Thoughts on medical school and the USMLE

Well, now that the USMLE Step 1 and two years of medical school are out of the way, I thought I’d write a brief reflection on the experience including my thoughts on what was good, what was bad and how it can be improved. I’ve actually been meaning to write this for some time but my thoughts have been concentrated on other matters.

For those who do not know, medical school is a four year program that culminates with one’s receipt of the Doctor of Medicine (MD) degree or the Doctor of Osteopathic Medicine (DO) degree. The two are equivalent though the DO is less recognized outside the United States than the MD. My studies have been in pursuit of the allopathic degree (MD) and thus I can only offer limited commentary on the process involved in earning the DO. The course work as presented at my medical school is as follows (courses listed in no particular order)

Year 1 Courses Year 2 Courses
Anatomy Pathology
Histology Microbiology
Biochemistry Nutrition
Bioethics Communication and Physical Diagnosis
Physiology Introduction to Clinical Medicine
Neuroscience Pathophysiology
Immunology Basic Science Foundation for Clinical Reasoning
Parasitology Pharmacology
Genetics Behavioral Science/Biostatistics/Jurisprudence
Community and Preventive Medicine

These first two years comprise the basic sciences underlying the practice of westernized medicine. As you can tell, there is great emphasis on learning how the human body operates in the first year and great emphasis on what goes wrong in the second year. For the most part, the information learned is interesting but it’s not always relevant to day-to-day clinical practice. I’ve been told by a number of practicing physicians that biochemistry should be scaled way back and replaced with more anatomy and physiology.

Neuroscience was AWESOME and had a couple of my favorite professors, including a very well-educated German guy that I kept expecting to say “How could you not know this? I knew the corticospinal tract when I was 5. They teach it on Blue’s Clues.”

Biochemistry was also a great course and had two of my favorite professors, both English guys. One was totally laid back and funny, the other had an attitude about him that didn’t come off as offensive but rather as humorous. I remember facilitating small groups in Term 1 and being disappointed when he wasn’t the facilitator trainer. Brilliant guy. But back to biochem – lots of pathways and enzymes to remember but if you make a game out of it, it’s not too bad. It was one of my favorite courses. “The glucose goes to the gly-coly-sis, the glycolysis head to the T-C-A, the T-C-A makes some A-T-P, and gives Repubs the power to be a douch.” Not really one of my rhymes but you get the idea.

Physiology was also very interesting, especially if you’re into math and physics. Lots of equations to be had and when you get bored, you can do derivations and substitutions to relate things together and yield needlessly complicated equations. “Oh, you need to solve that cardiac curve? Well, let’s start with a triple integral…”

Pathology is… well, pathology. They had a lab for us – 2 hours per day, every day – where we looked at slides and made up reports to present to the group. This was largely a waste of time as there was little to no guidelines on what information was important and what was just “nice to know.” If I were running the school, I’d drop this like George W. Bush dropped the hopes and dreams of America. That said, the class was interesting with lots of cool pictures and diseases about which to learn (well, cool to all but those affected by them). I think a pop-up book would be great for pathology. Think about it: A pop-up page of colon cancer. That’ll stick in your head guaranteed.

Pharm sucked. Lots of drugs and side-effects that I’ll just look up with Merck if I need to. I’d never prescribe a drug without first double-checking to see if it’s safe anyways.

Nutrition – Don’t eat Big Macs and Taco Bell everyday. Eat fruit and veggies. Drink water. Pretty simple stuff.

Bioethics – “Here’s my opinion on how things should be done based on some guy you may or may not agree with. But dammit, that’s how I’m testing it so learn it!”

Histology – “Look at that puppy! Take note, take note, take note”. Lots of pictures and text to go with them. Not too hard to remember if you’re a visual person or male. Males are visually-orientated…. wait, scratch that. That’s usually a selective visual orientation.

Immunology, Parasitology, Genetics – All cool classes and pretty short. Not too hard and the bugs you learn about in parasitology are wild, wild, wild. They have some specimens of elephantiasis (NOT elephantitis – your elephant is not inflamed!) at the National Museum of Health and Medicine in Washington, D.C. Very cool to see if you’re in the area or can manage a left click on this link.

Summary: For the practice of Western medicine, medical school is a valuable and necessary experience as it provides the educational foundation one needs to work as a capable physician. Yes, it’s in red for you ADD’ers out there so you can cut to the chase.

Now to the USMLE Step 1. This exam is 7 hours long and contains 336 questions, the breakdown being 7 one-hour blocks of 48 questions each. The exam’s purpose is “to assess whether an examinee understands and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy” (Source: USMLE score report).

Overall, not too bad of an exam and one you’ll be prepared for based on your medical school studies. You’ll finish your second year, buy some review books ($$) or take a review course ($$$$$), go to your booked exam (~$710), and take it. Each question is multiple choice and may have more than 5 choices. I remember one for me had ~10 choices but luckily 7 of them made no sense whatsoever. Once it’s all over, you’ll probably feel ok about the exam yet taken advantage of by the exorbitant and ridiculous amounts of money you had to spend to do it. Let no one ever say these guys don’t know how to make a buck.

If you haven’t figured it out by now, I ALWAYS have an opinion and I don’t mind sharing. This test could be redone in a smarter way that better reflects the real practice of medicine. I say keep the number of questions and time as-is but give access to the internet and a Merck manual during the exam just like a real doctor would use. Sure, some may not pass or do poorly if you have to try to memorize everything from the first two years and some would use this as a weak, asinine “weed out” argument but here’s a secret: Most practicing docs probably don’t know all that information either. You know what they do have though? Books and the internet. Make it a realistic simulation of medical practice and force people to spend some time during the first two years learning how to integrate technology, perform rapid information retrieval and and integrate new information in real-time. To me, that’s a MUCH more useful exam than the USMLE as it currently exists.

Anyways, as a med student, you’ll take the exam and then go party/drink/hook up/whatever you want to do. It’s an individual thing. You’ll wait three weeks and then receive a report with Pass/Fail, a 3 digit score and a 2 digit score that helps determine what kind of doctor you’ll be. It’s not the only determinate (also clerkship grades, Step 2, personal connections, etc.) but it’s a very important one. In the end, two years of your life, countless hours and sleepless nights will all boil down to one thing and one thing alone. One word that will determine your next step in life.


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