, 3 = 3-6 months to show improvement otherwise eligible for immediate dismissal.

All of this would be fine if there were any consistent methodology for ranking people, but mainly it's on a manager/director/vp's whim. If you're well liked and perform well you'll be a 1, 2 or 2+. If you're not liked or don't perform well you're a 3 or 4. Of the thousands of IBMers I met over my career, I can count on a single hand those that didn't perform well.

So today, having been laid off with thousands of my colleagues, here I sit, unemployed in mid 40s with a stay at home wife to 3 young children to support considering my next career.

Perhaps med students pray that they'll make it through med school and residency, but when you're done, you don't have to worry about your job ending up in China/India/Brazil like mine and many of my colleagues did.

At that point your biggest challenge will simply be getting rid of your med school debt. You are employable in just about any state and probably most countries of your choosing.

Friends that went through law school put in 100hr weeks their first few years. Yes, they were well compensated, at least for a few years before they were laid off. I have friends from Harvard, Stanford, Columbia, Wharton and NYU that went on to Wall St., top law firms and other top companies.

A significant percentage of which are all unemployed today or as we all refer to ourselves, "self-employed" / "business owner" / "consultant" all it takes is $200 to incorporate as an LLC and $20 to print out business cards and create the illusion.

A few like myself were fortunate enough to survive long enough to pay off our debts (school loans, car, credit) before we were summarily dismissed.

Now we all look for jobs that read like this:

"need cheese grater, must have 20yrs experience grating cheese".

Many of those jobs are not real. They are part and parcel of a corporation's show of "good faith" effort in order to show they've tried to hire Americans and be able to hire H1B workers at half to a third of what that job pays.

Every year your job is at risk of being outsourced, offshored, inshored, automated, eliminated, replaced by younger (cheaper) recently minted MBAs/JDs/EEs, etc. or simply become obsolete due to a technological or business innovation.

When we (used to) look around our places of work, there were few people in their late 40s and 50s and virtually none in their 60s with the exception of executive management or partners.

I consider myself one of the fortunate ones. I had a six figure salary which allowed us to buy and almost completely pay off a modest home (worth ~$500k) in California and pay off a car, student loans and credit cards. Yes, we have no debt and rely on emergency savings and unemployment for the time being.

We also have little to no future in corporate America or any of the 4 business specialties I'm trained in. My unemployed Intel neighbor in his 50s has been trying to find work for 2 years. I myself have applied to more than 500 jobs over the past 4 months with ~20 different resume versions given the different skillsets and majors that I hold. Plenty of companies like the skills, but the reality is that I'm not under 35 and no matter how fancy the suit, well dyed the hair, and how careful in speech, corporate america doesn't welcome older workers like healthcare does.

Ironically, one of the reasons they avoid older workers is the high cost of healthcare, and it's also true that a newly minted MBA/JD/EE in their late 20s costs less than one that has earned salary increases over the years.

Other than Harvard, one of the few institutions where MBA grades are sealed, I'm not aware of any colleague that ever failed a class except for those that didn't finish their respective programs. I'm not even sure if repeating a class was an option for most programs.

When I saw the comment that one can make up a failed medical school class, suddenly the notion became all that more interesting. I was always under the impression that if you failed a class you were done.

Realistically, at my age, a FNP or PA program would probably be the best compromise to 4yrs of med school and 3-7yrs of residency anyway as it would probably take the rest of my life to break even on the med student loans.

Just a different perspective to this Darwinian discussion....

 

[nancysinatra]

firecloud--thanks for joining our discussion! You don't even need to tell me you are unemployed if you read that whole exchange... I'm sorry to hear about your predicament. It sounds tough.

I'm not sure that health care "welcomes" older workers. There is a nursing shortage, yes, so probably any age nurse can get a job. Also I thought women of childbearing age were one of the most expensive age groups to insure? Older workers probably do cost more too. This leaves us with, hmmm... young able bodied men.

I want to clear something up which is that I think notdeadyet believed I was referring to med students actually flunking out. I was not really. I had in mind a slightly different disaster. For example, I know someone who applied in a different field who is really smart and dedicated, but maybe didn't have the best application on paper. One reason was that he was always on the floor with patients, which brought his shelf scores down. He matched at a small community program where he is not certain he'll be able to get the fellowships or academic jobs he wanted. His dreams are shot now, and I think it is arbitrary and unfair because we were TOLD by our school to be on the floor with patients. And it isn't like he was a terrible student on grades either. But those grades are used as weed out tools. Or take someone who's highly qualified for many fields, but simply does not match. The reasons could turn out to be quite trivial.

Now, you knew I would argue with every point brought up in this thread. So I have to say it--people with families to support, even in this grim economy--they chose to have the families. What were you thinking might happen when you made the choices you did in your life? The MBA, the family, etc? Since when did life come with guarantees? I am not debating that equally bad things can happen to people from all walks of life. I'm not denying that doctors have advantages with job security.

All I'm trying to say is that the medical school curriculum, with its emphasis on shelf scores and board scores but its lip service towards floor work and compassion--all of which then gets fed straight into the residency Match program--are at times ruthless and deconstructionistic in the sense of what you put in having no relationship to what comes out. As another example, witness the extent med schools go to dazzle applicants, to the point where I have heard people complain about dishonesty. This is different from putting a lot into a career and getting laid off or not making enough to support a family, which are misfortunes that can affect anyone.

I hope you get some good news soon!

 

[VMSmith]

All I'm trying to say is that the medical school curriculum, with its emphasis on shelf scores and board scores but its lip service towards floor work and compassion--all of which then gets fed straight into the residency Match program--are at times ruthless and deconstructionistic in the sense of what you put in having no relationship to what comes out. As another example, witness the extent med schools go to dazzle applicants, to the point where I have heard people complain about dishonesty. This is different from putting a lot into a career and getting laid off or not making enough to support a family, which are misfortunes that can affect anyone.

I don't think it is more unfair than putting a lot into a career and getting laid off though, nor is it that different from not making enough to support a family. It's different in the form that the unfairness takes, but to me it seems kind of similar.

In medicine, most of us tend to go into the field believing we'll be able to achieve whatever goals we have. That belief tends to be reinforced throughout high school and undergrad, since in order to get into med school in the first place, we usually need to succeed at every level. And in the instances where we don't succeed (not getting into our dream college, not getting into one of our top choices for med school, etc) we're told that it ultimately doesn't matter, we can still go into X specialty at X hospital if we work hard and do well in med school, which is more or less true. But on Match Day, when we find out that our dream residency position is permanently out of reach, it all seems very unfair.

Compare that with other fields, such as business or law. In these fields, the pedigree of your undergraduate and graduate/professional schools are MUCH more important. While not impossible, it's very difficult to land your dream job from a state law or business school unless you have excellent connections. For a lot of people in law or business school, getting their dream job is exactly that - a dream.

Maybe the difference is that in other fields, people can spend their career toward achieving their dream, whereas in medicine, Match Day is a discrete moment in time in which a computer algorithm seems responsible for deciding whether or not that dream will become reality.

There is unfairness in every field, and I really do not believe medicine is any more unfair than anything else. Yes, we're told that we have to be on the floors, and yes, people who take off early to study for shelf exams have an advantage because shelf exams tend to be weighted disproportionally. But do you really believe that in other fields you'll succeed if you do exactly what you're told to do? Part of succeeding in any field is using your own judgment to figure out what it really takes to succeed. You make the decision to leave early knowing it may hurt your clinical evaluation and your chances of getting an LOR out of the rotation, but that it will improve your score on the shelf exam. Or you decide to do the opposite.

One thing I do agree with you about is that shelf exams don't really measure clinical ability or even clinical knowledge. They measure one's ability to take tests. Two people can have the same knowledge base and have wildly different shelf scores based on test-taking ability. But this holds true in other fields as well. Standardized tests determine to a large degree what law school you get into, or what business school you get into. And nobody has come up with any better way to compare people from different schools, so standardized exams are all we have.

 

[nancysinatra]

I don't think it is more unfair than putting a lot into a career and getting laid off though, nor is it that different from not making enough to support a family. It's different in the form that the unfairness takes, but to me it seems kind of similar.

In medicine, most of us tend to go into the field believing we'll be able to achieve whatever goals we have. That belief tends to be reinforced throughout high school and undergrad, since in order to get into med school in the first place, we usually need to succeed at every level. And in the instances where we don't succeed (not getting into our dream college, not getting into one of our top choices for med school, etc) we're told that it ultimately doesn't matter, we can still go into X specialty at X hospital if we work hard and do well in med school, which is more or less true. But on Match Day, when we find out that our dream residency position is permanently out of reach, it all seems very unfair.

Compare that with other fields, such as business or law. In these fields, the pedigree of your undergraduate and graduate/professional schools are MUCH more important. While not impossible, it's very difficult to land your dream job from a state law or business school unless you have excellent connections. For a lot of people in law or business school, getting their dream job is exactly that - a dream.

Maybe the difference is that in other fields, people can spend their career toward achieving their dream, whereas in medicine, Match Day is a discrete moment in time in which a computer algorithm seems responsible for deciding whether or not that dream will become reality.

There is unfairness in every field, and I really do not believe medicine is any more unfair than anything else. Yes, we're told that we have to be on the floors, and yes, people who take off early to study for shelf exams have an advantage because shelf exams tend to be weighted disproportionally. But do you really believe that in other fields you'll succeed if you do exactly what you're told to do? Part of succeeding in any field is using your own judgment to figure out what it really takes to succeed. You make the decision to leave early knowing it may hurt your clinical evaluation and your chances of getting an LOR out of the rotation, but that it will improve your score on the shelf exam. Or you decide to do the opposite.

With a few exceptions, clerkship evaluations barely count at my school.

I am probably just sounding really annoying by posting on this matter. I agree with you in one sense; in that I am not complaining about the Match algorithm or standardized test taking (and for the record, I do not consider shelf exams to BE "standardized!") nor am I whining about the simple fact of life that people do not always reach their dreams. Really, I agree with you.

It's not unfairness I'm whining about. It's randomness. (Perhaps corruption would be a better word.) And then, being asked to pay $250,000 for randomness, which I could find in the world without ever having gone to med school, since randomness is the essence of life. By contrast, ORDER should characterize a profession, at least to some degree. Professions usually have codes people abide by and rules that dictate who will rise or fall. Even in bad times, and even in competitive situations (hence, antitrust laws, laws prohibiting cartels...). That's why there's the expression "all's fair in love and war" but there's no such expression for "all's fair at work or in school." But in med school, it seems like anything goes. Otherwise, WHY is it ok to skip class, not be on the floor, lie about attendance, never once do course reading, and other things I won't even mention..., and meanwhile, all with lip service to the "importance of honesty and compassion?" Only someone who answers this question will have addressed my "complaint," so to speak. Maybe it is equally random in law school, but lawyers would hardly tolerate that, I'd imagine.

Then there are people who do good work in med school and don't get credit for it... This is DIFFERENT from people who work hard and don't succeed. Do you see the difference?

I know that you have to learn to play "the game" in every profession. Even art school, even philosophy school will have some amount of game to it. But what seems different in med school is this: the game to curriculum ratio is very high.

I appreciate that people have responded here, but I hope it is clear I'm not just whining about medicine. That was not my intention. In a major way, I completely agree with you! But please at least understand my point.

However, I don't want to continue posting here because in order to make this point (which seems to keep being misunderstood) I feel I keep having to say it in a more scathing and extreme way. I can't even point out NICE things about med school in this thread now because it will undermine my point

 

[nancysinatra]

Ok, people will think I've lost it for posting this, but here is something I would like to compare:

Medical school vs. a commercial modeling school. They're obviously very different but something they have in common is a certain type of disorder. In modeling school, you'd think an important rule might be that only beautiful people should be admitted. But actually, anyone can go to modeling school (even some of the good ones, I believe), and get a "diploma," and learn how to pose and all that, as long as they have the money. A modeling school is not really a school at all, it is really just a place where people pay to hope they might get discovered, but of course, most people won't get discovered. The thing that's wrong with that is that most people already wouldn't have gotten discovered. If a person didn't know this going in, and paid all that money, they could become very disillusioned.

In med school, the order does not break down at admissions. Admissions are highly structured and seem to work. But inside the school, that's where things go crazy. People say one thing and do another. They say, study by reading Harrisons, but actually you need to study by reading "Pretest Medicine," a very cheap and undistinguished book. They say to be with patients a lot, but they reward being away from patients. This too can be disillusioning to someone who didn't know it, and paid a lot of money, and sat around reading Harrison's and being with patients.

I have no idea, honestly, what it's like inside a law or business school. But I do know that in law school they USE the Socratic method which they are famous for, whereas here in medicineland we just put Harrison's on our shelf and refer to it as needed. We USE Pretest, et al. as a staple of our learning. But I bet people would be pretty disgusted if Pretest came out in hardcover or leatherbound...

This is not meant to be a real world comparison, it is meant to be somewhat abstract. I am not trying to say, life is worse or better for models...

 

[daru1]

notdeadyet

If you don't do your research, you might get burned. Best lesson for anyone going into ANY career.

 

[VMSmith]

Agreed. A lot of what happens to people in this process makes no sense - we come up with reasons for why someone didn't get what they want but I think we do it less to actually understand what happened and more to rationalize why it can't happen to us.

As long as it doesn't happen to us everything seems "fair enough". But when it does, then we need to adjust the way we see the world and how we fit in it.

 

[BobA]

Ok, people will think I've lost it for posting this, but here is something I would like to compare:

Medical school vs. a commercial modeling school. They're obviously very different but something they have in common is a certain type of disorder. In modeling school, you'd think an important rule might be that only beautiful people should be admitted. But actually, anyone can go to modeling school (even some of the good ones, I believe), and get a "diploma," and learn how to pose and all that, as long as they have the money. A modeling school is not really a school at all, it is really just a place where people pay to hope they might get discovered, but of course, most people won't get discovered. The thing that's wrong with that is that most people already wouldn't have gotten discovered. If a person didn't know this going in, and paid all that money, they could become very disillusioned.

In med school, the order does not break down at admissions. Admissions are highly structured and seem to work. But inside the school, that's where things go crazy. People say one thing and do another. They say, study by reading Harrisons, but actually you need to study by reading "Pretest Medicine," a very cheap and undistinguished book. They say to be with patients a lot, but they reward being away from patients. This too can be disillusioning to someone who didn't know it, and paid a lot of money, and sat around reading Harrison's and being with patients.

I have no idea, honestly, what it's like inside a law or business school. But I do know that in law school they USE the Socratic method which they are famous for, whereas here in medicineland we just put Harrison's on our shelf and refer to it as needed. We USE Pretest, et al. as a staple of our learning. But I bet people would be pretty disgusted if Pretest came out in hardcover or leatherbound...

This is not meant to be a real world comparison, it is meant to be somewhat abstract. I am not trying to say, life is worse or better for models...

For what it's worth, nancysinatra that's just not how my school works. The shelf rarely counts for more than 25% of a clerkship grade at my school. Residents and attendings all do online evaluations of students (as students also do of all residents and attendings) and that counts for 75% of our grade. Basically, starting 3rd year we're expected to act like interns - admitting patients, talking to their family, gathering their history, formulating a treatment plan, following up on tests, labs, communicating with out team. We can even enter computerized orders which are "signed" online by our interns and residents and then that's what gets done. How well we perform on the wards is what determines our clerkship grades.

Of course, there are 2-3 jerks who still manage to get AOA every year by working the system but by and large it works to promote students who excel at patient care.

OTOH, so what if someone can't be a plastic surgeon?! I've always wanted to be an astronaut but that's just not gonna happen.

 

[nancysinatra]

For what it's worth, nancysinatra that's just not how my school works. The shelf rarely counts for more than 25% of a clerkship grade at my school. Residents and attendings all do online evaluations of students (as students also do of all residents and attendings) and that counts for 75% of our grade. Basically, starting 3rd year we're expected to act like interns - admitting patients, talking to their family, gathering their history, formulating a treatment plan, following up on tests, labs, communicating with out team. We can even enter computerized orders which are "signed" online by our interns and residents and then that's what gets done. How well we perform on the wards is what determines our clerkship grades.

Ok, so see, that would be a totally different situation and I could really respect that. I'm talking about my school, but I don't want to specifically complain about my school, you know?

Another thing about shelfs is that they reward memorizing vignettes. They don't really reward that much clinical reasoning, even though I believe that was the justification for changing the style of the boards to vignettes, years ago. Shelfs are retired board questions. Maybe people disagree? That would be worth debating.

So those who are recommending people "research" their chosen careers, how could a prospective med student research enough to uncover that at certain medical schools, faculty and residents often won't even FILL OUT those course evals? They just can't be bothered. That's not something you research and learn. That's unprofessionalism. People are going to hide that. It can't be just at my one school either. I wasn't lazy in investigating med schools. I simply expected a professional and high minded field in which if an educational establishment espoused a certain pedagogical philosophy, they meant it. Why wouldn't they? If someone tells me there's no class rank, there should be no class rank. I shouldn't have to hire a detective to find out the truth. Medical people should be honest. Do folks disagree?

And it's not my own situation I'm complaining about! Good grief, if people think there's nothing wrong in medical education, then why is there another thread in this forum where attendings were saying that they wished medical students didn't "lose" their compassion during the four years? There must be something that's happening that's causing a drain on idealism. If we live in a buyer beware world, fine, but what message does that send to patients?

Schools will vary though. Whining is rampant at mine though I can't say people are whining about the same things as I am... ;-)

 

[nancysinatra]

OTOH, so what if someone can't be a plastic surgeon?! I've always wanted to be an astronaut but that's just not gonna happen.

What if the only reason was because someone wouldn't fill out a course evaluation for that person? Like the attending misplaced it, or wanted to have lunch instead and then forgot, and got angry when the student emailed them multiple times asking for it. Now I am really exaggerating, but that's what I'm talking about.

 

[BobA]

What if the only reason was because someone wouldn't fill out a course evaluation for that person? Like the attending misplaced it, or wanted to have lunch instead and then forgot, and got angry when the student emailed them multiple times asking for it. Now I am really exaggerating, but that's what I'm talking about.

I think attendings and residents are pretty good about filling out the online evals. Most of the attendings take much less money to be at my academic medical center because they WANT to teach students and residents. So they want to give feedback. However, there are some out there (Cariologists/Radiologists/Surgeons) who'd rather teach Fellows than medical students and I can't see them filling out an eval when they could've been stenting someone or doing a Whipple and charging for it.

As third years we have to electronically track every single patient we work with using the patient's medical record number, and we have to say who the intern/resident /and attending were on that patient and then at the end of the week the computer will send an eval out to the intern/residents/attendings that we worked with during that week and they will evaluate us on a scale of 0-1-2-3 (3 being honors) and will also write comments for us.

I will further boast about my school's electronic eval system to say that it even tracks the diagnoses that we see, the procedures we perform (Sometimes we're required to place a central line, or chest tube or whatever on a given rotation), etc. It's a really great tool to manage our educational environment.

However, it's up to the STUDENT to impress the attending with excellent morning presentations and medical knowledge. The STUDENT has to make this attending like them so much that the attending will go to bat for the student. That's just how it works. You have to earn it.

I want to be an astronaut, but no one's going to give me the keys to the Space Shuttle just because I passed the test, paid my tuition, and was a nice guy. The same is true for Integrated Plastics/ IR / Derm /Ortho/EM/Rads/Psych residency at MGH. You've got to go get that job you really want.

EDIT: I plan on being the first psychiatrist in space.

 

[nancysinatra]

However, it's up to the STUDENT to impress the attending with excellent morning presentations and medical knowledge. The STUDENT has to make this attending like them so much that the attending will go to bat for the student. That's just how it works. You have to earn it.

Agreed 100%!

Sounds like your school has things figured out with the evals! Tell them to psychically send vibes to all the other schools out there... Online is the way to go. I think ours are still filled out on stone tablets. In triplicate.

 

[getunconcsious]

I've heard this same rumor for most specialties. I've heard that many programs won't rank you if you don't get honors in medicine for Emergency Medicine, Neurology, Anesthesia, and PM&R. And those are just specialties I'm familiar with.

This post does not really relate to the particulars of the discussion at hand, but in case any worried MS3's are reading this, reports of the medicine clerkship's importance at least in psychiatry are greatly exaggerated. I did not honor medicine. I high passed, so I don't know how much that helps, if at all. I did honor psychiatry. I was offered interviews at Yale, Brown, UCLA, Baylor, Pittsburgh, and several other programs that I would guess are "top 20%." The only ones to give me the ix-nay were MGH/Harvard and Columbia, which may or may not have anything at all to do with my medicine grade.

so, definitely no need to panic if you didn't honor medicine.

Even if you didn't honor the MS3 psych clerkship itself, it's not the end of the world. A friend of mine didn't honor psych and he also interviewed at UCLA, UCSD, and several other good programs in California.

Not much to do with the topic I know, but I just wanted to add my 0.02 to save some worry on the part of upcoming psych applicants.

Oh, and if you want the gist of this thread:
notdeadyet: "Life is a **** sandwich, and everyone has to take a bite. It could always be worse."
nancysinatra: "The system is flawed and oppressive, and we must do whatever it takes to fix this."

Whichever viewpoint you agree with, the argument itself appears to be going nowhere slow.

 

[billypilgrim37]

so, definitely no need to panic if you didn't honor medicine.

Especially if you go to a high-ranking medical school.

 

[BobA]

Especially if you go to a high-ranking medical school.

That's true. I go to a high ranking medical school and I didn't honor 3rd year medicine, but I got interviews everwhere I wanted except Columbia, Cornell, MGH, UCSF. My school doesn't even give High Passes. It's Honors, Pass, Fail. And only 15-20/105 get honors in medicine.

Again for MS3's who might be reading this, I did honor 2x 4th year medicine Sub-I's and I sent copis of those transcripts with grades and comments to PD's and they were well recieved. Some PD's even called me up to tell me how impressed they were.

 

[nancysinatra]

Oh, and if you want the gist of this thread:
notdeadyet: "Life is a **** sandwich, and everyone has to take a bite. It could always be worse."
nancysinatra: "The system is flawed and oppressive, and we must do whatever it takes to fix this."

Whichever viewpoint you agree with, the argument itself appears to be going nowhere slow.

That's a pretty good summary! Maybe the only one that gets at what I was trying to say! Thanks. The only thing is, I never mentioned fixing things given that the system hires henchman to squelch any reformers, but that does seem like a good idea.

I would say though, the argument was going nowhere at the rate of zero. But actually, just to clarify, because I got in a fight with notdeadyet yesterday, and should he resurrect himself in this thread, I was making a strawman argument just for the fun of it. No one seemed to be reading the thread so it's not like anyone got hurt. If anyone comes away with the impression they should panic, it's partly their own fault for reading such an inane thread to begin with.

I got a high pass in medicine and got interviews at all those places too and matched somewhere great. I have heard from some trusted sources that a few snooty programs will seriously rank candidates lower with a high pass in medicine vs an honors. It's not the end of the world and may very well be those programs' own loss. It's just a small handful.

The end of the world in my view is pure chaos in the system. Some days it does look that way, but then others, you see things working and I'd say it's pretty nice. If you have a streak where it isn't working or see others get hurt, that can be disheartening. I only mentioned the medicine honors thing as one tiny grain of an example of something within the much larger system we were discussing. (It wasn't a great example anyway and NOT the primary area where I see the system being broken). If people think that's bad let me know and I will leave the board entirely because it's no fun to just talk about application details in every thread, and this thread had long since moved away from its original purpose, PLUS I made requests that we move away from the psych forum SO that I wouldn't mislead any MS3s or otherwise misuse the thread. What's been frustrating on this thread is that people can't often distinguish disillusionment from disappointment--they're totally, words apart from each other... I don't think "disillusionment" is in the lexicon of the person I was debating with (or honestly, a lot of med students), and the argument limped along. Sorry everyone.

 

[notdeadyet]

This post does not really relate to the particulars of the discussion at hand, but in case any worried MS3's are reading this, reports of the medicine clerkship's importance at least in psychiatry are greatly exaggerated.

Agreed. I think it's exaggerated for Emergency Medicine, Neurology, Anesthesia, and PM&R, too. I half wonder if the rumors of the "required" honors in medicine isn't some plan hatched by an internal medicine cartel. I'm sure the Big Dogs have all sorts of separate high requirements, but to be honest, they aren't on the radar for most of us anyway.

Oh, and if you want the gist of this thread:
notdeadyet: "Life is a **** sandwich, and everyone has to take a bite. It could always be worse."

I don't think it's a **** sandwhich. I think the sandwich may not taste great, but I think it pretty much tastes like every other sandwich on the menu...

 

[nancysinatra]

Just to be constructive, some things I think that could be done to improve things would include:

1) Finding some way to measure compassion and hold students and doctors accountable for this in the same way knowledge is tested, so that med school (and beyond) is more than just a game about getting ahead. I mean a real hard core test (i.e. no Step II CS!). A special focus should be how we act towards the most unlikable patients (a lot of these are psych--personality disorders, substance abuse, somatoform, chronic pain, but also obesity, diabetes), because everyone can be nice to a child leukemia pt, but the challenge is with the more difficult pts. I'm NOT criticizing humor used to deal with stress here, just wanting to assess empathy, or at least people's ability to be compassionate and professional when empathy is lacking. And it is lacking a lot of the time. I hear a lot of comments where SA or PDs don't get equated with even being real diseases, as if there weren't always a person in distress behind that illness who needs help and can be rehabilitated. For example why isn't there an outcry about Axis II not being reimbursable... If child cancer weren't reimbursable, or even bipolar...

2) Making sure that if grading itself is not consistent and fair in medical school, that reporting OF grading and the paperwork kept by medical schools is done at a competent level. Med students should not be subjected to the helter-skelter tyranny of poorly functioning administrative practices. Nor should med students band together and say "all's fair, just suck it up" when things don't work out due to administrative failures. If the NRMP Match computer had broken down this year, students would not be saying "oh, that's just life."

3) I think at some point all med students should be confronted with witnessing an instance of manipulation, sadism or abuse in the workplace (or elsewhere) so they know what it is and are disabused of any naivete. I wouldn't wish such a bad experience UPON anyone, but being naive and one day telling patients life's a sandwich of any kind--how's that going to sound? Some patients don't even get a sandwich.

4) Changing the boards and shelf exams back to straightforward questions. Memorizing information is the cornerstone of medical knowledge, and at the most granular level I think is where it would be best assessed. The vignettes just seem to me like memorizing protocols, and protocols can vary and change.

5) I wish I could do a real intern year with lots of procedures, but that's just me!

As far as program "requirements"--programs can only wish for what they wish for. It's just the match algorithm at the end of the day. Of course the better you do the higher they'll rank you.

 

[nancysinatra]

Relating to some posts above, this appeared in today's New York Times:

"And as many borrowers have learned, student loans are among the most ironclad debts, on par with child support, alimony and overdue taxes. They stick with you no matter what.

Bankruptcy usually doesn't provide relief, except in the most dire of circumstances. Even death isn't a good enough excuse for discharging some private loan debts. And the government can wield a heavy hand to collect what it is due: If you fail to repay your federal loans, it can garnish up to 15 percent of your wages or take your tax refund or part of your Social Security benefits."

http://www.nytimes.com/2009/04/18/your-money/student-loans/18student.html?hp

Another matter related to this is that in calculating how much students need to borrow, medical schools sometimes use adult students' parents' incomes. I haven't heard of law or business schools doing this. This can dramatically increase the amount of private loans a student will have to resort to using, and the terms of those loans, as the article points out, are much more grim.