What would you change about the way medical education is practiced?

[efle]

I Had a Cholecystectomy 14 hours ago and will hopefuly get discharged tomorrow.

This was after I went to the ER knowing what my diagnosis was beforehand because of clinical findings. Literally told the ER residents that I had a positive Murphy sign and I suggested labs and USG. I'm sure they were more than capable to getting to the diagnosis on their own, but that is something I would have never been able to do if this "Psychiatry School" were a thing instead of being normal medical training.

As I said before, you aren't supposed to know everything of every field. Just have an idea of what's happening, be able to identify key facts and events and know when to refer and what to do first before the experts come.

Pretty sure if you told a dentist your presentation they'd also know you should get chemistries and an ultrasound...

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[Tangerine123]

My mentality going into a rotation was to always prioritizing the bread and butter and emergency disorders/management.

As an ortho, you are not expected to know the chemotherapy regimen and staging of Leukemias. But god I hope you know how to identify and act accordingly to a patient having a seizure, or cardiac arrest or acutely psychotic) agitated patient.It should also be expected that you have a good grasp of general disorders such as DM and Hypertension.

 

[Tangerine123]

Pretty sure if you told a dentist your presentation they'd also know you should get chemistries and an ultrasound...

Perhaps, but would they know that the pain irradiates to the shoulder via the phrenic nerve? Ahahaha

My point was. Before a Psych/Ortho/Dermatologist/etc you are a medical doctor. And as such, you have certain standards to abide to.

 

[efle]

Perhaps, but would they know that the pain irradiates to the shoulder via the phrenic nerve? Ahahaha

My point was. Before a Psych/Ortho/Dermatologist/etc you are a medical doctor. And as such, you have certain standards to abide to.

Again, often yes, many dental programs have their students taking the exact same courses alongside their MD students for the first years. Historically many of them took NBME CBSE same as many of us. They then spend far more time specifically on dental-related knowledge and skills after that.

I feel like this is nicely illustrating the point that nobody can judge the adequacy of other paths because were largely clueless about what they do (or hypothetically would) cover.

 

[VA Hopeful Dr]

Very fair point, if I'm not mistaken dental and pod are still 4 years. More about tailoring what you study than doing it all faster.

Yes, and apparently in my state if you're a podiatrist and want to do any ankle work you must have done a residency. So that tacks on another 3 years just to add ankle privileges.

 

[VA Hopeful Dr]

Again, often yes, many dental programs have their students taking the exact same courses alongside their MD students for the first years. Historically many of them took NBME CBSE same as many of us. They then spend far more time specifically on dental-related knowledge and skills after that.

I feel like this is nicely illustrating the point that nobody can judge the adequacy of other paths because were largely clueless about what they do (or hypothetically would) cover.

Not entirely true. Not sure if he/she is still around, but there was a poster here who was an OD and then went back and became an ophthalmologist. Seems the ideal person to at least compared optometry school to med school + ophtho residency.

 

[efle]

Yes, and apparently in my state if you're a podiatrist and want to do any ankle work you must have done a residency. So that tacks on another 3 years just to add ankle privileges.

Im a fan of that part too. Last thing to reduce would be people's time in their specialized residency training.

Not entirely true. Not sure if he/she is still around, but there was a poster here who was an OD and then went back and became an ophthalmologist. Seems the ideal person to at least compared optometry school to med school + ophtho residency.

That's more like an NP going into an MD program I think. Dental and pod and pharma are terminal levels of knowledge and training in their subject.

 

[Tangerine123]

I feel like this is nicely illustrating the point that nobody can judge the adequacy of other paths because were largely clueless about what they do (or hypothetically would) cover.

True. Where I coms from Podiatrists don't exist, Surgery and other specialties would take care of that. Dental Students do recieve medical courses to an extent, but Oral health is a field where they don't dab into. And I still don't 100% understand what a DO is in the US and what difference does it have when compared to an MD.

We also don't have anything such as Physician Assistants and Nursing isn't such a developed field as in the US

 

[VA Hopeful Dr]

Im a fan of that part too. Last thing to reduce would be people's time in their specialized residency training.


That's more like an NP going into an MD program I think. Dental and pod and pharma are terminal levels of knowledge and training in their subject.

So maybe get one of the MD/DDS oral surgeons to weigh in?

I don't think using pharmacists is helping your cause. at the risk of an appeal to authority, wait till you're a practicing physician and have to deal with those people. the ones that stay in the hospital and work their tend to really know their stuff, but the retail ones very quickly forget a lot of what they learned or never learn to actually apply it clinically. Not sure which.

 

[efle]

So maybe get one of the MD/DDS oral surgeons to weigh in?

I don't think using pharmacists is helping your cause. at the risk of an appeal to authority, wait till you're a practicing physician and have to deal with those people. the ones that stay in the hospital and work their tend to really know their stuff, but the retail ones very quickly forget a lot of what they learned or never learn to actually apply it clinically. Not sure which.

Yeah that could certainly be interesting to hear from an OMFS whether people in the field with an MD are superior at the same job to people with just a DMD. My guess is no.

Fair point again but variable quality is true for physicians too. The hospital I'm at re-reads outside rads and path instead of using the community reports. And like I said plenty of older and highly specialized docs would not pass a USMLE tomorrow.

 

[VA Hopeful Dr]

Yeah that could certainly be interesting to hear from an OMFS whether people in the field with an MD are superior at the same job to people with just a DMD. My guess is no.

Fair point again but variable quality is true for physicians too. The hospital I'm at re-reads outside rads and path instead of using the community reports. And like I said plenty of older and highly specialized docs would not pass a USMLE tomorrow.

Depends which one. I'd happily take on Step 2 or 3 tomorrow. Step 1, I'd be hosed.

with some of the subpar physician's that we all see I can never decide if they're actually bad at what they do or you just kind of given up and gotten very lazy.

 

[Splenda88]

Or maybe we should borrow a page from dentistry and have every person graduating med school be a GP upon graduation. I must admit that a 5th year MUST be added to medical school to make that more palatable... My preferred design would be:

2-yr of prereqs after HS (not a system where there direct entry from HS)
2-yr of basic science interspersed with some basic rotation ...and the last
3 yrs should be a well-designed system where everyone do meaningful rotations in which one will gradually (emphasis on the word 'gradually') act like a resident... Then upon graduation, everyone is a GP, so we all can function well as a outpatient primary care MD/DO

We can design a system to have these fellowships as follows:

Hospital medicine, Pediatrics, palliative, sport medicine: 1-yr fellowship
Psych, Neuro, PM&R, EM, Anesthesia, Derm, A&I, Endo, Rheum, ID: 2 yrs
GI/Cardio, HemeOnc, Nephrology: 3 yrs
GS, Ortho, ENT, Ophtho, OMS, Radiology, Radonc: 3 yrs
Vascular surgery, CT surgery, Plastics, IR: 4 yrs
Neurosurgery: 5 yrs

No plan is perfect. That plan will rely on the last 3 years of med school to be designed somewhat like residency. That means states will grant "restricted license" to practice after the first 2 yrs. Allow these students to have NPI # so insurance companies can reimburse for service provided with attending co-signature.

The problem with clerkship in med school is that we are not given responsibilities and it becomes a passive learning, so I think designing a system like that will make the whole process more 'integrated' and probably less painful.

I might be CRAZY to suggest such proposal... since I am always thinking there must be a better way to "produce" competent physicians in this country after going thru this process.

To be perfectly honest, the process as I stand right now is good in producing EXCELLENT physician but I just think we can do better in making it more efficient.

The financial logistics of the last 3-year of med school should be very low tuition per year (half of what students would pay for the 1st 2 yrs)...

 

[Tangerine123]

Yeah that could certainly be interesting to hear from an OMFS whether people in the field with an MD are superior at the same job to people with just a DMD. My guess is no.

Fair point again but variable quality is true for physicians too. The hospital I'm at re-reads outside rads and path instead of using the community reports. And like I said plenty of older and highly specialized docs would not pass a USMLE tomorrow.

Well, the USMLE weighs more route memorization than critical thinking and problem solving. The later being what counts more in your day to day practice.

 

[Tangerine123]

Or maybe we should borrow a page from dentistry and have every person graduating med school be a GP upon graduation. I must admit that a 5th year MUST be added to medical school to make that more palatable... My preferred design would be:

2-yr of prereqs after HS (not a system where there direct entry from HS)
2-yr of basic science interspersed with some basic rotation ...and the last
3 yrs should be a well-designed system where everyone do meaningful rotations in which one will gradually (emphasis on the word 'gradually') act like a resident... Then upon graduation, everyone is a GP, so we all can function well as a outpatient primary care MD/DO

Well you juat described what happens in most of the world. You finish your 6 year curriculum and you can start working as a GP or continue on to residency.

 

[Splenda88]

Well you juat described what happens in most of the world. You finish your 6 year curriculum and you can start working as a GP or continue on to residency.

I thought that was novel idea...

 

[Tangerine123]

I thought that was novel idea...

Ahahahaha. Some countries, such as the US have different systems. I graduated from Latin America. While most of my friends did continue on to a Residency, some just opened their own clinic as a GP (usually at their home town or some area in need of physicians).

Then again, our curriculum is really different. Not only must we do our internship (where you sometimes act as a resident) but we also have to do around 6 months of rural medicine in your last year. Here you act as a GP (usually the only one for miles) in a rural village. Harvard's medical school has some sort of treaty with my University so that they can come and do a rural rotation in a village as well. The usually love it!

 

[Taddy Mason]

Dental and pod and pharma are terminal levels of knowledge and training in their subject.

Not really. All three fields have the option of doing residency which are required to practice certain subspecialties within their respective fields. Also, I believe residency is required for pods.

 

[longhaul3]

Huh, an interesting take, the usual opinion from everyone I've asked IRL was that they learned all the knowledge and skills of their job in their specialist residency or fellowship. Like, less than 12 hours ago had three different rads residents at a big name program telling me how useless their entire prelim year was and that everyone starts off at 0% for PGY2. Heard similar in the past from derm and several surgical specialties regarding all the USMLE content they had to master at the time so they'd match.

Prelim year may be useless because you're a scut monkey but I have to think that radiology of all specialties draws the most upon the breadth of material from med school. Radiology is basically a general consultation service that has to have expertise in diagnosing diseases of every organ system and in every specialty. Radiologists have to know, in a fair amount of detail, everything from PE to tuberous sclerosis to uterine fibroids to PBC to hereditary hemorrhagic telangiectasia. That is just like med school.

 

[Tangerine123]

Prelim year may be useless because you're a scut monkey but I have to think that radiology of all specialties draws the most upon the breadth of material from med school. Radiology is basically a general consultation service that has to have expertise in diagnosing diseases of every organ system and in every specialty. Radiologists have to know, in a fair amount of detail, everything from PE to tuberous sclerosis to uterine fibroids to PBC to hereditary hemorrhagic telangiectasia. That is just like med school.

"Clinically correlate" Ahahaha. But yeah, Rads and Path most know a little bit of everything

 

[efle]

Prelim year may be useless because you're a scut monkey but I have to think that radiology of all specialties draws the most upon the breadth of material from med school. Radiology is basically a general consultation service that has to have expertise in diagnosing diseases of every organ system and in every specialty. Radiologists have to know, in a fair amount of detail, everything from PE to tuberous sclerosis to uterine fibroids to PBC to hereditary hemorrhagic telangiectasia. That is just like med school.

Well my argument has never been that radiologists shouldnt know all that kind of stuff. Like I said many dentists even study the same MS1-MS2 NBME materials. It's just that I can envision a Doctor of Radiology program that then gives a big headstart on the career by teaching it alongside the associated imaging and replacing some of the less useful third year rotations with more relevant ones (e.g. an IR block instead of psych).

The goal isnt to make a knock-off easier MD, it's to consider letting people decide on a subject from the get go like they to with teeth.

 

[Tangerine123]

Well my argument has never been that radiologists shouldnt know all that kind of stuff. Like I said many dentists even study the same MS1-MS2 NBME materials. It's just that I can envision a Doctor of Radiology program that then gives a big headstart on the career by teaching it alongside the associated imaging and replacing some of the less useful third year rotations with more relevant ones (e.g. an IR block instead of psych).

The goal isnt to make a knock-off easier MD, it's to consider letting people decide on a subject from the get go like they to with teeth.

Well, if you want to go back to psych. My PhD is based around neuroimaging in clinical trials in depression. We colaborate a lot with the radiology and physics department. You can argue that Radiology can get involved in any field.

 

[efle]

Well, if you want to go back to psych. My PhD is based around neuroimaging in clinical trials in depression. We colaborate a lot with the radiology and physics department. You can argue that Radiology can get involved in any field.

When people start ordering head scans with "Major Depressive Episodes" as the indication itll go right back into the curriculum dont worry!

 

[Tangerine123]

When people start ordering head scans with "Major Depressive Episodes" as the indication itll go right back into the curriculum dont worry!

You have to think deeper! BOLD activation or resting state fMRI of the DFPLC in non invasive brain stimulation. Or the meassurement of Lithium concentration at the DFPLC using Multivoxel MR spectroscopy! Ahahaha.

But yeah, I guess that for clinical medicine it's not that big of a deal. Now for research... Yup

 

[longhaul3]

Well my argument has never been that radiologists shouldnt know all that kind of stuff. Like I said many dentists even study the same MS1-MS2 NBME materials. It's just that I can envision a Doctor of Radiology program that then gives a big headstart on the career by teaching it alongside the associated imaging and replacing some of the less useful third year rotations with more relevant ones (e.g. an IR block instead of psych).

The goal isnt to make a knock-off easier MD, it's to consider letting people decide on a subject from the get go like they to with teeth.

I disagree. There is a certain body of knowledge and experience that IMO med students need to gain from each clinical rotation. There are certain key things that are relevant to clinical practice that you learn by repetition, seeing those patients, and having that image in your mind.

As a radiologist you will do procedures in IR that require anesthesia, conscious sedation, and post-procedural care for which you will be the responsible physician. Psych meds have extremely important drug-drug interactions and side effects that I'm sure were beaten into you on your psych rotation and shelf. Your post-angio patient has 10/10 nausea and a mild headache. He sees a psychiatrist who went to psychiatry school and knows nothing about his upcoming procedure or anything about perioperative medicine. As a cath jockey your instinct is to just give zofran and toradol because that's what you learned to give for pain and nausea in radiology school. Whoops, he was supratherapeutic on lithium and you wrecked his kidneys. Or he was on an SSRI and he has serotonin syndrome. Or he was on an antipsychotic and he's in torsades and coding. Better call the code doctors who went to code doctor school.

The most clueless med student could have told you not to do that after 2 weeks on a psych clerkship. But at least you have something to talk about at the next M&M, where they will still find a way to blame anesthesia.

 

[efle]

I disagree. There is a certain body of knowledge and experience that IMO med students need to gain from each clinical rotation. There are certain key things that are relevant to clinical practice that you learn by repetition, seeing those patients, and having that image in your mind.

As a radiologist you will do procedures in IR that require anesthesia, conscious sedation, and post-procedural care for which you will be the responsible physician. Psych meds have extremely important drug-drug interactions and side effects that I'm sure were beaten into you on your psych rotation and shelf. Your post-angio patient has 10/10 nausea and a mild headache. He sees a psychiatrist who went to psychiatry school and knows nothing about his upcoming procedure or anything about perioperative medicine. As a cath jockey your instinct is to just give zofran and toradol because that's what you learned to give for pain and nausea in radiology school. Whoops, he was supratherapeutic on lithium and you wrecked his kidneys. Or he was on an SSRI and he has serotonin syndrome. Or he was on an antipsychotic and he's in torsades and coding. Better call the code doctors who went to code doctor school.

The most clueless med student could have told you not to do that after 2 weeks on a psych clerkship. But at least you have something to talk about at the next M&M, where they will still find a way to blame anesthesia.

What would your thoughts be on my school lacking any third year primary care/ambulatory rotation? You can graduate here without once spending a day in a primary care clinic, the backbone of our medical system.

Is that really going to make me a worse radiologist? The Rads residencies themselves dont seem to mind.

 

[Tangerine123]

What would your thoughts be on my school lacking any third year primary care/ambulatory rotation? You can graduate here without once spending a day in a primary care clinic, the backbone of our medical system.

Is that really going to make me a worse radiologist? The Rads residencies themselves dont seem to mind.

I wouldn't say that it would make you a worse radiologist. Rather a Medical Doctor lacking quite a chunck of essential knowledge, that could infact prove to be useful at certain points of your career.

We are in an era of Hyper-specialization, we can't know everything about every disorder. However you aren't just a radiologist. You're an MD and that implies much more than just what you learned in your residency.

 

[efle]

Rather a Medical Doctor lacking quite a chunck of essential knowledge

That does make sense. I've noticed all of my classmates and alumni professors tend to embarrass ourselves whenever we interact with physicians from med schools with an FM rotation

 

[Tangerine123]

That does make sense. I've noticed all of my classmates and alumni professors tend to embarrass ourselves whenever we interact with physicians from med schools with an FM rotation

I wouldn't take FM for granted. Some topics are discarded as "easy" or "worthless", but as an MD you should have an idea of what's happening and be able to emmit an opinion with criteria. Take Nutrition for example, many MDs have no idea about this topic. Basic stuff like immunization schemes, prenatal screening, child neurodevelopment, depression, upper respiratory infection, DM/Hypertension, Non complex skin conditions, etc etc.

It won't directly help you as a radiologist. But you can't always be oblivious to the rest of the patient's health. Sometimes you won't have the ability to refer or consult and are expected, as an MD, to solve basic stuff.

Then again, I guess this is influenced by the curriculum and mentality of your medical schooling system. Like I mentioned before, in 6+ years programs we usually get trained to also be GPs at the end of our studies.

Even though I went for Genetics/Psych sometimes I have to solve comorbidities and questions that patients have that might not be related to the field

 

[longhaul3]

What would your thoughts be on my school lacking any third year primary care/ambulatory rotation? You can graduate here without once spending a day in a primary care clinic, the backbone of our medical system.

Is that really going to make me a worse radiologist? The Rads residencies themselves dont seem to mind.

Primary care for the purposes of a med student is just internal medicine (plus/minus peds and obgyn in the case of FM) in the ambulatory setting. I don't think there's really a discrete body of knowledge that is separate from IM at the med student level. And since med school is basically 4 years of IM with a few other subjects here and there, it doesn't bother me. I absolutely hate clinic.

 

[Neopolymath]

Primary care for the purposes of a med student is just internal medicine (plus/minus peds and obgyn in the case of FM) in the ambulatory setting. I don't think there's really a discrete body of knowledge that is separate from IM at the med student level. And since med school is basically 4 years of IM with a few other subjects here and there, it doesn't bother me. I absolutely hate clinic.

Ideally there would be no ambulatory IM type rotations until 4th year at any school. 3rd year should be pretty much only in the hospital in my opinion. I think clinic rotations are important after establishing the framework in the hospital but I'm biased too in that I think it's far easier to learn in-patient medicine and then transition to outpatient than vice-versa.

 

[longhaul3]

Ideally there would be no ambulatory IM type rotations until 4th year at any school. 3rd year should be pretty much only in the hospital in my opinion. I think clinic rotations are important after establishing the framework in the hospital but I'm biased too in that I think it's far easier to learn in-patient medicine and then transition to outpatient than vice-versa.

I strongly agree. I never spent a single day in my specialty's outpatient clinic until residency, except to do the whole song and dance where you shadow the chairman on your sub-i's and ask for a letter. Not that hard to see postop patients and new consults in clinic when you spend all your time doing the same thing in the hospital in much more acute settings.

I understand that it's different in primary care specialties where you don't know what could be coming through the door and you have to figure out a way to address all their problems, not just the one issue they were referred to subspecialty clinic for. But you still learn all those basics on IM in med school.

 

[Ho0v-man]

I think a solid FM rotation is probably the best use of your preclinical and clinical knowledge. Aside from nitty gritty cell bio and calculations of stats and pharm I can say I really had to use just about everything I learned in med school up to that point and then some. It was a blast tbh.

 

[Neopolymath]

I think a solid FM rotation is probably the best use of your preclinical and clinical knowledge. Aside from nitty gritty cell bio and calculations of stats and pharm I can say I really had to use just about everything I learned in med school up to that point and then some. It was a blast tbh.

That's why I think it should be a 4th year requirement not 3rd year.

 

[VA Hopeful Dr]

That's why I think it should be a 4th year requirement not 3rd year.

Nope. Family medicine is the 2nd largest specialty in the country. You need exposure in 3rd year.

That said, it could easily be a pretty short rotation. A month is more than enough: 2 weeks with a regular outpatient practice and 2 weeks in the residency clinic (if applicable) or do all 4 weeks with the private office.

 

[Ho0v-man]

That's why I think it should be a 4th year requirement not 3rd year.

I actually like the idea. But kinda hard to get it knocked out for everyone before apps go out.

 

[VA Hopeful Dr]

I actually like the idea. But kinda hard to get it knocked out for everyone before apps go out.

And that's the trick. If you look at the 2020 match results, only 2 of the specialties that have over 1200 positions offered/year aren't the 6 traditional 3rd year rotations (those being EM and anesthesia). Its why those were all required 3rd year rotations - they made up 61% of the Match this year.

The trend, at least in my area, is to cut down the time on those 6 so you have elective time to look into everything else. FM can easily be 1 month, so that's another month of elective time. Have some rotations include subspecialty time - your 8 weeks on surgery can include 2 weeks on vascular/trauma/CT/plastics. Same with IM/Peds and their various subspecialties. My school tacked on neuro with psych. OB was only 6 weeks - 2 each of L&D, clinic, and GYN surgery; that way you get another 2 weeks of elective time.

 

[readmypostsMD]

There is no hard requirement to take classes at all to sign up for the MCAT, so I don’t really understand this comment. The courses on Khan Academy are enough to do well without ever stepping foot on a college campus, and Khan Academy is free. I took the MCAT before I finished the premed courses, and learning the material I hadn’t had classes on yet on Khan Academy was enough for me to pull a 515.

If anything, I personally think the current system hurts URM/low SES students more - they currently have to pay for classes that are completely useless if you don’t get into med school, when they could learn the material for free online otherwise. There’s not much you can do with a handful of intro bio, intro chem, physics, etc. classes in the real world.

Removing college courses also takes GPA out of the equation, which is nice for people who worked full time through undergrad. The rich kid advantage also comes in from getting to sit pretty in an on-campus apartment and not work, while someone else might be working two jobs to pay for a place to live during undergrad, negatively impacting their grades.

rich people will always have an advantage no matter what nifty changes you make to the system. I honestly don’t think you can engineer a system that wealthy people can’t use their money and resources to game. no matter what you do, they’ll access to more things than poorer people. I mean, isn’t one of the reasons to making $ to provide a better life for your children, which really just unfortunately means a life that is better than those of other children?

 

[Vulf]

rich people will always have an advantage no matter what nifty changes you make to the system. I honestly don’t think you can engineer a system that wealthy people can’t use their money and resources to game. no matter what you do, they’ll access to more things than poorer people. I mean, isn’t one of the reasons to making $ to provide a better life for your children, which really just unfortunately means a life that is better than those of other children?

A total lottery system might work, but even then you might pay off the guys that design the process...

 

[Chibucks15]

A total lottery system might work, but even then you might pay off the guys that design the process...

A total lottery system completely takes out merit in the process. This is a professional school that literally takes care of people and saves lives. You wanna leave that into a complete lottery? Absolute insanity

Not everyone who has money bribes the people who set it up...and before you accuse me of being “biased”, I grew up middle class at best. I got very minimal benefits growing up. The worldview of some people these days spends more time finding “systemic inequalities” than anything. Sure they exist but at a certain point merit has to matter...

 

[readmypostsMD]

A total lottery system completely takes out merit in the process. This is a professional school that literally takes care of people and saves lives. You wanna leave that into a complete lottery? Absolute insanity

Not everyone who has money bribes the people who set it up...and before you accuse me of being “biased”, I grew up middle class at best. I got very minimal benefits growing up. The worldview of some people these days spends more time finding “systemic inequalities” than anything. Sure they exist but at a certain point merit has to matter...

better year, if you want to equalize the playing field make applicants take IQ tests in addition to the mcat

 

[Vulf]

A total lottery system completely takes out merit in the process. This is a professional school that literally takes care of people and saves lives. You wanna leave that into a complete lottery? Absolute insanity

Not everyone who has money bribes the people who set it up...and before you accuse me of being “biased”, I grew up middle class at best. I got very minimal benefits growing up. The worldview of some people these days spends more time finding “systemic inequalities” than anything. Sure they exist but at a certain point merit has to matter...

Oh, I agree it should be a merit-based system. I feel as if the current med-ed environment is focused on taking away ways to measure merit and the end logic to that for absolute equality of outcomes can only be lottery which (I agree) would be insanity. Can "holistic" evaluation evaluate for merit? Even the "holistic" evaluators have biases and such that may not be explicit. Clinical evals are biased, step scores are biased, research opportunities are biased, school prestige biases. Where does it end? At some point, you need to retain some measures to be able to pick qualified candidates.

 

[Chibucks15]

Oh, I agree it should be a merit-based system. I feel as if the current med-ed environment is focused on taking away ways to measure merit and the end logic to that for absolute equality of outcomes can only be lottery which (I agree) would be insanity. Can "holistic" evaluation evaluate for merit? Even the "holistic" evaluators have biases and such that may not be explicit. Clinical evals are biased, step scores are biased, research opportunities are biased, school prestige biases. Where does it end? At some point, you need to retain some measures to be able to pick qualified candidates.

Most of these “biases” are overblown and really don’t end up mattering all that much. People just love to find ways the world is “against them”