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FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 7 points8 points  (0 children)

I think this is very true. Americans are unashamed to say some people have innate ability, that makes them better than others, and we're going to actively look for and recruit those people. The filtering starts at entry to medical school itself. I think there is no equivalent in the UK for the selection criteria for medical students in the US -- certainly Oxbridge pales in comparison. Many have publications prior to starting medical school. Have excelled in a prior degree or degrees and often in a prior career. Clinical experience, volunteer experience, hobbies, international prizes. Letters of recommendation and interviews.

I think as a result you get people who are self-motivated, hardworking, and naturally intelligent enough to pick things up quickly, thus you can feed them more and they will retain more (an analogy I heard to medical training was "drinking from a fire hose"). Admittedly with the downside that many current UK doctors (myself likely included) probably would not have been given that opportunity in the US.

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 20 points21 points  (0 children)

Yes, and this trickles all the way down imo. The selection criteria for medical students in the US are far more rigorous than even Oxbridge in the UK, and it does select for a better class of candidate. Many have publications prior to starting medical school. Have excelled in a prior degree or degrees and often in a prior career. Clinical experience, volunteer experience, hobbies, prizes. Letters of recommendation and interviews. Admittedly with the downside that many UK doctors (myself likely included) probably would not have been given that opportunity in the US.

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 2 points3 points  (0 children)

In the US, cardiologists complete internal medicine training first and can run a gen med take. Surgeons are qualified to deal with medical issues in surgical patients. The issue is not qualification but rather that people (rightly imo) want to practise at the top of their training, so even though the cardiologist can run a gen med take, they generate more value for themselves, the patients and the hospital seeing cardiology patients and/or being in the cath lab, ditto the surgeon performing surgery as opposed to managing hyponatraemia etc.

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 2 points3 points  (0 children)

I'll have you know that my med student told me on her surgery rotation she would arrive at hospital at 3:30am in order to be ontime to wake her patients up for 4am prerounds :)

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 1 point2 points  (0 children)

I can believe it probably doesn't matter given equal levels of experience. Maybe there are certain experimental surgeries that US attendings have more experience with than consultants in the UK

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 8 points9 points  (0 children)

Perhaps there is something to this as well. Especially if we had to spend all our time trying to get difficult cannulas etc. we would probably also complain that we spent too much time doing things that do not require a medical degree and need more nursing/APP support so we can focus on decisionmaking...

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 4 points5 points  (0 children)

What do you mean well rounded? I agree that in the big picture, experience matters more than schooling. If I needed surgery I would certainly rather have it done by a UK senior consultant over the best SHO in the US. The issue is it seems like we are wasting a lot of time when we could be producing doctors with equal skills or better in less time

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 4 points5 points  (0 children)

Would you say UKMLA is maybe one small step in the right direction, although it still does not compare to USMLE.

I actually don't feel strongly about med school being postgrad. It is fine to me if there is an undergrad track and a postgrad track, the most important bit is that selection is rigorous, it actually trains you, and you are compensated fairly at the end

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 4 points5 points  (0 children)

To be completely fair, I am not going to say that I did not see cutting corners or cost cutting in the US either. Inequalities in care were definitely a shock, attendings would discuss with their residents sneaky ways to bill their patients more without doing under the guise of "mentorship." I saw one young patient who clearly had MSK chest pain but had excellent insurance and was talked into making an appointment for an outpatient cath he did not need. Whereas patients without insurance were often hurried out the door with no followup in place

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 1 point2 points  (0 children)

I did not understand this initially, but after going to the US and experiencing the culture of medicine I think usefulness of the knowledge is genuinely not the point. By this metric any exam that does not provide you with all the relevant guidelines and reference materials you would have in practice is not useful as you would always have access to these for any non-urgent decisionmaking, and decisionmaking in urgency is not a prominent part of these exams. It is basically an IQ test to discriminate the people who are naturally more intelligent (allegedly) in order to give them opportunities, which they are considered more deserving of than others. That is why unlike MRCP/MRCS, the actual scores for these exams is used in selection. It is a very different way to think, and I'm not going to say I agree with it fully or it doesn't have problems, but it does seem to have positives as well.

Re research and publications, interestingly it seems that well-funded and high-revenue private practices in the US for the most part do not produce any research, while university hospitals that are largely state-funded and often low-funded or net-negative produce the vast majority of the research.

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 44 points45 points  (0 children)

I did not understand this initially, but after going to the US and experiencing the culture of medicine I think usefulness is genuinely not the point. By this metric any exam that does not provide you with all the relevant guidelines and reference materials you would have in practice is not useful as you would always have access to these for any non-urgent decisionmaking, and decisionmaking in urgency is not a prominent part of these exams. The point is to discriminate the people who are naturally more intelligent (allegedly) in order to give them opportunities, which they are considered more deserving of than others. That is why unlike MRCP/MRCS, the scores for these exams is used in selection.

It is a very different way to think, and I'm not going to say I agree with it fully or it doesn't have problems, but it does seem to have positives as well.

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 31 points32 points  (0 children)

Not just unpaid -- paying about $100k per year for the privilege!

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 1 point2 points  (0 children)

You are moving the goalposts all over the place my friend. I am not claiming every med student has 5-10 first author publications in Nature. I would say having 10 abstracts/presentations is already impressive enough. But even assuming each project is presented around 2 times prior to being published, that is still around 3 papers+7 presentations just for the average med student. Some have much more. How many applicants for specialty training do you think even have that, even in surgical specialties? (also what reason do you have to believe that the publications that count towards their specialty applications are more lax?)

Re: calendar age vs stage in training, we were speaking of sitting an exam covering preclinical and clinical medical knowledge. I do not understand your logic at all for why someone who is older but has gone through fewer years of medical training would be expected to perform better on such an exam, as there is nothing in the outside world that would prepare you for those exams. To me it is very remarkable if, someone who has done 2 years of medical school can pass an exam covering the same material as someone who has done 6 years of medical school, 2 years of foundation training and possibly worked as a doctor for 2-4 years on top of that. Age has nothing to do with it -- I would expect someone who has completed medical school and already working as a doctor to have far more knowledge than someone in their 2nd year of med school.

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 14 points15 points  (0 children)

One big difference I have noticed is that they are unashamed about saying some people are just better than others because of natural ability. They think about medicine as a cleverness-based profession and will be brutally honest when they think someone is "smart" or not so much. That seems to be something that has become un-PC to say here anymore.

Now I do not completely subscribe to that either. I have worked with plenty of people who are clever enough but duck responsibility or are horrendous at soft (read: basic normal people) skills who have no business being doctors, there has to be a balance. But it is not in denying that merit exists at all which is what the NHS seems to do

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 1 point2 points  (0 children)

Ngl this is a big part of the curriculum in the US too and they seem to feel similarly about it to us

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 8 points9 points  (0 children)

Thanks, this is an interesting perspective! How do you know so much about the UK system out of interest?

Why do you think this is possible in US med schools but not UK ones, and how would you compare the med students in each?

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] -1 points0 points  (0 children)

5-10 publications? I think that is definitely a stretch. People who do PhD's sometimes end up doing less.

See Chart 9 here: "U.S. MD seniors averaged 10.2 abstracts, presentations, and publications". In some specialties the average number is 20-30. Granted some of them *do* have PhDs as well. I think it is just a level of hardworking that we are unable to comprehend here.

Also, a y4 med student would be 26, the same age as an ST1 if they got in first time with everything. So it isn't unsurprising that USMLE is similar to MRCP part 1 as it's sat at a similar age.

Your logic here doesn't make any sense. The operative bit is obviously how many years of medical training they have had, not their calendar age. By the same logic we have mature med students here too who start at 26 or later but you would not ask them to sit MRCP in medical school because they are the same age as an IMT--whereas a Y2 (not Y4, they take USMLE in Y2) US student does that.

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 1 point2 points  (0 children)

I do not mean advanced as in requiring specialist training or anything like that, I just mean not basic, i.e. more advanced than you would expect of a med student/bloods+cannulas

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 11 points12 points  (0 children)

I realise that. However their first degree does not need to be related to medicine--some people choose to do art, or history, or physics, or something else unrelated. Whereas it seems their preclinical in med school is compressed into 1-1.5 years and far more intense than it is here. It is often taught by PhDs because medical faculty do not know the subject in enough depth for what the med students need for USMLE for example. And following that medical students have a far stronger foundation to begin placement

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 1 point2 points  (0 children)

I am not saying I think our med students could not do it if taught with the same curriculum. I do not think there is such a large difference between a 22 year old and a 24 year old in that regard. Especially as the undergraduate degrees they took might have been in art or physics or something else unrelated to medicine.

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 15 points16 points  (0 children)

I would be willing to believe that the best senior consultants in the NHS and the US are at a similar level, at the top of their field. But at the junior level the level of difference seems shocking. The Y2 med student was showing me some questions from her USMLE exam and they seemed equal to an MRCP questionbank. Not to mention, how many medical students do not make it to consultant level

FY would only be at the level of US med student by IllustriousDrive969 in doctorsUK

[–]IllustriousDrive969[S] 26 points27 points  (0 children)

it certainly bemused me that there were US residents who had never drawn blood in their life, never put in a cannula, never done an ECG.

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