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    (Original post by Mushi_master)
    Actually quite enjoying this haematology scenario, this is surprising.

    Along with this debate, I don't think a small amount of clinical exposure (i.e. a couple of days at a GP practice/ward over preclinical years) is a bad thing - for us these are based more on psychology/sociology teaching, with second year being more based on public health. We also get a small amount of communication skills/basic history taking - which I guess is useful in preparation for clinical years, also this is mainly aimed at exploring social effects of ill health and illness behaviours too. My only issue is when it gets as much focus as preclinical science at this stage - as in having full firm attachments so early on before you've gained enough science to really take anything away from it.
    I do think a small amount is a good thing, and I think that's what this debate is lacking realising- we don't just do science and turn into robots or boring scientists. There is definitely a focus on communication, in a clinical manner or otherwise, and the clinical relevance of everything we learn is generally quite obvious anyway (for example, it's easy to see the relevance of a module on biochemistry/metabolism when you learn about malabsorption/malnutrtion and all the **** that goes along with it). So we don't "forget" what we're becoming, there's always a focus on what we're becoming, it's just we don't mess around with clinical skills models as much and the stuff I have learnt in any "clinical skills" sessions we have is just nonsensical.
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    (Original post by Philosoraptor)
    Oh broski - how's the stuff regarding USMLE and all that going? Did you get anywhere?
    Slow and steady...percentages are around the 70s now, want to get around 80% before I sit it. Biochem, pharm, micro and genetics are my sticking points (thanks Barts)
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    (Original post by digitalis)
    Robbin's is good. BRS path is a nice review book. And if you are really keen, there are audio lectures available to download, search 'the usual sources' for "goljan audio"
    Oh I know it is. I looked at it briefly and seen it would be perfect but it wasn't good for my course layout. Our course goes through specifics, starting with immunology then virology, parasitology, bacteriology, vascular path and finally cancer. Robbins is system based meaning the information needed is scattered across the book and also it is more clinical, which unfortunately at the minute isn't what I need. Thanks for the tips though
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    Last lecture finished at 5; going home tomorrow, haven't packed. Going out in 20 minutes and probably won't be back until the early hours. FML.
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    (Original post by Jessaay!)
    I'm a bit confused as to what your point IS then.
    My point was that early clinical exposure isn't a bad thing. But it's descended into this because from that it was deduced that I was a science-hater or that I was personally insulting their course.

    There is definitely a disparity between the knowledge of different med schools- some have more preclinical, clinical knowledge and some have more scientific knowledge in their preclinical years. You're basically saying non-traditional start out with a beneficial head start in terms of communication but this is caught up with quite easily, but we all have the same level of science. I don't believe the same level of science thing is really true and that's kind of the point of the difference between our courses. I'm not sure which is more beneficial and which is not, but considering the difference in time we focus on different things, we can't be as even as you're saying, really.
    According to who? You? At least I said "I think" when I was making an assumption based on little evidence.

    initially your point was that good communication makes you a better medical student and I definitely don't despute this, but we said we do learn communication and stuff, but there's a lower focus on this and clinical aspects of the course and more focus on the science.
    I know. I just wanted to offer a different view point on early clinical exposure. It was getting a one-sided bashing.

    What I'm trying to say, is that science knowledge can't be as "easy" or as even between schools as you're saying, really. Considering in our most recent module alone I believe there were around 60 hours of lectures (not including PDS) as well as other styles of teaching (computer labs, case study exercises, actual lab work, dissection etc...) all equating to probably about 80 contact hours, there must be a difference in scientific knowledge base to those who don't have as much of a focus on science. Otherwise we spend an incredible amount of unneccessary time studying science that others do in a shorter period of time to the same level.
    You might do 60 hours of lectures per module. Is that a semester? Four weeks? What is a module?

    And you're assuming that contact hours = scientific focus. What do you think we do on PBL courses? Just wait for lectures/labs and then spend the rest of our time reading medical sociology books? Not quite.
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    (Original post by It could be lupus)
    So you used Robbins as a path textbook? I haven't been able to find one that I like. All of them don't match the course and most are systems based, which is good for clinical but not great for IB Pathology. Also, any advice on Part II subjects?
    I used Basic Robbins and Underwood. Underwood was a little basic so I'd use the lecture handouts more than a textbook at your stage to be honest. The "Big" Robbins is better suited for Final MB pathology, though it might be overkill. Part II-wise, what have you enjoyed about Part IA and IB? I loved immunology, mostly because my supervisor and DoS was in that field and manage to bring immunology into most of our supervisions. About half my year ended up doing pathology. Mechanisms of Disease will hold you in good stead for clinical stuff and Final MB pathology, but it can be really hard work. I'd try and do a project-based one and attempt to get published. I sort of regret doing a dissertation, but it did mean I had a really chilled out year and could concentrate on extracurricular stuff like JCR work and running a couple of university societies.

    FWIW, I don't buy the argument that early clinical contact makes you a good communicator. It's much more innate than that (at least to an extent), and we get a ****-tonne of clinical communication skills teaching in clinical school to supplement that. Our first three weeks of clinical school concentrated on getting the basic examinations down and learning how to take a history. I don't think many people were shy or unconfident about taking histories or examining people after their first placement. Three weeks versus however many weeks of less high-yield work as a junior student with little background knowledge? I know what I'd pick.

    As for practical skills, it's not difficult to find lots of opportunity to suture/cannulate/venesect/catheterise as a clinical student and get pretty damned good at it. Hell, I've managed to scrub for over 40 cases and over 250 hours as a student (mostly as first-assistant) off my own back and in my own time and have been told numerous times by consultants that I'm at an SHO-level, surgical skills-wise. No, I didn't do a surgical SSC.
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    (Original post by Kinkerz)
    My point was that early clinical exposure isn't a bad thing. But it's descended into this because from that it was deduced that I was a science-hater or that I was personally insulting their course.


    According to who? You? At least I said "I think" when I was making an assumption based on little evidence.
    http://www.biomedcentral.com/content...1-7015-6-5.pdf

    Granted, it's just one paper...
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    (Original post by visesh)
    As for practical skills, it's not difficult to find lots of opportunity to suture/cannulate/venesect/catheterise as a clinical student and get pretty damned good at it. Hell, I've managed to scrub for over 40 cases and over 250 hours as a student (mostly as first-assistant) off my own back and in my own time and have been told numerous times by consultants that I'm at an SHO-level, surgical skills-wise. No, I didn't do a surgical SSC.
    Agreed. We don't have surgical SSC's and we don't get theatre rotations til fourth year, but I've scrubbed in on over 80 cases and feel confident cannulating and taking blood despite the fact the medical school's attempt at teaching that was to give us three venflons and a plastic arm to play with. Maybe it's overkill, but I'd rather that than be the FY1 that can't stick a venflon in (and I have heard of people getting to FY1 having only done 3 or 4 in their entire time at med school). And at least I can now focus on 4th year with the aim being to pass written finals, instead of trying to juggle learning practical and theoretical stuff together.
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    (Original post by visesh)
    FWIW, I don't buy the argument that early clinical contact makes you a good communicator.
    That's fine. I said that I think it might make someone better, not necessarily good. But whatever, this argument/discussion/whatever you want to call it isn't going anywhere, it's not balanced enough... one person vs. five people.

    (Original post by visesh)
    http://www.biomedcentral.com/content...1-7015-6-5.pdf

    Granted, it's just one paper...
    Cool. I haven't got the time to read it properly at the moment, but I will do tomorrow.

    Though, just scanning:
    However, the report also highlighted the very limited evidence that existed to support the contention that significant differences in ability existed between graduates of different UK universities.
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    (Original post by Kinkerz)
    That's fine. I said that I think it might make someone better, not necessarily good. But whatever, this argument/discussion/whatever you want to call it isn't going anywhere, it's not balanced enough... one person vs. five people.


    Cool. I haven't got the time to read it properly at the moment, but I will do tomorrow.

    Though, just scanning:
    Yeah, it's a bit of a crappy study.
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    i am such an amazing medical student. i spend all my times on the wards. i have catherised patients over 100 times. i am such an amazing medical student. i am better than the fy1s. i could do their jobs easily. i have sat in during 10 thousand hours of surgery. my consultant says i am a better surgeon than him. i am a better medical student than you etc.

    people do fail every year because they focus on areas they are interested on and even if you are a wannabe surgeon it is not the time to spend hours in theatre in you final year. also practical procedures need to revised 'osce-style'. this is under exam conditions and with someone marking the osce sheet there. you need to learn the hoops and you need to learn to jump through them. it is a very minor part of the exam and something you can learn very close to exams.

    you need to competenet in examination of neck, breast, vascular, groin - etc. all fy1 skills must be known well -prescibing. ecg/xray interpretation needs to be perfect. you need to sharpen your communication stations. spread yourself thin. play the game. you can play doctor later in your carreer.
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    (Original post by digitalis)
    No offence, but to say you are doing 'F1 things' from the start is total bollox.
    You could teach a monkey how to suture. What doctors get paid for is seeing patients, diagnosing things and carrying out effective management.

    Yes, it may seem cool and exciting to play doctor in theatre all scrubbed up and doing a few stitches, but it is actually of zero importance to your medical training. When you do surgery in third year, you won't be scrubbed in for hours practising your AAA bypass technique, you will be learning how to examine surgical patients, take good histories and learn how to keep them alive when they turn septic. That's F1 stuff.
    And again, I was doing that today too. I was setting treatment pathways, taking histories from patients and looking at worst case scenarios. I've only been on Dermatology since Monday and haven't done any work on it before. Because I'm seeing things for real it's appealing to me kinaesthetic and visual learning style so I'm remembering things and picking up stuff much faster than I would do from reading a book.

    I didn't say we were F1s from the very beginning, but our course focuses on training you to be able to do the job you will have to do when you get there. No, we won't get much more advanced than that on this course because that's not what it's for - that training comes later if you choose to pursue that speciality. The more stuff you see the earlier in a controlled environment, the more you get to practise it, the better you will be at it when you come to have to do it for real. Practise makes perfect, you can't dispute that. If we practise the clinical stuff now and continue to do so throughout the next five years we should be super slick at it when we graduate. So you can do it when you're half asleep in the middle of a night shift on a particularly difficult patient because you've done it so many times before.

    From having incompetent Dr's myself I don't care if you're the brainiest Dr in the world, if you can't do the basic stuff like take blood without botching it or listen to me when I'm talking to you and understand what I'm not happy with, I'm going to think you're rubbish.
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    (Original post by Revenged)
    i am such an amazing medical student. i spend all my times on the wards. i have catherised patients over 100 times. i am such an amazing medical student. i am better than the fy1s. i could do their jobs easily. i have sat in during 10 thousand hours of surgery. my consultant says i am a better surgeon than him. i am a better medical student than you etc.

    people do fail every year because they focus on areas they are interested on and even if you are a wannabe surgeon it is not the time to spend hours in theatre in you final year. also practical procedures need to revised 'osce-style'. this is under exam conditions and with someone marking the osce sheet there. you need to learn the hoops and you need to learn to jump through them. it is a very minor part of the exam and something you can learn very close to exams.

    you need to competenet in examination of neck, breast, vascular, groin - etc. all fy1 skills must be known well -prescibing. ecg/xray interpretation needs to be perfect. you need to sharpen your communication stations. spread yourself thin. play the game. you can play doctor later in your carreer.
    I take your point- there's no disputing that. Basics are basics and need to be covered thoroughly. I only mentioned the thing you're parodying to make the point that, in my opinion, you don't need clinical exposure from day one to be able to be a semi-competent FY doctor.
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    On a separate note, if you noticed the consultant you were with had done something wrong, would you tell him? Patient was complaining of muscle cramps in the right iliac fossa but the consultant had noted this down as right hypochondrium and was thinking it might have been pancreatitis and had ordered an ultrasound of the right hypochondrium and an amylase blood test. Firstly the pancreas isn't in the right iliac fossa and together with the way the patient was describing the pain and the fact he had raised creatinine kinase it sort of sounded like muscle death of a section of the obliques maybe. However I recognise that that was way way over my head and not for me to be speculating on or to be telling the Dr he had it wrong. I kept quiet because I couldn't figure a way to tactfully tell the Dr he'd confused his abdominal sections. I was hoping when they start ultrasound the wrong bit the patient will tell them he's getting pain in a different area. Did I do the right thing? What would you do?
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    opinion splitter i am very happy with having clinically focussed interesting science now in place of vast swathes of clinical contact.

    as far as i am concerned medical practitioners have responsibilities as a scientist as well as a clinician. i think they should be able to interpret directions of preclinical research and have the capacity to contribute to it whether in a lab or not. mechanisms are important to improving treatments for patients, being really good at reading what the bnf tells you to do is necessary but not sufficient for that.

    edit: in addition, the quality of basic science teaching is outstanding, it would be absolute madness to not want to spend lots of time making the most of it! whether directly clinically relevant or for academic interest (:suith:)
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    (Original post by Kinkerz)
    My point was that early clinical exposure isn't a bad thing. But it's descended into this because from that it was deduced that I was a science-hater or that I was personally insulting their course.


    According to who? You? At least I said "I think" when I was making an assumption based on little evidence.


    I know. I just wanted to offer a different view point on early clinical exposure. It was getting a one-sided bashing.


    You might do 60 hours of lectures per module. Is that a semester? Four weeks? What is a module?

    And you're assuming that contact hours = scientific focus. What do you think we do on PBL courses? Just wait for lectures/labs and then spend the rest of our time reading medical sociology books? Not quite.
    By saying "disparity of knowledge", I think I meant difference in focus of learning, which as a result causes a disparity in what you know in a way (like Baby boo mentioned she knew a lot about rheum, ortho etc and I doubt I will until clinics). It wasn't very clear, but my mind is turning to mush.

    This module is 7 weeks long (could be 6 but they spread it out a bit just because it ends close to exams), usual modules are about 4-6 weeks long and we have 4 in first year and I think there are 5 or 6 (can't remember) in second year, and second year is much more intense.

    No, I know what PBL is, and did I ever mention sociology books? No. I wasn't saying that. However, I believe that the reason we have such a focus on that is FOR a reason- our medical schools choose to teach more about science than some, perhaps. Certainly, I don't think that a lot of the stuff we cover could be covered in some parts of PBL.
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    (Original post by Jessaay!)
    No, I know what PBL is, and did I ever mention sociology books? No. I wasn't saying that. However, I believe that the reason we have such a focus on that is FOR a reason- our medical schools choose to teach more about science than some, perhaps. Certainly, I don't think that a lot of the stuff we cover could be covered in some parts of PBL.
    PBL courses also have lectures and lab sessions. We get less teaching, sure, but I don't think that inherently makes us less knowledgeable.
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    (Original post by ilovehotchocolate)
    And again, I was doing that today too. I was setting treatment pathways, taking histories from patients and looking at worst case scenarios. I've only been on Dermatology since Monday and haven't done any work on it before. Because I'm seeing things for real it's appealing to me kinaesthetic and visual learning style so I'm remembering things and picking up stuff much faster than I would do from reading a book.

    I didn't say we were F1s from the very beginning, but our course focuses on training you to be able to do the job you will have to do when you get there. No, we won't get much more advanced than that on this course because that's not what it's for - that training comes later if you choose to pursue that speciality. The more stuff you see the earlier in a controlled environment, the more you get to practise it, the better you will be at it when you come to have to do it for real. Practise makes perfect, you can't dispute that. If we practise the clinical stuff now and continue to do so throughout the next five years we should be super slick at it when we graduate. So you can do it when you're half asleep in the middle of a night shift on a particularly difficult patient because you've done it so many times before.

    From having incompetent Dr's myself I don't care if you're the brainiest Dr in the world, if you can't do the basic stuff like take blood without botching it or listen to me when I'm talking to you and understand what I'm not happy with, I'm going to think you're rubbish.
    Though, arguably, I see you're a biomed grad. You have a good science grounding and already have learnt the skills a degree entails and tries to teach you (which are, of course, very relevent to any job and relevent to being a doctor as well- you need to acquire a way of thinking and gaining knowledge that contrasts in some ways to what you were taught in school), and now you can pretty much focus "on the job". However, I know if I was thrown into dermatology right now, I'd be so much in the deep end I think I'd probably drown. Whilst it's fine being a kinaesthetic learner, which I often am, it depends on the case. I imagine I'd get the jist of things but that would make some of the finer details difficult to pick up on and if I graduated without knowing these finer details it's entirely possible to miss something.

    That and yes, I do believe competance as a doctor is obviously a fine thing to have, you don't want a doctor who does a "botch job", as you put it. But we will have time to do this sort of thing when we get to our clinical years and practice them til we bleed, and I think if a doctor graduates without competance in these areas it's either their own fault for probably not trying hard enough in their clinical years to get as much out of it as possible, or the fault of the clinical teaching in their medical school, rather than the fault of the preclinical teaching. Let's face it, we've got 3 years entirely focussed on that sort of thing, basic stuff such as suturing should be of no issue whatsoever.

    I also do believe "competance" can be in two categories- knowledge and the ability to DO the procedures. I'm not saying that people with more contact in their preclinical years have a lack of knowledge, but that's the core of this argument- what is the difference in knowledge.
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    we don't have that many hours of lectures per week and yet we do a fair bit of sciencey stuff
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    (Original post by Kinkerz)
    PBL courses also have lectures and lab sessions. We get less teaching, sure, but I don't think that inherently makes us less knowledgeable.
    I was using lectures as more of an example of the amount of science we study, really, more than a definition of the amount of science we do. I do believe there must be SOME difference between the science knowledge of the two types of courses, though, considering we focus so hard on it. Otherwise there'd be very little point in traditional courses existing anymore.
 
 
 
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