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Are We Just Learning for the Test?

Kendracampbell272x721_1Kendra Campbell -- I’ve been reading a lot lately about the issue of teaching the basic sciences in medical school. This is certainly not a new issue. In fact, it began in 1910 with the Flexner Report, in which Abraham Flexner recommended that students be required to have a basic science background before entering medical school, and that basic sciences be incorporated into the medical school curriculum.

Now, almost 100 years later, people are beginning to realize that the pendulum may have swung too far in the direction of teaching the basic sciences, with less emphasis on the clinical aspects of medicine. As a medical student, I can say that we are certainly overloaded with information. We are expected to learn an overwhelming quantity of minutiae. And we are expected to blindly accept that we must know all of this information in the hope that it will make us better doctors. I sometimes feel that we are forced to memorize facts not to help us in medicine, but to prove that we are motivated enough to do so.

In fact, every doctor that I’ve ever spoken to has told me that I will likely use very little of my basic science education in the actual practice of medicine. While I understand that the basic sciences are a good foundation upon which to build your knowledge and understanding of the human body, I’m not convinced that we truly need to know the level of detail that the National Board of Medical Examiners requires.

I also believe that there needs to be more context to our basic science education. All of my professors try to incorporate clinical case correlations whenever possible, but there still seems to be a huge gap between the basic science education and its relation to the clinical world.

Perhaps it’s time to reevaluate the basic science and clinical medical curriculum, and the processes that we use to teach our students. We should also consider whether we are teaching students valuable information that they will use in their future medical practice, or whether we are blindly forcing them to memorize information so that they can pass the next test.

October 17, 2006 in Kendra Campbell | Permalink


If want to hear my advice, study math and physics big time. It's plainly practical stuff. The more you know the basics and mechanisms the better doc you are.
I'm from Poland - here teaching is more towards clinical stuff with lots of extra things about receptors etc. But there's always sth missing and that something is that little word WHY, or HOW...
Right now, i'm discovering british and american medicine - you guys start each chapter with a look-back at pathophysiology or basic processes (physical aspects).
and that - i'm in intensive care and anaesthesia - helps A LOT!

maybe i'm not clear enough on that - anyway , my conclusion is: basics are helpful big time :)

Posted by: Mike | Oct 18, 2006 2:02:24 PM

yeah,its too much yet i have got this feeling that we really need all that info to help us clearly intergrate the clinical skills,for how can u understant the abnormal with little understandin of the normal!!

Posted by: anthony | Oct 19, 2006 1:36:57 AM

i agree with the previous entries. once you reach 3rd/4th semester and take path and pharm, you come to realize the importance of the biochem and physio from 1st/2nd. it always seems like a light bulb goes off above my head. a lot of things finally make more sense. there is no greater satisfaction than the one you get when you start to integrate the things taught in 1st/2nd with the things taught in 3rd/4th.

Posted by: elle | Oct 21, 2006 8:41:00 PM

Hear hear, girl! Here in Cambridge they overload us with the sciencey stuff, and I didn't get warned before I applied. So in I walk, this idealistic med student thinking about those docs on House and Grey's Anatomy and ER, and then bang. I get to do Really Advanced A-Level Science instead. Here's to more clinical relevance in universities!

Posted by: Angry Medic | Oct 23, 2006 10:33:59 AM

Second year of med school is wasted on sophmores. I am a 3rd year and sometimes I wish I could go back to 2nd year so I could learn more, now that I know more of the clinical side. Come to think about it I don't really want to go back all that bad...

Posted by: Shawn Uraine | Oct 24, 2006 5:07:38 PM

We have been talking ALOT about this very topic, and we are of the opinion as y'all, but with a twist... I feel the science stuff is a vital foundation for the clinical part (gettin'-to-know-ya b4 sex, if you will) but we have run into the problem of our profs lecture/test us on science minutiae that is neither board tested nor clinically relevent!! So what is the point? Our school claims to "not teach TO the boards" but also has has (OMG so many!) lectures that are downright contradictory! My point is that we spend so much of our time (wasted) on learning things 3 diff time/ways- for the class(waste-O'-my-time), for the boards, and for real life. I want to be taught, one time, things I will use for the rest of my life. New House of God Law: Give me a class that only wastes 2/3 of my time and I will kiss the feet of the instructor.

Posted by: Damon | Oct 25, 2006 6:04:46 AM

I was very glad when I read the article written by Kendra because this topic is a worldwide issue.
I'm a 6th year medical student (internship) from Chile, and the first two years of our carreer are completely hyperthrofied by basic sciences. After all these years of medical school there are a lot of topics and what's more, a lot of courses on basic science that have not had any importance on my medical formation.
The curriculum organizers (or however called)must focuss on on the real needing for our future practice and for the well-treating of patients, considering that the time spent on the formation of a doctor is never long enough.

Posted by: Roberto Sunkel | Oct 25, 2006 10:19:58 AM

I am a first year medical student in the U.S. and I think the purpose of all this information being thrown at us is for a good purpose. In the real world, we will be bombarded with information from real patients. They will tell us information that may or may not be pertinent to the diagnosis. It is our job to figure out what is important and that is precisely what we are learning to do in these years. I agree that clinical relavance is important, but I definitely appreciate the depth of the basic sciences I am receiving. Just a thought.

Posted by: Roxanne | Oct 25, 2006 10:36:49 AM

Kendra Campbell, you put my thoughts into words. I'm not saying that basic sciences aren't important. (Physiology, pharmacology and pathology are essencial for understanding the pathophysiology and tx of diseases) but when I was in my first and second year of medical student, I felt that I was studying to become a scientist and not a MD. Also, you have to memorize a lot of concept in so little time, that the integration of concepts becomes difficult (because of time). You have to focus your reading and time in what you think is going to be on the test, because you have to survive and succeed as a medical student, and grades are their definition of success. They need to reevaluate the curriculum of first and second med years so that they can integrate and focus more on clinical vignnette and clinical settings.

Posted by: L | Oct 25, 2006 6:35:47 PM

Im on first year on med school in colombia and there are some techers that think that your memo is unlimited, therefore you overload your brain for the test and just remember a little (hopefully the most important info) also, sometimes your teachers are not MD´s so they think a lot of their information as biologist or biochemenstrist is important to the medical practice. may be for research, but may be NOT for ER...

Posted by: Baene | Oct 25, 2006 6:51:56 PM

I'm 4th Year studing in Lebanon
I think that we have to study these basic scinces for an important reason which is widining our thoughts...when u learn this huge information about the human body "and most of the time won't be beneficial in clinical life" u can just know how can this body works
ofcourse u won't remember anything later but this view about the mechanisms of many things remain the same

Posted by: Ameer Al Wafai | Oct 25, 2006 7:16:13 PM

I think that the basics are needed to understand the cause of a disease, so in that way you can't act knowing at least what are you affecting with a treatment. Be a medician is not prescript a drug just knowing the dose and know what you are waiting when the drug makes the macro-effect in the patient(cause you wont understand the real effect, i mean the biochemycal effect, without basics, and in fact it will have been really but really hard learn the clinical subjects without the basics), be a doctor is know how the human body works and know how the enviroment or his own nature can affect him, doing this is really easy practise your pasion, i hope medicine is, cause is not you will be a incopetent doctor (at least that you have a pocket version of Harrison).

Posted by: MedstudentColombia | Oct 25, 2006 8:10:16 PM

Hi! I'm a second year med student in the philippines, and our curriculum is trying to do what you're article was saying: integrating basic with clinical medicine. I can't say whether it's better or not yet, although our consultants comment we know more practical info than higher batches. But most of the time, we still feel lost learning the basics AND the clinical at the same time, add to that the pressure of time constraints. For example,we learn the basics of pharma in 2 wks while it took traditionally 3 1/2 semesters..
We don't bother learning the minutiae that you guys say, we go straight to the "need-to-knows," the most impt info we need to know when we're actually THERE with the patients. our consultants teach what they think we need to be armed with in the clinics..
it's less workload for the brain but sometimes, I can't help feeling we're missing out somehow. i'm not sure what it's future repercussions are.
i guess each way of learning medicine has its positives & negatives.

Posted by: Pauline Camposano | Oct 26, 2006 8:09:02 AM

iam post graduate student in orthopeadic physical therapy.illustrator in Cairo University, Egypt . Dear Kendra my personal opinion about these basic sciences that it is important not only in clinical life , but also in opening our minds to know what,how,and why every thing happens in our body like that , even actually we do not use all of this information in our clinical life but it helps us to understand our bodies . i think that in order to treat our patients , we need to know how every thing in there bodies work like that , this is my point . But actually we need to konw this informations in a larg period of time ,not in only two years , we always complaining from the huge information and the limited time in the first two years , I hope to find solution to this big problem .

Posted by: mona | Oct 26, 2006 4:55:25 PM

thanks so very much for your article. i've been grappling with this VERY issue recently (just as immunity and infection is FINALLY wrapping up). as a married, mom of 2, second-year med student with not a whole heck of a lot of time to study, i often find myself disheartened that perhaps i'm not learning what i need to know to be a good physician (my grades are certainly not reflecting it anyway). it's good to know that all these little details we're expected to know now are not a gage of how we'll do as doctors. it's true that we do need a solid science base in order to know the hows and whys of medicine, but some of the information is just too tedious and, i have the feeling, thrown in just to DRIVE US CRAZY. and i agree, there definitely needs to be more context and relevance put into the basic science curriculum. simply memorizing and regurgitating information for a test(and, quite frankly, FORGETTING it soon after the test)almost seems to be a waste of energy, time and MONEY. thanks again...

Posted by: jbird | Oct 27, 2006 7:48:16 AM

im a 2nd year med-student in malaysia.during my 1st year,i have to admit it was a big-time stressful days and nights!!lots of basic sciences to be learned and memorized in so little time.i dont know how system in the medical university of the other country looks like,but here we have the problem-based learning where we have to integrate our knowledge in order to solve the clinical case.that's when all the basic sciences make sense cuz we can correlate it with each other and understand the mechanism of how both the physiology and pathology condition occurs and results in certain diagnosis.i would agree that there are certain infos that we need to memorize like the drugs and their pharmacokinetics and dinamics.but it would be much better if we can totally understand the mechanism and correlate it with clinical things

Posted by: milla | Oct 27, 2006 11:50:19 PM

basic science is the core of medicine. if you do not know the basics, there's no way you can progress on to do anymore, as you will get lost in the world of science. medicine is essentially science. as we graduate through the ranks, basic science becomes more and more imporant. realise that primary exams to medicine/surgery/emergency/whatever the specialty is always based on the basics. i've just completed my FRACS Part One in Australia. just remember that if you do your basics well, you will know the disease processes a lot better and be a much better doctor. not just one which churns out prescriptions! wish someone told me this when i was a med student!

Posted by: joy | Oct 29, 2006 4:50:45 AM

i'm a third year student from india.whatever you have said was exactly what i was wondering for the past two years.first two years of college was spent in learning and memorising the basic sciences. but to be frank i remember a very little now, especially biochemistry.now i regret for forgetting and have to refer to the basic science books often.but i think i should have studied my basic sciences by correlating with clinical situations.no one told me this before.

Posted by: asha jalal | Oct 29, 2006 7:43:35 AM

i'm a second year student from mexico and i totally agree with what you're saying. in my school, i feel we don't correlate clinic with basic sciences that much. the teachers just give us all the information and sometimes they don't even give it to us, we have to do a lot of research and we get all doubious about all kinds of stuff and they just don't answer our questions. of course, not all of the teachers do that, but i feel we may lack some information. but, in the end, it seems that everything just kind of falls into place by practicing and repeating the same info we got from biochem, phys and anatomy

Posted by: Claudia | Oct 30, 2006 12:55:39 PM

hey guys!
i'm a 5th year med student from the West Indies, i know how it felt having to swallow those large junks of biochem and anatomy..how crazy it was to get through exams and learn things that seemed to be in a "vacuum"..but trust me, as u go through clinical years, you appreciate the concept of diseases much more!...it makes clinical work much more fun, exciting and easier to get through, just hang in there!!it's actually worth it! and yes..you'll forget alot of it , and you'll have to go back, but it's sometimes better the second time around! :)

Posted by: Sudha | Nov 3, 2006 1:04:12 PM

Not for attribution. This comes from a non-MD, non-ND, non-premed and a non-entity [just joking]. From an outsider, I knew a MD, COL who learned HPLC [high performance liquid chromatography chromatography (some equate HP with high-priced)], seaching data bases using Boolean technoque and methods similar to that used in Elsevier (Lockheed DIALOG in the '90's) or in STN and was familar with hplc-ms (hplc as before and ms = mass spectrocopy). Also, I knew of an MD who asked knowledgeable, penetrating questions to a panel of chemists drawn from academia and industry These remarks come one in the so-called hard sciences. Crack those books, you slaves. Respectively, "Hey, you"

Posted by: "Hey, you" | Nov 15, 2006 1:32:50 PM

you can't learn calculus unless you know how to add/subtract/multiply/divide!!!

Posted by: captainwada | Nov 20, 2006 1:20:09 PM

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