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Thursday, May 11, 2006

Basic Science In Medical School

A few days ago I got fifty dollars to trash "pseudoscience," to use Dr. RW's term. My school is one of a few to receive a grant from the American Medical Student Association to develop a Complimentary and Alternative Medicine curriculum.

I'll never see it because it is still being developed, and God willing with the answers I gave on that survey neither will any future basic science year students at my school. I felt kind've bad for basically cursing any attempt to introduce this into our curriculum, seeing as taking the survey entered you into a raffle to win a $50 Barnes and Noble gift card (which bought me Dan Harrington's first volume on tournament hold'em and a history of the Knights Templar). At the least I should've spent the gift card on this.

It is an odd trend we're experiencing. On the one hand more and more basic science is being crammed into the first two years. It is remarkable what I'm taught compared to my parents 20 years ago. The growth of the volume of information presented has forced students to decide earlier and earlier that they are called to medicine. The schools want to build off what you should have already studied in college. Next year for the college seniors applying to my medical school they will have had to have taken 2 semesters of physics, 2 semesters of general chemistry, 2 semesters of organic chemistry, 4 semesters of biology/zoology, 1 semester of calculus or statistics, 1 semester of biochemistry.

That is nearly two full years, half or you college education, dedicated to science. Imagine wanting to be well rounded, being an English major (or in my case a Screenwriting major) and trying to accomplish this. All I can say is thank God for summer school (and I didn't even have to have biochemistry).

At the same time material like medical ethics and alternative medicine are trying to be worked into the first two years of medical school.

Stories like this one from Australia are a little concerning and have prompted Orac and Dr. RW to comment on the story's focus, that touchy feely subjects are crowding out time for basic sciences. Dr. Rangel got the debate started with his opinion that medical students actually don't need so much basic science.

I'm not really sure where I really stand. A lot of this is important stuff, and God forbid it be replaced by CAM but is there too much basic science? Dr. RW has already put it best,
Memorizing all the steps in the glycolytic sequence and the Krebs cycle won’t make you a better doctor but it could be important to understand how those reactions yield energy, why a molecule of glucose yields only a couple of ATPs in the glycolytic sequence, but an additional 30 some odd in the Krebs cycle, a fact that explains the difference between aerobic and anaerobic metabolism and why folks have to breathe. It’s all about the how and why of health and disease.
I've never witnessed medical students misidentifying the heart but if there is a glut of basic science ignorance on the wards then the problem stems from time constraints. Sure, these fluff classes can certainly be part of the problem. Although my school doesn't have required art appreciation courses (from Orac), I get the sense that such courses aren't the major factor that is driving basic science ignorance. Basic science itself is driving the ignorance.

I hear it when I go home for a free meal with my two doctor parents, I hear it from physicians who interact with 1st and 2nd years regularly, the amount of basic science information presented in medical schools is growing year to year. There is so much information nowadays that your goal is to study it only long enough to remember it for a three hour test. You hope that when you start studying fo the Step 1 it somehow all comes back.

I suppose I'm a poor one to be making this claim considering the time I've spent posting over the past few days. Clearly not like I'm buried in books all day.

A very closely associated contributing problem is the lack of relevance of the basic science material. No doubt, some schools do better than others at integrating 1st and 2nd year material with clinical experience. My school is probably somewhere in the middle, not poor by any stretch of the imagination. But with so much information (and the classes after me will only have more) even when you shadow a physician every once and a while or when a surgeon comes into an anatomy lecture and shows you video, the basic science information doesn't mean anything to you, in terms of the actual practice of medicine. By the time they're trying to show you info's relevance you're already off cramming for the next exam.

Basically, you can't decipher what is important and what isn't to the actual practice of medicine as a first year. At least I can't all the time. It is all a mush.

Let me make it clear, this is not a complaint. It is not like I've forgotten all of first year already (we'll see how many brain cells I kill drinking after my last exam) or that there is so much information that students can't even manage their first two years, but if there is a lack of basic science knowledge as presented by that story from Australia then this is the culprit. Perhaps medical school should be five years (and not the five year pathway innitiated by student performance) or perhaps the basic science curriculum needs to be weened down to more basics, that emphasis what is truly clinically important. Like Dr. RW says himself, do I really need to be forced to memorize the Krebs Cycle?

Such changes however would take a considerable national effort involving the NBME. You have to teach to the USMLE Step 1.


Anonymous Anonymous said...

You are going to find out in a few years that basic science knowledge is what separates physicians from physician-extenders. It's what will give you the intellectual understanding of medicine that nurses, PA's, and all of the other healthcare workers you will encounter don't have. It will give you the ability to ask questions that need to be asked when protocols and guidelines just don't make sense. I agree that rote memorizing of anatomical facts and biochemical pathways lacks relevance. It is the duty of a skilled and creative medical school basic science faculty to teach the relevance of the material as they are teaching the facts. Don't blame basic science education when the problem in most cases is poor basic science education.

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