Why you should pick McMaster?

[Persephone]

1 hour ago, Aetherus said:

I don’t mean to be perceived as rude but your comment reinforces my point. 

Firstly, I am not sure how you qualify that most students do well. There is no real metric that successfully evaluates the competence of students. The P/F system masks any possible deficiencies and the only thing remaining to evaluate students is based on your interactions with them. As a resident, I can tell you that on average, I have been unimpressed by the students that are in three year programs. Are there superstars that shine despite this handicap, absolutely, but if you are an average medical students, the 3 year program is a disservice. 

Secondly, your comment that you wanted to do Psychiatry before entering medical school speaks exactly to my point that the curriculum does not force you to be a well rounded clinician. People can come in with an idea in mind of what they want to do in their career and coast through the remainder of the curriculum without being required to truly learn the material. 

Will the differences in training dissipated through residency, yes. However, I do think that an average student at a three year program will be less prepared when entering residency.

I mean the overwhelming majority are able to pass their MCCQE part 1 (at similar rates as 4 year schools as far as I know), and start residency with few issues. There's some evidence that Mac students, while having less breadth of knowledge on leaving medical school, end up surpassing 4 year school students in terms of knowledge by the end of residency because of the learning model that's instilled during medical school. In the end, 3 year schools produce competent physicians, just like 4 year schools. I feel like this debate has been had so many times on this forum at this point. There are pros and cons to each, you have to just decide what you're more comfortable with, if you even end up having the luxury of choosing between a 4 year and 3 year school. I did have that luxury and I am simply glad to be finished haha. It's a marathon in either model.

That's unfortunate about the fellowship thing, I have never heard of that happening before, it seems like a stupid bureaucratic obstacle and not at all reasonable.

[Persephone]

16 minutes ago, Persephone said:

Secondly, your comment that you wanted to do Psychiatry before entering medical school speaks exactly to my point that the curriculum does not force you to be a well rounded clinician. People can come in with an idea in mind of what they want to do in their career and coast through the remainder of the curriculum without being required to truly learn the material. 

I neglected to address this part of your reply. I was in fact forced to be a well-rounded physician, I just didn't need an extra year of exploring to figure out what I wanted to be. I had to learn all sorts of things I had no interest in and had to demonstrate my competency in them at multiple points! lol I find it kind of presumptuous that you assume how well rounded I am because I was focused in on psychiatry early?

Part of how we were required to demonstrate broad based competency was through end of clerkship rotation exams (we use the NBME shelf exams for several of them, and the ones that don't are similar in style and difficulty level), another part was through documented observation of clinical skills by preceptors on each core rotation. I was also quizzed by preceptors on rotations that weren't psychiatry just like any other school and expected to read on my off time. We also had progress index exams that let us know if we were keeping up with the rest of the class every few months and are somewhat correlated to performance on the MCCQE Part 1. I feel you speak with a level of authority on the topic of Mac's curriculum that is not justified.

[jb24]

37 minutes ago, Persephone said:

I mean the overwhelming majority are able to pass their MCCQE part 1 (at similar rates as 4 year schools as far as I know), and start residency with few issues. There's some evidence that Mac students, while having less breadth of knowledge on leaving medical school, end up surpassing 4 year school students in terms of knowledge by the end of residency because of the learning model that's instilled during medical school. In the end, 3 year schools produce competent physicians, just like 4 year schools. I feel like this debate has been had so many times on this forum at this point. There are pros and cons to each, you have to just decide what you're more comfortable with, if you even end up having the luxury of choosing between a 4 year and 3 year school. I did have that luxury and I am simply glad to be finished haha. It's a marathon in either model.

That's unfortunate about the fellowship thing, I have never heard of that happening before, it seems like a stupid bureaucratic obstacle and not at all reasonable.

I don't buy that at all, but I would love to see the evidence that suggests this.

You learn everything in residency anyway. Although I do think it helps to have more elective time after a full third year of core rotations in terms of performing better on electives.

[Aetherus]

2 hours ago, Persephone said:

Most people do well at Mac, so I don't know if there's an argument to be made to say that only some do well, but certainly it is better suited to certain types of people than others. Being a non-trad with a humanities background, I could have definitely benefited from more structure and guidance on what to study, but I also knew I wanted psychiatry before entering medical school and as an older student coming in with more debt, 3 years was ideal. I would say the school could definitely do better for our struggling students, but I've heard similar sentiments from students at other schools, that academic support is often limited at best. That's been my impression at least.

I apologize. I interpreted this sentence as you lacked structured and guidance in what to study, but it did not matter as you knew you wanted to go into Psychiatry anyways. 

In terms of your other comment about the LMCC Part 1, I am sure that Mac med students do just as well as other schools. My point was more that the LMCC is a poor measure of competency and that we do not have any good metric to really compare medical students from different schools. 

With regards to me commenting on Mac Med’s curriculum specifically, if you go back through my posts, I have not mentioned Mac Med specifically at all. I have talked about 3 year programs as a whole. I do not claim to know the intricacies of the Mac Med curriculum. But I have had some experience with clerks from 3 year programs and overall have been underwhelmed. That being said, I have also seen some of the best medical students I have worked with come from these schools. 

[Persephone]

10 minutes ago, jb24 said:

I don't buy that at all, but I would love to see the evidence that suggests this.

You learn everything in residency anyway. Although I do think it helps to have more elective time after a full third year of core rotations in terms of performing better on electives.

We were showed some data from a study during O-week! I don't remember what particular study it was from but that's what it claimed! I think it was comparing U of T and Mac grads.

I don't disagree with your latter point, I would very much have preferred not to have had early electives, especially in psychiatry, which requires confidence in your ability to keep up a patient interaction for more than an hour long period, kind of daunting! They do have fewer electives early on now though, so things are improving on this front. More clinical time certainly cannot hurt, especially if you're a young  and indecisive med student. I do think 3 year schools are better suited to people who know themselves a bit better, and older students just tend to have a better sense of what they want out of life. That being said most of our students are the "traditional" age for a medical student and most of them figure it out in time to match to their top choices.

[bearded frog]

16 hours ago, Aetherus said:

In my opinion, there is no question that the quality of education is far superior in a 4 year program

In my opinion, a lax curriculum coupled with 3 years of schooling is a recipe to create poor clinicians or at the very least unbalanced clinicians.

Please point me to any data that shows that Mac and Calgary do worse than the other schools in Canada when it comes to LMCC1 or LMCC2 performance, residency matching, residency board exams, fellowship matching, college complains, CMPA lawsuits, faculty positions, research funding/publications, or literally any other objective measurement.

Until you do you're frankly just spouting BS.

14 hours ago, Aetherus said:

Another aspect that I forgot to mention in my previous post is that the 3 year program is not recognized in certain countries. This can end up being a big deal for fellowships (I know someone who had a top fellowship lined up in England that fell through because her MD was not recognized).

Citation needed. The UK licensing authority has no problem with accredited three year medical degrees.

[Aetherus]

5 minutes ago, bearded frog said:

Please point me to any data that shows that Mac and Calgary do worse than the other schools in Canada when it comes to LMCC1 or LMCC2 performance, residency matching, residency board exams, fellowship matching, college complains, CMPA lawsuits, faculty positions, research funding/publications, or literally any other objective measurement.

Until you do you're frankly just spouting BS.

Citation needed. The UK licensing authority has no problem with accredited three year medical degrees.

I prefaced my statement with “In my Opinion”. You are welcome to disagree. As I’ve mentioned previously, I think you would be hard pressed to get anyone to agree that the LMCC is a good metric of competency. It’s a poorly designed exam that provides little information on the competency of the practitioner. Furthermore, I’ve stated that residency equalizes the playing field so frankly the remainder of the metrics you mentioned are inconsequential. My main point is that a three year program puts you at a disadvantage from a clinical standpoint when compared to 4 year schools. However this is not insurmountable and many will do well. My experience is that once in residency, where you have gone to medical school has no influence on how good of a clinician you are. But I do suspect the learning curve initially may be steeper for people from 3 year schools.

Finally I would be interested if you could provide the data you had mentioned.

(PS I’m not trying to say that students at 3 year programs make less competent physicians at the end of training, that is untrue. I am trying to point out that the jump to residency may be more challenging for the average medical student in a 3 year program vs an average medical student in a 4 year program)

[1D7]

My experience is that Mac medical students are not as well rounded in terms of knowledge, especially in fields heavy in anatomy or anything related to the more esoteric topics like embryology. Some of it I think is because some elective rotations are done really early on in clerkship (whereas most other schools have you finish core rotations first).

This isn't some hidden secret... Quite a few of the senior residents and attendings on my surgery rotations had similar thoughts.

Anyway I think in the end people end up fine in residency and beyond since lacking knowledge outside your own field is rarely critical for patient care.

[indefatigable]

2 hours ago, 1D7 said:

My experience is that Mac medical students are not as well rounded in terms of knowledge, especially in fields heavy in anatomy or anything related to the more esoteric topics like embryology. Some of it I think is because some elective rotations are done really early on in clerkship (whereas most other schools have you finish core rotations first).

This isn't some hidden secret... Quite a few of the senior residents and attendings on my surgery rotations had similar thoughts.

Anyway I think in the end people end up fine in residency and beyond since lacking knowledge outside your own field is rarely critical for patient care.

The school that I went to, in QC, was a 4-year school that was built on the same model as Mac - i.e. PBL and early-electives.

I think it had similar curricular weaknesses - anatomy, etc.. although unlike Mac this was coupled with lack of research and other opportunities.  

That being said, students at French-speaking schools tend to only compete against themselves given the language barrier (with UdeM students typically ahead).  For the few that attempted to match more broadly, they were sometimes fairly disadvantaged by all these factors - it was pretty much match at home school or not for most surgery gunners (with some exceptions).   In fact, I saw much more emphasis  on anatomy in early residency in one surgery "home school" program likely due to this relative weakness.   

Still, I think if Mac were one's only Med school offer it could work - almost infinitely more tractable than the "language barrier" that I faced.  It would just be a matter of being pro-active and realizing for surgery especially that anatomy/exposure may be a relative weakness.  

 I mean I'm sure Mac graduates have matched to anything and everything - it's just harder and one has relatively less opportunity/chances in some cases to explore and be competitive.  Surgery is very particular though and it's worth knowing this going in.  

[zxcccxz]

6 hours ago, Aetherus said:

I prefaced my statement with “In my Opinion”. You are welcome to disagree. As I’ve mentioned previously, I think you would be hard pressed to get anyone to agree that the LMCC is a good metric of competency. It’s a poorly designed exam that provides little information on the competency of the practitioner. Furthermore, I’ve stated that residency equalizes the playing field so frankly the remainder of the metrics you mentioned are inconsequential. My main point is that a three year program puts you at a disadvantage from a clinical standpoint when compared to 4 year schools. However this is not insurmountable and many will do well. My experience is that once in residency, where you have gone to medical school has no influence on how good of a clinician you are. But I do suspect the learning curve initially may be steeper for people from 3 year schools.

Finally I would be interested if you could provide the data you had mentioned.

(PS I’m not trying to say that students at 3 year programs make less competent physicians at the end of training, that is untrue. I am trying to point out that the jump to residency may be more challenging for the average medical student in a 3 year program vs an average medical student in a 4 year program)

I'm not quite a whiz with the data as BeardedFrog is, but I think most of the data he referenced can be found online.

For example, UofC med publishes outcomes for their graduates on their website: https://cumming.ucalgary.ca/mdprogram/about/governance/national-ranking-outcome-measures

Most relevant to your points may be this survey of residency program directors regarding the performance of UofC graduates compared to graduates of other medical schools.

 

Other data such as match data is easily available through CaRMS and also I summarized some of it in a previous post: https://forums.premed101.com/topic/112747-why-did-you-choose-ucalgary-medical-school/?tab=comments#comment-1233746

I do understand your concerns though. I had heard many of these same things when I was debating between 3y vs. 4y programs. Ultimately, after looking at the data more closely I came to the conclusion that 3y program students don't fare any worse than their 4y counterparts. One thing I will say is that I have (anecdotally) noticed that UofC med students are less basic science proficient and if I had to guess it probably largely has to do with the fact that the admissions process purposefully selects for non-traditional applicants who don't have to perform well on the science sections of the MCAT to gain admission. But again, I don't think there's any evidence to suggest that this affects their ability to suceed as pre-clerks/clerks/residents.

[zoxy]

1 hour ago, zxcccxz said:

I'm not quite a whiz with the data as BeardedFrog is, but I think most of the data he referenced can be found online.

For example, UofC med publishes outcomes for their graduates on their website: https://cumming.ucalgary.ca/mdprogram/about/governance/national-ranking-outcome-measures

Most relevant to your points may be this survey of residency program directors regarding the performance of UofC graduates compared to graduates of other medical schools.

I'm not commenting on the quality of Mac and UCalgary trainees and as I commented in the post that you linked, I think that Calgary and Mac students do fine when it comes to matching. But there's an inherent problem with this form of evaluation surveys that uses the "stronger than most, average, weaker" criteria. In these sort of evaluations, like when writing reference letters, it's a death knell to numerically place a candidate anywhere but in the top 10-5 percent even though it should theoretically be fine. 

I'd bet that every Canadian medical school would have a similar distribution if this survey was sent to program directors. While it makes no statistical sense to evaluate everyone as above average, this form of evaluation always leads to nonsensical results. So I don't think the results of this survey is valid.

[Aetherus]

I agree with Zoxy. I commend the effort of UofC to be transparent with their data. Unfortunately this survey has limited validity. 

I don't think it's far fetched to say that having an extra year of training makes most average applicants better clinicians in the short term. If the extra year was useless, we would have more than two 3 year schools. 

Its the same way that many American Specialities (Ophtho, Neuro etc) are Four years instead of the five years in Canada. Mid career it doesn't make a difference anymore, but for recent graduates...the Canadians are much more competent.

[zoxy]

1 hour ago, Aetherus said:

we would have more than two 3 year schools

Something that several American schools have is the option of doing a 3 year degree while the default remains the 4 year degree. These programs are usually geared towards producing FMs or rural specialists. McMaster is actually somewhat of a leader and trendsetter in getting universities to offer this option.

NYU's 3-year program though is unique in that it guarantees its 3 year program candidates a residency at NYU in things like Neurosurgery or Integrated Cardiothoracic. Interestingly MUSC and Duke have an accelerated program but only in Ortho. I guess you don't need too much schooling for: Bone break-> Give patient Ancef-> Fix Bone Break -> Turf to medicine.

List of programs and their characteristics:

https://www.acceleratedmdpathways.org/

[bearded frog]

10 hours ago, Aetherus said:

I prefaced my statement with “In my Opinion”. You are welcome to disagree. As I’ve mentioned previously, I think you would be hard pressed to get anyone to agree that the LMCC is a good metric of competency. It’s a poorly designed exam that provides little information on the competency of the practitioner. Furthermore, I’ve stated that residency equalizes the playing field so frankly the remainder of the metrics you mentioned are inconsequential. My main point is that a three year program puts you at a disadvantage from a clinical standpoint when compared to 4 year schools. However this is not insurmountable and many will do well. My experience is that once in residency, where you have gone to medical school has no influence on how good of a clinician you are. But I do suspect the learning curve initially may be steeper for people from 3 year schools.

Finally I would be interested if you could provide the data you had mentioned.

(PS I’m not trying to say that students at 3 year programs make less competent physicians at the end of training, that is untrue. I am trying to point out that the jump to residency may be more challenging for the average medical student in a 3 year program vs an average medical student in a 4 year program)

You're the one making the claim, it's up to you to provide evidence to support it. I agree the LMCC is not a great barometer of performance in medicine, and I will be happy to concede the point if you can provide any other bit of objective data to support your statement that graduates of 3 year programs are inferior to 4 year programs, in any aspect of medicine.

3 hours ago, Aetherus said:

I don't think it's far fetched to say that having an extra year of training makes most average applicants better clinicians in the short term. If the extra year was useless, we would have more than two 3 year schools.

I would advance that for the vast majority of medical students an extra year (of mostly preclerkship, clerkship is only slightly shorter) does not make a difference in the near or long term, and inter-student variability (and other variables such as desired specialty) is much more significant than length of medical school. If the extra year made a significant difference, mac and u of c would have extended their programs years ago.

I'm not going to go out of my way to find data to refute your baseless opinion, but the most temporally relevant measure of even a brief deficiency upon completion of medical school would be CaRMS results, and Mac and Calgary are on par with the rest of the country. If your theory is correct, you would assume that PDs would know that 3-year program graduates would be deficient and preferentially ranking applicants from 4 year programs, and reducing Mac/Calgary's match rate, which does not occur.

[zxcccxz]

3 hours ago, zoxy said:

I'm not commenting on the quality of Mac and UCalgary trainees and as I commented in the post that you linked, I think that Calgary and Mac students do fine when it comes to matching. But there's an inherent problem with this form of evaluation surveys that uses the "stronger than most, average, weaker" criteria. In these sort of evaluations, like when writing reference letters, it's a death knell to numerically place a candidate anywhere but in the top 10-5 percent even though it should theoretically be fine. 

I'd bet that every Canadian medical school would have a similar distribution if this survey was sent to program directors. While it makes no statistical sense to evaluate everyone as above average, this form of evaluation always leads to nonsensical results. So I don't think the results of this survey is valid.

This is absolutely true. I posted it merely as a means to say that there is no evidence to suggest that program directors are of the opinion that UofC students are any weaker than students from other schools. And it was an anonymous survey that reports aggregate results from ~100 programs, so while I think it definitely would still be plagued by the problem of giving out too many "stronger than most"s, there's less of a pressure to give out bloated evaluations because it's not going to be affecting any individuals application nor can it be traced back to the person giving that evaluation, as is the case with a reference letter. 

Additionally, even if they did give out a disprortionate amount of "stronger than most"s, if every medical school got that disproportionate amount, then it still reinforces my point since I was never trying to say that 3y programs were better than 4y programs, just that 3y programs fare no worse than 4y programs.

[Aetherus]

10 hours ago, bearded frog said:

You're the one making the claim, it's up to you to provide evidence to support it. I agree the LMCC is not a great barometer of performance in medicine, and I will be happy to concede the point if you can provide any other bit of objective data to support your statement that graduates of 3 year programs are inferior to 4 year programs, in any aspect of medicine.

I would advance that for the vast majority of medical students an extra year (of mostly preclerkship, clerkship is only slightly shorter) does not make a difference in the near or long term, and inter-student variability (and other variables such as desired specialty) is much more significant than length of medical school. If the extra year made a significant difference, mac and u of c would have extended their programs years ago.

I'm not going to go out of my way to find data to refute your baseless opinion, but the most temporally relevant measure of even a brief deficiency upon completion of medical school would be CaRMS results, and Mac and Calgary are on par with the rest of the country. If your theory is correct, you would assume that PDs would know that 3-year program graduates would be deficient and preferentially ranking applicants from 4 year programs, and reducing Mac/Calgary's match rate, which does not occur.

I agree that 3 year programs is not a factor that is looked at explicitly while doing file review for CARMS in my experience being a file reviewer for the last two years for a competitive specialty. 

My point is merely that by cutting a year of medical school, you will invariably get less exposure to things like Ophthalmology, Dermatology, Pathology etc. Things like Embryology and Anatomy that are important for certain specialties will not be covered in as much depth either. Will this make a difference in most of your day to day practice, probably not. But I would argue that these are important fields to be considered a well rounded clinician. 

Without revealing too much, I am a resident involved in medical student teaching for my specialty at a 3 year school and I can say that the amount of time that is allocated to our speciality is underwhelming and not enough to be competent.

[CaRMS2021]

39 minutes ago, Aetherus said:

I agree that 3 year programs is not a factor that is looked at explicitly while doing file review for CARMS in my experience being a file reviewer for the last two years for a competitive specialty. 

This^ We all know how research, publications, presentations takes time and can be hit and miss (the process of getting any article published from a final manuscript took 6-12 months alone). Even if you went in to medical school having a good idea of what you wanted to do, by CaRMS time in 2+ years, your CV will be average or lower compared to someone at a 4-year who had summers and overall another year for prepping

Not to say there aren't advantages to a 3year program (less tuition, less rent/expenses, +1yr of earnings) but it may not be right for everyone. 

[bearded frog]

1 hour ago, Aetherus said:

Without revealing too much, I am a resident involved in medical student teaching for my specialty at a 3 year school and I can say that the amount of time that is allocated to our speciality is underwhelming and not enough to be competent.

I would argue that 6 weeks in any specialty is not enough to be competent, and people generally do extra reading/prep/involvement in their desired specialties as well as electives/selectives for experience. Can't speak for Calgary but at Mac at least the entire philosophy of self-directed learning is that you focus on the aspects of medicine that are important for you. Studying beyond the basics of embryology is irrelevant for the vast majority of physicians, and what degree of anatomy knowledge required is highly variable. Conversely, the Venn diagram of "required knowledge" of a orthopedic surgeon, a psychiatrist, and a pathologist likely has a relatively small area of overlap of all three. It is not wrong to know more than you need, by any means, but it is also reasonable to empower students to choose what knowledge is important to them in their medical education. I'm a month away from being a board certified pediatrician but I'm probably a barely more competent general surgeon than I was at the end of my core rotation back in medical school, which is to say not at all. Would it not be a reasonable alternative to a general but less relevant 4th year to instead allow students to choose what to focus on and allow them to move on sooner? We both know that the vast majority of specialty specific learning comes in residency.

And I'm a resident involved in medical student teaching at a 4 year school which has a full 6 weeks of pediatrics and they are likely equally as incompetent at the end ha

1 hour ago, CaRMS2021 said:

This^

They're saying the opposite of what you are saying though? That PDs do not care about length of program, and somehow Mac and Calgary applicants have just as compeditive applications with research etc. that they match to compeditive residencies as much as 4 year schools?

I'm not saying that a 3 year program would be superior for everyone. I'm glad there are options. And if you randomly assorted people into different program lengths you might run into problems. All I'm saying is that the people who either self select for application/acceptance into a 3 year program (or are only selected to a 3 year program) seem to flourish and/or struggle just as much as those that choose or only get into a 4 year program, and it's not inherently worse.

There just isn't any basis or evidence for the opinion that graduates of 3 year program, on balance, are any way inferior to graduates of 4 year programs. Any suggestion otherwise is based on anecdotes. If anyone can demonstrate any objective evidence to the contrary, I will gladly concede the point.

[Aetherus]

42 minutes ago, bearded frog said:

I would argue that 6 weeks in any specialty is not enough to be competent, and people generally do extra reading/prep/involvement in their desired specialties as well as electives/selectives for experience. Can't speak for Calgary but at Mac at least the entire philosophy of self-directed learning is that you focus on the aspects of medicine that are important for you. Studying beyond the basics of embryology is irrelevant for the vast majority of physicians, and what degree of anatomy knowledge required is highly variable. Conversely, the Venn diagram of "required knowledge" of a orthopedic surgeon, a psychiatrist, and a pathologist likely has a relatively small area of overlap of all three. It is not wrong to know more than you need, by any means, but it is also reasonable to empower students to choose what knowledge is important to them in their medical education. I'm a month away from being a board certified pediatrician but I'm probably a barely more competent general surgeon than I was at the end of my core rotation back in medical school, which is to say not at all. Would it not be a reasonable alternative to a general but less relevant 4th year to instead allow students to choose what to focus on and allow them to move on sooner? We both know that the vast majority of specialty specific learning comes in residency.

And I'm a resident involved in medical student teaching at a 4 year school which has a full 6 weeks of pediatrics and they are likely equally as incompetent at the end ha

They're saying the opposite of what you are saying though? That PDs do not care about length of program, and somehow Mac and Calgary applicants have just as compeditive applications with research etc. that they match to compeditive residencies as much as 4 year schools?

I'm not saying that a 3 year program would be superior for everyone. I'm glad there are options. And if you randomly assorted people into different program lengths you might run into problems. All I'm saying is that the people who either self select for application/acceptance into a 3 year program (or are only selected to a 3 year program) seem to flourish and/or struggle just as much as those that choose or only get into a 4 year program, and it's not inherently worse.

There just isn't any basis or evidence for the opinion that graduates of 3 year program, on balance, are any way inferior to graduates of 4 year programs. Any suggestion otherwise is based on anecdotes. If anyone can demonstrate any objective evidence to the contrary, I will gladly concede the point.

Yeah my point was that your school of graduation does not make a difference from an objective standpoint during file review. But I do agree with the point made that it is more challenging to be on par with other applicants from a CV perspective when you have one less year to build your CV and no summers.

I agree that the major specialties seen in medical school are usually revisited in residency if relevant to your specialty. But there are certain things that everyone should know about each specialty that can get lost if you don’t have a minimum amount of teaching in that specialty. I think every physicians should be able to describe a rash better than maculopapular, every physician should be able to check vision/pupil/eye pressures and perform fundoscopy.

As a pediatrics resident, did you feel like you have enough exposure to things like Ophthalmology (Bruckner reflex, strabismus, congenital cataracts etc). These are things that should be taught at the medical school level and if they aren’t, then people go through their career without knowing the basics necessary to communicate with other specialties.

[bearded frog]

1 hour ago, Aetherus said:

I think every physicians should be able to describe a rash better than maculopapular, every physician should be able to check vision/pupil/eye pressures and perform fundoscopy.

If they have to, they will properly learn to in residency?

1 hour ago, Aetherus said:

As a pediatrics resident, did you feel like you have enough exposure to things like Ophthalmology (Bruckner reflex, strabismus, congenital cataracts etc). These are things that should be taught at the medical school level and if they aren’t, then people go through their career without knowing the basics necessary to communicate with other specialties.

The red-eye reflex is definitely something you learn in preclerkship and practically taught in the first few days of pediatrics clerkship. RB is a can't miss and we pound everyone over the head about it. Strabismus is is also taught, as well as corneal light reflex and cover testing (and defiantly testable at the resident level) however practically we don't see it even in residency as unless it's an incidental concern, it would not be an appropriate referral to pediatrics and (as I think you would agree) should be referred directly to optho. I disagree congenital cataracts is required teaching at the medical school level, but should be known by pediatrics and family medicine residents (and obviously optho). I'm assuming you're an optho resident, and we all would like every other specialty to be more familiar with our domains (especially pediatrics!). However yours is a highly specialized field, and you are correct that at Mac we did not have a dedicated optho rotation, but an unbiased assessment of weather a dedicated optho rotation (or derm, or plastics) would end up equivocal. Certainly has some value for FM/peds/neuro but very little beyond that.

In terms of adequate communication and appropriate referrals for your given specialty, that is definitely a residency competency and should not be expected at the medical school level.

For a compeditive field like optho/derm/plastics I agree that unless you come in with background research etc. It can be daunting to match in 3 years vs 4, especially with the volume of research and other stuff required these days. However, students do match to these fields, from Mac at least, after 3 years, and there is an option to take an extra year to do a research masters or other further electives/prep etc. in your desired field, which may put someone at an advantage applying in the 4th year vs a 4 year program with no masters (Although I will defer to you, as someone who actually reviews these applicants, if that's actually true or not).

[Aetherus]

53 minutes ago, bearded frog said:

If they have to, they will properly learn to in residency?

The red-eye reflex is definitely something you learn in preclerkship and practically taught in the first few days of pediatrics clerkship. RB is a can't miss and we pound everyone over the head about it. Strabismus is is also taught, as well as corneal light reflex and cover testing (and defiantly testable at the resident level) however practically we don't see it even in residency as unless it's an incidental concern, it would not be an appropriate referral to pediatrics and (as I think you would agree) should be referred directly to optho. I disagree congenital cataracts is required teaching at the medical school level, but should be known by pediatrics and family medicine residents (and obviously optho). I'm assuming you're an optho resident, and we all would like every other specialty to be more familiar with our domains (especially pediatrics!). However yours is a highly specialized field, and you are correct that at Mac we did not have a dedicated optho rotation, but an unbiased assessment of weather a dedicated optho rotation (or derm, or plastics) would end up equivocal. Certainly has some value for FM/peds/neuro but very little beyond that.

In terms of adequate communication and appropriate referrals for your given specialty, that is definitely a residency competency and should not be expected at the medical school level.

For a compeditive field like optho/derm/plastics I agree that unless you come in with background research etc. It can be daunting to match in 3 years vs 4, especially with the volume of research and other stuff required these days. However, students do match to these fields, from Mac at least, after 3 years, and there is an option to take an extra year to do a research masters or other further electives/prep etc. in your desired field, which may put someone at an advantage applying in the 4th year vs a 4 year program with no masters (Although I will defer to you, as someone who actually reviews these applicants, if that's actually true or not).

I agree that not everyone needs to know about Ophthalmology, but I would say that more specialties than you mentioned would benefit from Ophthalmology teaching. My list would include Family, Pediatrics, Emergency Medicine, Internal, Neurology, Neurosurgery, Plastics, ENT. 
 

If you look at that list, that would compose 60-80% of what people match to. 
 

My expectation of what a physician can communicate to me is very low. The amount of consults I get that someone doesn’t know how to check pupils or a vision is disappointing. This is a problem not only with 3-year graduates but also 4 year graduates. The problem is, by shortening training, there is no way we can address these deficiencies. There are real consequences to this for patients as well, the amount of brain tumors I have diagnosed that were first diagnosed as migraines is heartbreaking. If people could at least visualize the optic nerve, this would not happen.

In terms of the 3 year + 1 year of research. It’s a good option. I wouldn’t say that it puts you at an advantage, but if done properly it definitely could. 

[bearded frog]

8 minutes ago, Aetherus said:

I agree that not everyone needs to know about Ophthalmology, but I would say that more specialties than you mentioned would benefit from Ophthalmology teaching. My list would include Family, Pediatrics, Emergency Medicine, Internal, Neurology, Neurosurgery, Plastics, ENT.

Oops yes forgot EM, and I'll take your word on the others!

10 minutes ago, Aetherus said:

My expectation of what a physician can communicate to me is very low. The amount of consults I get that someone doesn’t know how to check pupils or a vision is disappointing. This is a problem not only with 3-year graduates but also 4 year graduates. The problem is, by shortening training, there is no way we can address these deficiencies. There are real consequences to this for patients as well, the amount of brain tumors I have diagnosed that were first diagnosed as migraines is heartbreaking. If people could at least visualize the optic nerve, this would not happen.

I 100% agree that there are important things about each of our fields that other disciplines would benefit to know more of, we also see brain tumors in children full of red flags that for whatever reason were not addressed until coming to pediatric attention. We are on the same page about this but I don't have any reason to believe that 3 vs 4 year programs would make any difference in this regard, and have seen nothing to suggest that critical misses are more frequent in Mac/U of C grads.

[Aetherus]

35 minutes ago, bearded frog said:

Oops yes forgot EM, and I'll take your word on the others!

I 100% agree that there are important things about each of our fields that other disciplines would benefit to know more of, we also see brain tumors in children full of red flags that for whatever reason were not addressed until coming to pediatric attention. We are on the same page about this but I don't have any reason to believe that 3 vs 4 year programs would make any difference in this regard, and have seen nothing to suggest that critical misses are more frequent in Mac/U of C grads.

I agree that there is no metric that would point towards 3 year graduates doing worse in these situations. 
My main concern is that I think our current system is failing to educate clinicians on the basics for many specialities and that a 4 year program has more room to try and improve the situation. This also is way I am against letting students focus on what they think is important for their future career goals as I don’t think medical students have the required perspective to make those choices.

[Edict]

On 5/19/2021 at 10:41 PM, Aetherus said:

Another aspect that I forgot to mention in my previous post is that the 3 year program is not recognized in certain countries. This can end up being a big deal for fellowships (I know someone who had a top fellowship lined up in England that fell through because her MD was not recognized).

I am the first to have issues with McMaster's program, but I have never heard of this and don't believe it.  

[indefatigable]

5 hours ago, Aetherus said:

I agree that there is no metric that would point towards 3 year graduates doing worse in these situations. 
My main concern is that I think our current system is failing to educate clinicians on the basics for many specialities and that a 4 year program has more room to try and improve the situation. This also is way I am against letting students focus on what they think is important for their future career goals as I don’t think medical students have the required perspective to make those choices.

I believe there is some validity to this point - but I don't think there's an easy solution.

I know people that may disagree, but I do think that some schools may (or may not) offer better general or specialized foundations.  

All schools meet the requisite pan-Canadian standards, but it doesn't mean that their education is equal.

TEACHING

Anatomy

Anatomy teaching is a great example since it's been an area where some schools have chosen to continue to emphasize traditional dissection whereas others have almost abandoned cadavers entirely.  No one disputes that learning detailed anatomy is essential for surgery; but the importance of anatomy is for the rest of medicine elicits different opinions/perspectives.  

For instance, at UofT trainees apparently spend over 100 hours/year dissecting cadavers; there was perhaps 5-10 hours of exposure to old cadavers at the school that I went to in a single early pre-clerkship block.  I do believe that additional exposure means additional preparedness for a surgical residency - but it had obviously been decided that learning detailed anatomy through dissection was not an important priority as surgery was not where most would end up.  

Ultimately, it was a known issue/inside joke how about how little surgical preparation there was within our curriculum (although I think this was slightly improved with a curricular renewal).  Sure, for "home school" rotations it wouldn't matter that much, but, unquestionably it would probably be harder to impress on an away elective with such differences in exposure/knowledge.  Is it a coincidence that UofT seems to have the highest number of students that rank surgery first?

https://medicine.utoronto.ca/giving/anatomy-lab-renovation-fund

https://www.carms.ca/wp-content/uploads/2020/05/2020_r1_tbl36e.pdf (almost 1.5 x Mac)

https://www.carms.ca/wp-content/uploads/2019/05/2019_r1_tbl36e.pdf (almost 2 x Mac)

Educational Direction

Another example is the general educational focus: the four year school that I went followed the Mac PBL curriculum with extensive pathophysiological teaching blocks (with focused discussions reaching the molecular level).  However, there was less emphasis on underlying anatomy, histopathology or applied pharmacological aspects, not to mention any embryology.  So incredibly detailed pathophysiology was taught without that much clinical correlation (although some exceptions with ECG reading for instance) - it wasn't easy either - there was a relatively high attrition rate.  

In contrast, when I prepared for the MLE Step 1, I found that it had a very different focus including detailed pathology (e.g. histologically distinguishing different tumors) as well as applied pharmacology (e.g. knowing anti-retroviral classes, mechanisms, side-effects..), more anatomy and an expectation of some embryological knowledge.  I would not say that what I had learned had really prepared me for that test - on the other hand, I don't believe that knowing extensive histopathology necessarily creates better clinicians either.  And most clinicians will never prescribe biologics either - so what is the point of being able to distinguish their names/classes through memory?  Although derm was on the MLEs, some might say that there was overkill too - for instance knowing the molecular intricacies of rare dermatological conditions.

CLERKSHIP

Finally, the same holds true for clerkship.  

• Derm at UBC is an actual required short block - the formal exposure at the school that I went was one three hour lecture in later clerkship.  Sure most derm conditions are not life threatening, but having a "blind spot" for derm doesn't help either - just more remedial work for the many clinicians that need to know some derm.  

https://derm.med.ubc.ca/education/md-undergraduate/

• Another example - the McGiIl structure seems like it includes formalized exposure to ophthalmology and radiology just before full-clerkship for every student.   On the other hand at the school that I went to, ophthalmology was almost taught apologetically as an after-thought, through a lecture, just before the LMCC (although this also may have been improved).  I can't see how formalized exposure would hurt before family, emergency, pediatrics, ... core blocks as was mentioned above.  

https://www.mcgill.ca/ugme/files/ugme/mdcm_schema_2020-02-07_en.pdf

Summary

Med students and residents are generally highly capable and competent and will figure things out.  That doesn't mean that things are set-up perfectly, or optimally, as most will simply compensate with extra-work on their own or during blocks.  Obviously specialization is also more highly-valued than general knowledge - where everything you need to know will be usually taught during residency (minimal pre-requisite knowledge supposed).  

But, most would agree that time is precious and short, so I think it makes sense to optimize curriculums and clerkship to ensure that people have excellent foundations and aren't learning/working inefficiently.  It's partly about the end-goal, but it's partly about the process.  Needless effort risks burn-out and worse clinical outcomes.  

I can attest as someone that had to work through a very serious language barrier during medical school - not only was the barrier extremely difficult in of itself, the difficulty was compounded by the inefficiency.  I knew that I was not close to being able to work/perform at my highest-level, but that I had to spend much more additional time.

Unfortunately, there is considerable beyond one's control - both McGill and UBC admit 90-95% IP, so whatever their education offers is largely irrelevant to most of those without IP status.  Still, I think awareness of differences is a good first step.    

And many may find it hard to be objective with respect to weaknesses/strengths of their education experience as they are concerned it may ill reflect on them and their competency.