Is UOttawa a low tier medical school?

[la marzocco]

25 minutes ago, Edict said:

I think specifically it was the balance of social medicine vs clinical medicine at Mac particularly. There was very little clinical medicine teaching at Mac, huge topics were covered in a single lecture or a simple tutorial, with little oversight. Our only CXR teaching was 1 hour on normal and 1 hour on abnormal x-rays. We spent a full 3 hours each week discussing social medicine topics. Some of the tutors were not physicians, one only had a masters degree, which meant for that entire unit, the group had essentially no one to lead them through a very complex and challenging organ system. I don't mind having the social medicine at all, but not when there is barely enough teaching of clinical medicine itself. It is all easy to say "physician teach thyself", but if that's the case, why are we paying 27000 a year again? Definitely, without any guidance, no one can feasibly distinguish what is important and what isn't important. Some students insisted on the importance of the molecular aspects of medicine in tutorial only to later confess after clerkship that all that ended up being useless.

UofA itself may have been different, I know UofA tends to lean more traditional and may have had a better balance. 

Even now, nurses are surprised when they find out how little we know about practical day to day things on the ward, like rectal tubes, PEG tubes, NG tubes, much of this you have no idea about until you hit clerkship and some of it, you only find out in residency.

In perclerkship, I found McGill to be very focused on the basic sciences - we seem to focus a lot on the basic physiology of the organ system then piling on pathophysiology, then pharm, etc.

We had a whole block dedicated to social medicine, etc., and Indigenous/PH theme is weaved in during preclerkship longitudinally. We have way too many lectures imo. We have at least 3 hours of lectures every day, plus small group/CBL in the afternoon for 2-3 afternoons each week.

[la marzocco]

we are comparing 3-yr versus 4-yr schools. Pacing is obviously very different and everyone works differently and have a different experience with the cadence.

[Edict]

13 minutes ago, la marzocco said:

 In perclerkship, I found McGill to be very focused on the basic sciences - we seem to focus a lot on the basic physiology of the organ system then piling on pathophysiology, then pharm, etc.

We had a whole block dedicated to social medicine, etc., and Indigenous/PH theme is weaved in during preclerkship longitudinally. We have way too many lectures imo. We have at least 3 hours of lectures every day, plus small group/CBL in the afternoon for 2-3 afternoons each week.

That sounds like a proper medical school curriculum haha. 

[Aetherus]

Unfortunately I think the emphasis on social medicine is caused by the accreditation process and is most likely a problem at most Canadian schools who do well on the accreditation process. Furthermore, I felt like the curriculum at Queen’s was heavily influenced by political topics. I fail to understand why certain topics such as OB/GYN and Psychiatry got a 1 month course in PreClerkship as well as a 6 week clerkship rotation. This is in contrast to Ophtho, Derm, Pathology, ID, Neuro getting quite limited exposure. 

[medigeek]

The american classic curriculum of heavy basic sciences first then heavy clinical sciences is ideal and schools resembling that like uoft or mcgill will be more optimal for a greater knowledge base.

Rotation quality is what ultimately matters though. Anyone can (and everyone should) study for usmle step 2, if they want a truly strong knowledge base. But hands on training is done during rotations, and not during CBL. 

[la marzocco]

27 minutes ago, Aetherus said:

Unfortunately I think the emphasis on social medicine is caused by the accreditation process and is most likely a problem at most Canadian schools who do well on the accreditation process. Furthermore, I felt like the curriculum at Queen’s was heavily influenced by political topics. I fail to understand why certain topics such as OB/GYN and Psychiatry got a 1 month course in PreClerkship as well as a 6 week clerkship rotation. This is in contrast to Ophtho, Derm, Pathology, ID, Neuro getting quite limited exposure. 

i can see why psych would get overrepresented. i think all schools are really pushing for more primary care exposure as a career path. we have similar at mcgill too - longitudinal family medicine, a lot of psychiatry exposure etc

https://www.mcgill.ca/ugme/files/ugme/curriculum_schema_en.pdf

[Monkey D. Luffy]

27 minutes ago, medigeek said:

The american classic curriculum of heavy basic sciences first then heavy clinical sciences is ideal and schools resembling that like uoft or mcgill will be more optimal for a greater knowledge base.

Rotation quality is what ultimately matters though. Anyone can (and everyone should) study for usmle step 2, if they want a truly strong knowledge base. But hands on training is done during rotations, and not during CBL. 

U of T's curriculum does not resemble that at all anymore.

[medigeek]

4 minutes ago, Monkey D. Luffy said:

U of T's curriculum does not resemble that at all anymore.

Well you get my point  

Very in-depth knowledge, especially in internal medicine, matters. It guides your differential diagnosis and your management options. A good student can name 10 causes for elevated ALT AST off the top of their head and the work up for each of them. That kind of stuff matters more than social sciences as it is what separates us from NPs etc. 

[la marzocco]

12 minutes ago, medigeek said:

Well you get my point  

Very in-depth knowledge, especially in internal medicine, matters. It guides your differential diagnosis and your management options. A good student can name 10 causes for elevated ALT AST off the top of their head and the work up for each of them. That kind of stuff matters more than social sciences as it is what separates us from NPs etc. 

Risking to be more tangential to the thread.. but I am very curious to see what will happen between family medicine and the NPs' expansion of scope.. Even physician assistants are arguing for more legal recognition by the provinces. 

[GH0ST]

I get where people are coming from and to be fair that kind of shows in what you're practicing now... ofc those interested in internal or surgery will be less interested in PHPM related topics and societal aspects of medicine while those in a primary care setting (and to some extent psych and EM) may care more... but honestly the attitudes reflected here honestly suggests that these topics are less important or not medicine... which isn't true when physicians play a big role in societal change and influencing future health in our communities. 

I mean I'm not saying everyone should be MOH's but still... the level of apathy towards these important social topics is disheartening... 

- G

[la marzocco]

7 minutes ago, GH0ST said:

I get where people are coming from and to be fair that kind of shows in what you're practicing now... ofc those interested in internal or surgery will be less interested in PHPM related topics and societal aspects of medicine while those in a primary care setting (and to some extent psych and EM) may care more... but honestly the attitudes reflected here honestly suggests that these topics are less important or not medicine... which isn't true when physicians play a big role in societal change and influencing future health in our communities. 

I mean I'm not saying everyone should be MOH's but still... the level of apathy towards these important social topics is disheartening... 

- G

I don't think anyone is disagreeing that public health and broaden SDOHs are important topics and yes doctors can and should use their privileged position to advocate for broaden societal changes. But we shouldn't forget that the "medical expert" is still at the centre of the CanMEDS competencies. Clinical medicine should still be at the core of the development of the physician. Social accountability and health advocacy are a tenet of CanMEDS - and yes, awareness of SDOH and public health are important. 

[GH0ST]

9 minutes ago, la marzocco said:

I don't think anyone is disagreeing that public health and broaden SDOHs are important topics and yes doctors can and should use their privileged position to advocate for broaden societal changes. But we shouldn't forget that the "medical expert" is still at the centre of the CanMEDS competencies. Clinical medicine should still be at the core of the development of the physician. Social accountability and health advocacy are a tenet of CanMEDS - and yes, awareness of SDOH and public health are important. 

No I get that point as well... just in practice I see a lot of docs just scoff at public health or think that good public health practice is just referring someone to a social worker and be done with it...

To balance the health inequity that contributes to patients repeatedly visiting the ER or being readmitted over and over again... there's so much we all can do and I'd argue that helping with disposition is as critical as managing their physical ailments. 

Even physicians getting better at utilizing or having knowledge of different services available in the community can be a big help for patients. Another is putting some more emphasis on the social history beyond substance use.  

Just my pet peeve and I doubt I'd really change anyone's opinion here but I do hope that with our privileged position we also try to be better engaged with the community for the better... we are capable of a lot for the preservation and improvement of our nation's longevity. 

- G 

[medigeek]

41 minutes ago, la marzocco said:

Risking to be more tangential to the thread.. but I am very curious to see what will happen between family medicine and the NPs' expansion of scope.. Even physician assistants are arguing for more legal recognition by the provinces. 

Can't get worse than USA where they're running doctors over. They have an enormous army which is the key difference. 

 

20 minutes ago, GH0ST said:

I get where people are coming from and to be fair that kind of shows in what you're practicing now... ofc those interested in internal or surgery will be less interested in PHPM related topics and societal aspects of medicine while those in a primary care setting (and to some extent psych and EM) may care more... but honestly the attitudes reflected here honestly suggests that these topics are less important or not medicine... which isn't true when physicians play a big role in societal change and influencing future health in our communities. 

I mean I'm not saying everyone should be MOH's but still... the level of apathy towards these important social topics is disheartening... 

- G

New FM grads get hate for not doing seeing their own inpatients or not being competent enough to work in the ER. It's bad enough that they came down with restrictions for new FM grads to have some sort of supervisor in the ED.

This is largely what happens when you put clinical knowledge aside and focus on other things. Developing in-depth knowledge takes time. I did uworld step 2 twice, did step 3 uworld 1.5x and did the internal medicine residency boards uworld once + mksap just as a pre-residency run. 

A lot of the social elements are heavily based on regional logistics and institutional protocols too. You can't educate yourself for those. You adapt to the setting you train and work in. 

[xiphoid]

5 hours ago, Aetherus said:

Unfortunately I think the emphasis on social medicine is caused by the accreditation process and is most likely a problem at most Canadian schools who do well on the accreditation process. Furthermore, I felt like the curriculum at Queen’s was heavily influenced by political topics. I fail to understand why certain topics such as OB/GYN and Psychiatry got a 1 month course in PreClerkship as well as a 6 week clerkship rotation. This is in contrast to Ophtho, Derm, Pathology, ID, Neuro getting quite limited exposure. 

This.

I've always considered myself pretty left-leaning, but I've found that quite of bit of the curriculum that is not based on hard and fast facts (e.g. not anatomy, physiology, etc.) is pretty SJW-y and presents the personal opinions of the lecturers as the only truly acceptable opinion as endorsed by the medical school. I've never felt more censored in my life, and I've sat through more than one of those panels and lectures feeling myself getting very upset but not feeling able to excuse myself to calm down because of what the optics would be. I can't imagine what it's like for my conservative classmates.

[GH0ST]

16 hours ago, medigeek said:

Can't get worse than USA where they're running doctors over. They have an enormous army which is the key difference. 

 

New FM grads get hate for not doing seeing their own inpatients or not being competent enough to work in the ER. It's bad enough that they came down with restrictions for new FM grads to have some sort of supervisor in the ED.

This is largely what happens when you put clinical knowledge aside and focus on other things. Developing in-depth knowledge takes time. I did uworld step 2 twice, did step 3 uworld 1.5x and did the internal medicine residency boards uworld once + mksap just as a pre-residency run. 

A lot of the social elements are heavily based on regional logistics and institutional protocols too. You can't educate yourself for those. You adapt to the setting you train and work in. 

I totally agree with you that there's a lot of work that needs to be done also to hone our clinical medicine... I for one have no intention of losing my clinical training even in an MOH role in the future....

I know for a number of students it's probably not something they are interested in... I also see a lot of physicians after their training want to do more and pursue public health oriented activities when they see the same patient return repeatedly because they can't afford their meds, or they struggle with addictions, etc.... 

There's obviously a responsibility for medical schools to teach as much clinical medicine as possible, but I find that the amount of students that roll their eyes around public health education to be disheartening. 

And to be completely honest... not everyone wants to do inpatient work after graduating medicine. 

Anyways I think I'm probably talking too much about this topic and people are already rolling their eyes at me. I'll leave this topic alone for now. 

- G

[Edict]

22 hours ago, medigeek said:

Can't get worse than USA where they're running doctors over. They have an enormous army which is the key difference. 

 

New FM grads get hate for not doing seeing their own inpatients or not being competent enough to work in the ER. It's bad enough that they came down with restrictions for new FM grads to have some sort of supervisor in the ED.

This is largely what happens when you put clinical knowledge aside and focus on other things. Developing in-depth knowledge takes time. I did uworld step 2 twice, did step 3 uworld 1.5x and did the internal medicine residency boards uworld once + mksap just as a pre-residency run. 

A lot of the social elements are heavily based on regional logistics and institutional protocols too. You can't educate yourself for those. You adapt to the setting you train and work in. 

Yes, I agree. I think I was most blown away with what one "could" potentially get away with at Mac. If you aimed for a less competitive specialty like family, you could potentially coast and end up 2 years of residency later making real staff level calls with what I would argue is limited knowledge. 

It is all nice to teach social medicine, but not at the expense of clinical medicine, which is really our basic job requirements at the end of the day. I mean, we haven't even talked about how surgery has essentially all but disappeared from the preclerkship curriculum at some schools. 

 

 

[thesupreme]

..

[1D7]

IMO the bigger problem is that most medical school curricula are just cobbled together with no real care. 1.5 years is enough to teach the clinical sciences and the relevant basic sciences (i.e. go through Step 1 & 2 board prep material), and 2 years is definitely enough to add some social sciences on top of that. However, at my school most lectures were inefficient and many were outright terrible. There is also not much student motivation to learn in M1-M2 beyond passing, which leads to poor long-term retention of knowledge.

With regards to social issues, it is important to expose students to these ideas because many wouldn't touch it otherwise. Many students come from privileged backgrounds and exposure to these ideas early on lets them digest it throughout medical school. Overall though the pendulum has probably swung too far at most schools.

[JohnGrisham]

On 11/27/2018 at 6:15 PM, medigeek said:

This is largely what happens when you put clinical knowledge aside and focus on other things. Developing in-depth knowledge takes time. I did uworld step 2 twice, did step 3 uworld 1.5x and did the internal medicine residency boards uworld once + mksap just as a pre-residency run.

Now that is gunning hard, i hope you're going into Infectious Disease with the level of strength of background you had pre-residency.

[medigeek]

21 minutes ago, JohnGrisham said:

Now that is gunning hard, i hope you're going into Infectious Disease with the level of strength of background you had pre-residency.

Haha why ID? 

[JohnGrisham]

42 minutes ago, medigeek said:

Haha why ID? 

IMO generally very broad knowledge sets and intellectuals hah.  That or Med Onc. 

[medigeek]

7 minutes ago, JohnGrisham said:

IMO generally very broad knowledge sets and intellectuals hah.  That or Med Onc. 

I like critical care tbh. ID I do like a lot yes but I like being hands on and placing lines/intubating etc.

[Edict]

21 hours ago, medigeek said:

I like critical care tbh. ID I do like a lot yes but I like being hands on and placing lines/intubating etc.

I would argue that CC requires more broad based knowledge than ID. A lot of ID day to day is algorithms and following a few set ones. They see a huge breadth of patients, many of them complex, but ID generally does the simple, which abx to give and leaves. 

[medigeek]

On 11/28/2018 at 1:59 PM, GH0ST said:

I totally agree with you that there's a lot of work that needs to be done also to hone our clinical medicine... I for one have no intention of losing my clinical training even in an MOH role in the future....

I know for a number of students it's probably not something they are interested in... I also see a lot of physicians after their training want to do more and pursue public health oriented activities when they see the same patient return repeatedly because they can't afford their meds, or they struggle with addictions, etc.... 

There's obviously a responsibility for medical schools to teach as much clinical medicine as possible, but I find that the amount of students that roll their eyes around public health education to be disheartening. 

And to be completely honest... not everyone wants to do inpatient work after graduating medicine. 

Anyways I think I'm probably talking too much about this topic and people are already rolling their eyes at me. I'll leave this topic alone for now. 

- G

Well it's easier to learn public health later than to learn clinical medicine later once you already have patients who rely on you. And outpatient management on its own is important so that we don't become refer everything out.