What do you actually learn at medical school?
I'm having a bit of a Vocational crisis. I've just finished year one of a graduate medicine. Next year we have half an academic year, and then off to placement for the remainder of our course (2.5 years)
I feel like I've learned so little. I'm 2/3 lf the way through pre-clinical. The image I get of placements for those on it is that you just sort of stand around, try to get clinical experience, tick off practical skills, but very little actually lecturing and learning.
I've covered the barebones of different body systems, one or two conditions from each, pharmacology (basics) correctly managing common conditions of those systems, but there are literally thousands of conditions and medicines I've not even heard mentioned at medical school, whole areas I've not touched upon, not a single real mention of surgery yet, I just don't understand what is going to happen moving forward.
Is the end goal that as an FY1, I don't yet know most conditions or medicines? If not, how will that change so drastically on placement? Just to be clear, I've covered everything objective for learning we've had. It's not that we've been taught it, but I'm rubbish. It's that we've been taught so little.
What is the actual end goal for medicine and how do we get there?
I feel like I've learned so little. I'm 2/3 lf the way through pre-clinical. The image I get of placements for those on it is that you just sort of stand around, try to get clinical experience, tick off practical skills, but very little actually lecturing and learning.
I've covered the barebones of different body systems, one or two conditions from each, pharmacology (basics) correctly managing common conditions of those systems, but there are literally thousands of conditions and medicines I've not even heard mentioned at medical school, whole areas I've not touched upon, not a single real mention of surgery yet, I just don't understand what is going to happen moving forward.
Is the end goal that as an FY1, I don't yet know most conditions or medicines? If not, how will that change so drastically on placement? Just to be clear, I've covered everything objective for learning we've had. It's not that we've been taught it, but I'm rubbish. It's that we've been taught so little.
What is the actual end goal for medicine and how do we get there?
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I have wondered this myself. It seems such a lot to learn in such a relatively short time, esp for grad med!
I am not a med student so cannot help unfortunately, but I think you may find that this will get more hits and more constructive responses if you post it in the current medical students and doctors sub forum below.
https://www.thestudentroom.co.uk/forumdisplay.php?f=356
Hope you get the clarity you are looking for !
I am not a med student so cannot help unfortunately, but I think you may find that this will get more hits and more constructive responses if you post it in the current medical students and doctors sub forum below.
https://www.thestudentroom.co.uk/forumdisplay.php?f=356
Hope you get the clarity you are looking for !
(edited 11 months ago)
GEM courses pack a lot into a short time. If I look back on the topics we've covered in the past three months alone I feel a bit dizzy. You'll be taught quite a lot more before placement, and I guarantee you already know more than you realise. It's just that the things you know will always feel minuscule next to the vast amount you don't know, and that does shake your confidence until you remember that it's simply the nature of medicine.
The aim of medical school isn't to become an encyclopaedia. It wouldn't be possible or useful to rote-learn literally thousands of conditions and their associated treatments. The aim is to acquire a sound foundational understanding of different body systems, which you can then use to solve unfamiliar problems by reasoning from first principles. It can be hard to trust this process at first. After our first SBA exam I told a tutor that I was worried by how few questions had answers that I immediately recognised as correct, and how many I'd had to tease out by process of logical elimination. She said, "That's what we're teaching you to do. There's no way to memorise everything, and patients don't always go by the book, so you need to be able to think on your feet." I think that only clicked into place for me during a hospital visit where a teaching fellow went through a stroke patient's investigation results with us. We hadn't even covered stroke at this point, but I was relieved and surprised by how much we were able to deduce from those results based on things we knew from other cases (some of which hadn't appeared relevant until the teaching fellow prodded us to think about them).
We're doing our transition to clinical years now, and we've been told that the style of teaching on placement can vary quite a lot. I doubt I know much more than you do about what to expect at this stage, but virtually everyone I've spoken to (lecturers, doctors, students in higher years) has said that it's important to be proactive in seeking out learning opportunities. At the moment it sounds as if you associate learning with lectures, and your previous posts suggest that you lean heavily on rote memorisation, so to get the most out of placement it might be helpful to adopt a more inductive approach.
The aim of medical school isn't to become an encyclopaedia. It wouldn't be possible or useful to rote-learn literally thousands of conditions and their associated treatments. The aim is to acquire a sound foundational understanding of different body systems, which you can then use to solve unfamiliar problems by reasoning from first principles. It can be hard to trust this process at first. After our first SBA exam I told a tutor that I was worried by how few questions had answers that I immediately recognised as correct, and how many I'd had to tease out by process of logical elimination. She said, "That's what we're teaching you to do. There's no way to memorise everything, and patients don't always go by the book, so you need to be able to think on your feet." I think that only clicked into place for me during a hospital visit where a teaching fellow went through a stroke patient's investigation results with us. We hadn't even covered stroke at this point, but I was relieved and surprised by how much we were able to deduce from those results based on things we knew from other cases (some of which hadn't appeared relevant until the teaching fellow prodded us to think about them).
We're doing our transition to clinical years now, and we've been told that the style of teaching on placement can vary quite a lot. I doubt I know much more than you do about what to expect at this stage, but virtually everyone I've spoken to (lecturers, doctors, students in higher years) has said that it's important to be proactive in seeking out learning opportunities. At the moment it sounds as if you associate learning with lectures, and your previous posts suggest that you lean heavily on rote memorisation, so to get the most out of placement it might be helpful to adopt a more inductive approach.
(edited 11 months ago)
Original post by TheMedicOwl
GEM courses pack a lot into a short time. If I look back on the topics we've covered in the past three months alone I feel a bit dizzy. You'll be taught quite a lot more before placement, and I guarantee you already know more than you realise. It's just that the things you know will always feel minuscule next to the vast amount you don't know, and that does shake your confidence until you remember that it's simply the nature of medicine.
The aim of medical school isn't to become an encyclopaedia. It wouldn't be possible or useful to rote-learn literally thousands of conditions and their associated treatments. The aim is to acquire a sound foundational understanding of different body systems, which you can then use to solve unfamiliar problems by reasoning from first principles. It can be hard to trust this process at first. After our first SBA exam I told a tutor that I was worried by how few questions had answers that I immediately recognised as correct, and how many I'd had to tease out by process of logical elimination. She said, "That's what we're teaching you to do. There's no way to memorise everything, and patients don't always go by the book, so you need to be able to think on your feet." I think that only clicked into place for me during a hospital visit where a teaching fellow went through a stroke patient's investigation results with us. We hadn't even covered stroke at this point, but I was relieved and surprised by how much we were able to deduce from those results based on things we knew from other cases (some of which hadn't appeared relevant until the teaching fellow prodded us to think about them).
We're doing our transition to clinical years now, and we've been told that the style of teaching on placement can vary quite a lot. I doubt I know much more than you do about what to expect at this stage, but virtually everyone I've spoken to (lecturers, doctors, students in higher years) has said that it's important to be proactive in seeking out learning opportunities. At the moment it sounds as if you associate learning with lectures, and your previous posts suggest that you lean heavily on rote memorisation, so to get the most out of placement it might be helpful to adopt a more inductive approach.
The aim of medical school isn't to become an encyclopaedia. It wouldn't be possible or useful to rote-learn literally thousands of conditions and their associated treatments. The aim is to acquire a sound foundational understanding of different body systems, which you can then use to solve unfamiliar problems by reasoning from first principles. It can be hard to trust this process at first. After our first SBA exam I told a tutor that I was worried by how few questions had answers that I immediately recognised as correct, and how many I'd had to tease out by process of logical elimination. She said, "That's what we're teaching you to do. There's no way to memorise everything, and patients don't always go by the book, so you need to be able to think on your feet." I think that only clicked into place for me during a hospital visit where a teaching fellow went through a stroke patient's investigation results with us. We hadn't even covered stroke at this point, but I was relieved and surprised by how much we were able to deduce from those results based on things we knew from other cases (some of which hadn't appeared relevant until the teaching fellow prodded us to think about them).
We're doing our transition to clinical years now, and we've been told that the style of teaching on placement can vary quite a lot. I doubt I know much more than you do about what to expect at this stage, but virtually everyone I've spoken to (lecturers, doctors, students in higher years) has said that it's important to be proactive in seeking out learning opportunities. At the moment it sounds as if you associate learning with lectures, and your previous posts suggest that you lean heavily on rote memorisation, so to get the most out of placement it might be helpful to adopt a more inductive approach.
Mmmm. I get what you mean, but still it doesn't quite sit right.
In terms of learning - I associate lectures with learning, but I'd be happy to learn through problem based clinical teaching, and about 2/3 of our objectives for learning each week are self directed study, so there's certainly a proactive approach.
I've also heard that placements depend on students being pro-active - and that makes my stomach crawl. The Idea that the amount you learn isn't standardised, depends on the doctors you're with and the level of extrovert you are... all the while essentially paying for the privilege. More terrifyingly, it seems to raise a situation In which FY1s have had different opportunities to practice and learn which is awful. Surely medical education which leads to a professional accreditation should be more standardised than that?!?!
I understand to an extent that were trained to spot patterns, but how do you put that pattern together to, for example, spot a less common arrhythmia if those arrhythmia aren't yet covered? For example, we did a four week respiratory block In which we learned four respiratory conditions... Surely, if there's no official teaching in placement and I'm not scheduled to cover respiratory again then there's something wrong there?
Bump
Original post by Ifyawanabmydr
Bump
As per my previous post.
As I suggested before - I would post in the current med students forum that I linked. The majority of readers here are aspiring med students and less likely to be able to help although theMedicOwl has kindly done so already.
Medical school exams are designed to meet standardised outcomes. Unless your med school has an unusually high attrition and failure rate, or its graduates consistently struggle to gain full registration, you'll almost certainly learn what you need to learn. This isn't to say that the curriculum must be perfect and there's no need for improvement, but if other people are succeeding there's no reason why you shouldn't be one of them.
Secondly, I think you're catastrophising here. I obviously can't speak for your med school, but I've never heard of anywhere that has no formal teaching in clinical years. As part of our clinical induction we got a tour of the hospital education block, which has a lecture theatre and seminar rooms as well as the simulation suite. There were students from a higher year using those rooms when we visited. So I doubt that placement means you'll never have another lecture again. I also think that at transitional points (e.g. preclinical to clinical year, final year to F1) people naturally tend to be more focused on their areas of weakness, which causes them to perceive the demands of the next stage as greater or at least very different from what they really are. I seriously doubt that anyone is going to expect a medical student on placement to single-handedly identify a rare arrythmia, for example. (Or to suture with confidence - a very kind surgical demonstrator had to remind me that I was getting way ahead of myself when I panicked over that!) What we can be expected to do is join dots. To go with your resp example, the main conditions we were taught about in our resp cases were COPD, asthma, and interstitial pulmonary fibrosis, but when sepsis came up in infectious diseases a few months later we were able to piece together a lot about the respiratory problems commonly seen in these patients using info about respiratory physiology that we already had. It's important to get confident at reasoning from what you know, which really will be more than you think.
There's always going to be a significant amount of uncertainty with medicine, no matter how we're taught. Our experience will be partly determined by the patients who happen to be on the ward on a given day, and it would be impossible to ensure that we all saw exactly the same conditions in similarly-presenting patients. This uncertainty is compounded by the fact that as GEM students our experiences already vary a lot. My cohort has someone who worked in health economics and statistics, former paramedics, and someone who was involved in a surgical research project. We all take different things out of every lecture or clinical situation depending on our background, which influences the questions we ask, the information that stands out as most memorable, and the things we prioritise. At first I felt as if I was at a massive disadvantage because my own background seemed much less relevant than some of the other students'. I felt I was playing catchup all the time and learning less than everyone else. It took me about eight months to discover that this isn't actually the case. It's common to underestimate what you're learning and to develop a sort of academic FOMO as a result, and as I said, I have a feeling this is probably worse at transitional points. We need to actively challenge these thoughts rather than just assume they're true.
I'll give an example of what I mean. I had three learning outcomes that I needed to get signed off, one of which was taking a history, and supposedly one day to do this in. I was assigned to theatres in the morning and to ICU in the afternoon. Taking a history isn't exactly feasible when the patients you're seeing are unconscious, intubated, or both, so I parked that idea and concentrated on learning what I could. I asked the anaesthetist lots of questions about pharmacology and practised writing a few mock prescriptions for the meds that patients often need after surgery. In ICU I had a conversation with the reg about the psychosocial needs of longer-term patients and how these can be met in the critical care setting. I have a background in mental health, so I was very interested in this side of things. Eventually I thought about how I could get my outstanding sign-off, and emailed my tutor to suggest that I pop in to ED at some point next week - there are always so many patients needing triage that it shouldn't be too difficult to get a history. This is what I meant when I spoke about being proactive. It's not about being a bubbly extrovert who tap-dances down the ward (I'm definitely not that!). It's about looking at each situation and thinking, "OK, what could I learn from this?" and being pragmatic in how you address any problems that do come up. There's no reason why a quieter person can't be just as effective at that as a more extroverted one.
Secondly, I think you're catastrophising here. I obviously can't speak for your med school, but I've never heard of anywhere that has no formal teaching in clinical years. As part of our clinical induction we got a tour of the hospital education block, which has a lecture theatre and seminar rooms as well as the simulation suite. There were students from a higher year using those rooms when we visited. So I doubt that placement means you'll never have another lecture again. I also think that at transitional points (e.g. preclinical to clinical year, final year to F1) people naturally tend to be more focused on their areas of weakness, which causes them to perceive the demands of the next stage as greater or at least very different from what they really are. I seriously doubt that anyone is going to expect a medical student on placement to single-handedly identify a rare arrythmia, for example. (Or to suture with confidence - a very kind surgical demonstrator had to remind me that I was getting way ahead of myself when I panicked over that!) What we can be expected to do is join dots. To go with your resp example, the main conditions we were taught about in our resp cases were COPD, asthma, and interstitial pulmonary fibrosis, but when sepsis came up in infectious diseases a few months later we were able to piece together a lot about the respiratory problems commonly seen in these patients using info about respiratory physiology that we already had. It's important to get confident at reasoning from what you know, which really will be more than you think.
There's always going to be a significant amount of uncertainty with medicine, no matter how we're taught. Our experience will be partly determined by the patients who happen to be on the ward on a given day, and it would be impossible to ensure that we all saw exactly the same conditions in similarly-presenting patients. This uncertainty is compounded by the fact that as GEM students our experiences already vary a lot. My cohort has someone who worked in health economics and statistics, former paramedics, and someone who was involved in a surgical research project. We all take different things out of every lecture or clinical situation depending on our background, which influences the questions we ask, the information that stands out as most memorable, and the things we prioritise. At first I felt as if I was at a massive disadvantage because my own background seemed much less relevant than some of the other students'. I felt I was playing catchup all the time and learning less than everyone else. It took me about eight months to discover that this isn't actually the case. It's common to underestimate what you're learning and to develop a sort of academic FOMO as a result, and as I said, I have a feeling this is probably worse at transitional points. We need to actively challenge these thoughts rather than just assume they're true.
I'll give an example of what I mean. I had three learning outcomes that I needed to get signed off, one of which was taking a history, and supposedly one day to do this in. I was assigned to theatres in the morning and to ICU in the afternoon. Taking a history isn't exactly feasible when the patients you're seeing are unconscious, intubated, or both, so I parked that idea and concentrated on learning what I could. I asked the anaesthetist lots of questions about pharmacology and practised writing a few mock prescriptions for the meds that patients often need after surgery. In ICU I had a conversation with the reg about the psychosocial needs of longer-term patients and how these can be met in the critical care setting. I have a background in mental health, so I was very interested in this side of things. Eventually I thought about how I could get my outstanding sign-off, and emailed my tutor to suggest that I pop in to ED at some point next week - there are always so many patients needing triage that it shouldn't be too difficult to get a history. This is what I meant when I spoke about being proactive. It's not about being a bubbly extrovert who tap-dances down the ward (I'm definitely not that!). It's about looking at each situation and thinking, "OK, what could I learn from this?" and being pragmatic in how you address any problems that do come up. There's no reason why a quieter person can't be just as effective at that as a more extroverted one.
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