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Thursday, May 11th 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.

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, of which these fluff classes no doubt contribute. Although my school doesn’t have required art appreciation courses (from Orac), I get the sense that these courses are just part of the problem.

I hear it all the time, 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.

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, do we really need to memorize the Krebs Cycle.

From physicians I’m close to, I think any objective, thoughtful look back by a physician reveals just how much s/he had to memorize during the first two years of their medical education which was rarely if ever relevant again?

Are the basic science years an important, invaluable part of any physician’s medical education? Of course. And yes, I need a stronger foundation in the sciences than a PA or a Nurse Practitioner. This post is merely to raise questions on the way the basic science years are taught and their incredibly growing breadth.