What to look for in a medical curriculum

I exist again. As an update, I have now finished my clinical year and am in the process of studying for the USMLEs (the MCAT equivalent) and preparing to take a year off to continue my research in the specialty that I intend to apply into. I thought I would just take a quick break from my studies to give my thoughts on what is important in a medical school curriculum, looking back on it from this perspective.

1) Grades

Above all, know what you are getting into. Schools have a vast array of grading and ranking policies. Many schools have switched their pre-clinical years to a pass fail system, but a significant portion have retained an internal system of rankings (meaning they aren't really p/f it is just a farce). A select and growing group is unranked pass fail for the pre-clinicals. I personally am a fan of this, because of the fact that it takes the edge off of the learning experience. It gives you confidence to take advantage of the free time that you have rather than freaking out over random tables and appendices. The sad truth is pre-clinical grades don't mean much any more to residency programs. It is far more likely to hurt you than help you. If you do good, great how did this applicant do on their clincial courses and what were the USMLE scores? If you do bad, uh oh maybe this applicant isn't someone we want. Would being #1 in your pre-clinicals possibly be a distinguishing mark, absolutely. However, ONLY ONE PERSON WILL HAVE THAT DISTINCTION AND IT WON'T BE YOU.

Most programs continue to have clinical grades that have some form of ranking, or at the very least AOA (the phi beta kappa of medical school). Know what this entails. For some schools, it is just grades. Others look at grades, scores, research experience, etc, etc. Know what you are getting yourself into, even if it probably shouldn't be a determining factor.

2) When do you take USMLE Step 1

Step 1 is the most important exam of your medical school life. Know when you will take it, and just as importantly how long you get to study for it. Some schools get only a couple weeks off to study, whereas others get up to 10 weeks! That's a huge difference in stress level. A growing number of schools are starting to let students take the step 1 after their clinical training. I'm in favor of this approach. The clinical vignettes on the step 1 would definitely be easier with additional clinical knowledge, and stuff like genetic basis of diseases and pharmacology tend to come up a lot as well. You definitely forget a little more, but I think the net gain from more knowledge and more test taking experience (one major 3 hour exam per rotation) is worth while.

As an aside, don't listen to nonsense about teaching towards the step 1. Step 1 is an exam that, like the MCAT, requires copious review on your part. It is nice to know what resources are available to you (some schools host review classes, give you free books/question banks, etc).

3) Clinical Year Format

The clinical years are often ignored during the interview season, for the simple reason that they are further away and most of your interactions will be with first and second year students. Seek out people knowledgeable about the last two years,

Know exactly what the expectations are for you during clinical year. How many blocks during the third year are there and what rotations are mandatory vs electives (i.e. some schools do not require neurology, or surgical sub-specialties. It behooves you to get some electives in all specialties, so know if that is an option). Do you have any say in the order of your rotations? Are there breaks in between each block? How many vacation weeks? How long are each of the blocks (this is relevant for studying for the standardized exam at the end)? What is the general grading format (grades versus clinical evaluations. Which are more important. There is no right answer, but I prefer a combination of the two). How many fourth year electives do students get? How many students go abroad for electives? Do students get time to take the step 2 of the USMLE after clinical year, or do they have to make their own time.

You should also ask about how much time students get to interview. Two months is ideal.

4) Clinical Skills Prep

This is also very important. Know the institutionalized practices that help students improve as clinicians. Know how often students are educated on how to do interviews, physical exams, and presentations to attending physicians. Ideally, you want to have a solid understanding of each before starting the wards. You also want to know the general atmosphere of learning useful clinical skills. How often to students get to do blood draws, IVs, lumbar punctures, paracentesis, chest tubes, suturing, etc. Are there workshops given on these things? Are you taught how to do a rectal and genital exam prior to the clinical year? How much training are you given during the clinical year? For example, my school has one week rotations through the surgical subspecialties. As well as being an experience of itself, these rotations are expected to endow upon students certain skills. In anesthesia, we are allowed to intubate and place IVs, in urology we do genital exams and rectal exams, in optho we learn how to examine the eyes like a boss, etc. All of this stuff was taught to us prior to the clinical year, but getting it straight from the experts was far more useful.

As a warning, all students and schools will say that they get lots of hands on experience. This is why it is important to elicit the actual examples and programs.

5) Match list

This is not important. I only bring it up so that I can stress that it is not important. You can't read a match list, and I can barely read it (only in the specialty of my interest). So much has to do What is somewhat of interest, however, is the general geographic distribution of the class match. People often match close to the medical school for various reasons, which isn't really important to you. What is important, however, is students tend to benefit form programs that have had significant experience with a given medical school. If a schools match list doesn't have a single person sent to, say, Colorado, and Colorado is your dream residency location, then it may be worth taking note. You can still match in Colorado, but it may be a bit more of an uphill battle than if 32 kids in your class match there yearly. Likewise, one might think to do this within the specialty of your choice. I would discourage this only because specialty choice tends to fluctuate a lot from year to year (the year before me has 9 neurology applicants, the year before them had 1), where as locations tend to be pretty grounded.