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Med school -> Memorization school. The medical profession needs to figure out how to use technology more effectively in its processes. I'm convinced that having

Med school -> Memorization school. The medical profession needs to figure out how to use technology more effectively in its processes. I'm convinced that having doctors spend years doing route memorization hinders their critical thinking. It also puts a ton of stress on medical students who have to spend an exorbitant amount of time drilling. Of course, that would harm the medical industrial complex, so we must make being a doctor as difficult as possible.

actualdc1 8y ago
You fail to appreciate that there is quite a bit of skills development and problem solving training. The first two years are more memorization heavy, as you have to learn the language and basics. Years 3 and 4 are more focused on navigating the health care system, interacting with patients, performing technical skills, physical examination, use of imaging, diagnosis, etc. Memorization is only a fraction of what you do to become a competent physician.
- Ericson2314 8y ago
  I take this as: 1,2: memorize 3,4, residency: poorly compensated labor
  - assblaster 8y ago
    Medical school is 4 years, pre-medical school is 4 years, internship is 1 year, residency is 2-7 years.
    - Ericson2314 8y ago
      Is that contradictory to what I wrote? Also note that EU combines premed and med school into <8 year bachelor degree.
      - assblaster 8y ago
        First two years of medical school are in classroom, second two years are clinical rotations. Residency is after medical school, and that's the first time you start earning a meager paycheck. In medical school, even when you're "working" with patients, you still pay tuition.
        Ericson2314 8y ago
        Yeah exactly. And at the very least an EU 6 year med bachelor model would pay you something for years 7 and 8 (counting feom high school).
riahi 8y ago
You have to build the background knowledge to even be able to speak the language of medicine. This is not difficult "just because", it's difficult because it's a huge amount of baseline knowledge that must be assimilated, before you can even begin to think critically. This is like telling someone "we need to figure out how to use technology to prevent people from spending years of rote memorization before they can speak <X_foreign_language>!"
- Retric 8y ago
  The problem with that analogy is Med school treats medicine like speaking English. But you can simplify the material and treat it like teaching a constructed language. For example if you named the bones in the fingers as left, thumb, two then it’s little effort to recall. Instead people need to recal the stuff like distal phalanges. Math is arguably worse with redundant notations for the same thing. So, I see the benifit of avoiding creating multiple systems.
  - nradov 8y ago
    I don't think that's a good example. There are only 206 bones in the adult human body. It doesn't take very long to memorize those. The real memorization time is spent on other stuff for which we don't even have common English names. You could invent new, simpler names for every anatomical part, every disease, every symptom, but that would be a huge undertaking and would only make memorization marginally easier.
    - Ericson2314 8y ago
      Yeah the idea is skip names as the foundation altogether. Instead characterize the spaces by their properties and symmetries, and when there's an exact number of things (like bones) use a GUI (body diagram, decision tree) to air recall so people can just learn the names on the job.
      - assblaster 8y ago
        >so people can just learn the names on the job Ah, yes, the best way to learn all the intricacies of a human: osmosis. Good luck attaining knowledge that takes 8+ years of focused study in medical training today through osmosis over 30 years of "on the job" training, being paid $0 because you are still "learning" and can't contribute to anyone's actual medical care during that time unlike a resident physician.
jacques_chester 8y ago
> The medical profession needs to figure out how to use technology more effectively in its processes. Med students are probably the most numerous users of spaced repetition tools like Anki. The rest of us are doing it the inefficient way.
- Ericson2314 8y ago
  Good tool wrong objective! OP means use technology to skip up-front memorization.
  - assblaster 8y ago
    How do you acquire knowledge without memorization? What technology do you anticipate using? Johnny Mnemonic neural implantation?
    - Ericson2314 8y ago
      All learning requires some memorization. That doesn't mean all memorization is equally good. Memorize that which is hard to look up. And compress what you need to memorize as much as possible; the compression process itself is intimical to understanding and generalizing. Medical school today would be like learning programming by memorizing the x86 ISA spec.
      - jacques_chester 8y ago
        The x86 ISA spec is a doddle compared to organic chemistry. Which is a pre-med subject. There is a minimum amount of material in any subject that needs to be available for rapid recall in order to be an expert in that subject. A wide variety of different areas have been studied to relate performance to level of learned information. Linguistic fluency requires easy recall of vocabulary. High rankings in chess depend on the recognition of thousands of distinct patterns. Musical improvisation requires thousands of hours of tedious repetition and practice. Effective programming requires a body of knowledge encompassing a variety of topics, a lot of which will be memorised as a side-effect of repeated exposure. But if you think you can be a better doctor than a doctor by scanning the indices of medical textbooks -- realising a little late that you are unfamiliar with a lot of the terms and also unsure in what order the concepts need to be assimilated before you can apply them -- then at least make sure your will is up to date.
GarrisonPrime 8y ago
>Med school -> Memorization school At a bad medical school, maybe. Pretty much anything can be taught as blank facts, versus a method that stimulates critical thinking. Programming, for instance. ;)
assblaster 8y ago
Yet another person with no experience in medicine, finally figured out how to "disrupt" medicine with technology. You can't practice medicine without knowledge. You can't learn how to practice medicine without knowledge. What knowledge is required? Physics, inorganic chemistry, organic chemistry, mathematics, microbiology, cellular biology, biochemical biology, molecular biology, developmental biology, physiology, pathophysiology, human anatomy, pharmacology, histology, gross pathology, statistical analysis, internal medicine, paediatric medicine, general surgery, orthopedic surgery, neurologic surgery, urologic surgery, gynecology, obstetrics, outpatient medicine, cardiology, pulmonology, nephrology, hepatology, radiology, neurology, psychiatry, critical care, healthcare economics, medical ethics, et cetera. If you don't have a knowledge base, you simply can not practice medicine because you don't understand how things actually work... Critical thinking without knowledge isn't critical thinking, it's ignorance.
- analog31 8y ago
  How does the brain work? Okay, that was sarcastic. But in my view no doctor knows all of those subjects in depth. Pre-med students take the basic STEM courses in order to pass their MCAT's, and then forget most of what they learned, and those courses were all just superficial intro courses anyway. To be fair, the same can be said of most engineers. Many med students (wisely) major in a STEM subject, so they may get into more depth than someone who majored in some kind of "studies." But what they know is a function of what they actually studied, learned, and kept up with after college, which does not make me super optimistic.
  - assblaster 8y ago
    Since you haven't been through medical education and training, you wouldn't understand that while certain details are forgotten, the core knowledge that serves as the basis for further learning is retained. Do you remember every detail of your first grade education? Probably not, but it has served as a foundation for everything else you learned in life. How do you learn calculus if you don't learn numbers and letters?
Ericson2314 8y ago
As you conclude with, this is really a social/economic problem mascarading manifesting as a technical one. The problem is doctors (and lawyers) are the best unionized workers in the country. I'm all for unions, but when a certain group of laborers is much better protected than everyone else, and their work legally distinguished creating extra monopoly power, the asymmetries erase the benefits to society. 1. All the memorization acts as gatekeeping to tighten supply. This is in addition to other explicit quotas. 2. Young post trainees (residents, young associates) do the boring drudgery (and in medicine are under-compensated relative to later). This internally is a hazing ritual, pure and simple. Externally, this is again terrible for productivity. Reducing the drudgery at the top of the food chain removes the psychological yearning for improvement from those with more power. And in the resident case exacerbates the lack of competition which would force change. The long hours of residents + stigma talked about here also exposes the rank hypocrisy.
- bookofjoe 8y ago
  My three-year (1977-1980) anesthesiology residency at UCLA Hospital was wonderful. Loved almost every minute, including the all-nighters. And no, I wasn't on antidepressants or stimulants other than occasional coffee.
  - Ericson2314 8y ago
    How long were your shifts?
    - bookofjoe 8y ago
      Final year of residency — schedule as senior resident in the house overnight: Day 1 (weekday): Report for duty at 3 pm, take over from the day team with night call team. Try to send everyone on day team home by 5 pm. Cover hospital and all services for Code Blues; emergency intubations; difficult catheterizations/IVs; patients who arrived late and required pre-op history & physical before next day's surgery; anesthesia for deliveries in OB; anesthesia for cases ongoing from day plus emergencies from ER and in-house. Done at 7 am the next day (Day 2). So 16 hours. No sleep as a rule. Day 2: Off (home to sleep during day to make up for missed night; to bed that night as usual. Day 3: Report for work at 7 am; light duties such as pre-op workups of ambulatory patients; start IVs/arterial lines in pre-op area; Code Blue coverage of hospital and all services. Off at 3 p.m. Day 4: Repeat Day 1. This schedule applied for six months. Note: If Day 1 fell on Saturday or Sunday or a holiday, report to work at 7 am (rather than 3 pm), otherwise identical to weekday. Off at 7 am the next day, so 24 hour shift. Sometimes a nap or two.
SkyPuncher 8y ago
> The medical profession needs to figure out how to use technology more effectively in its processes. My wife is in med school. It has nothing to do with technology. It comes down to an insane risk aversion present throughout all of medicine. If you can't prove an alternative method is empirically better, it won't even get tried. If it's not tried, you can't get the numbers. Even when things are obvious improvements or carry limited down-sides, the whole medical field is hesitant to pursue them.
kendallpark 8y ago
You can't really get around the drilling. Medicine is fundamentally different than programming in this regard. You have to know the names, not just the concepts, and there are a TON of names. There IS technology that does help with memorization. Many, many students use Anki for spaced repetition. Most subscription study sources offer some kind of spaced rep (USMLERx Flash Facts, Firecracker, etc). There is also Sketchy and Picmonics for pictorial memorization of microbes and drugs.
- BucketSort 8y ago
  You can't get around the drilling in anything, but the point is that students do an OBSCENE amount of it, and forget most of it. Also, as other's have said, most material is totally irrelevant to the actual practice of medicine and will be forgotten quickly. EX: You don't need to know organic chemistry to be anything but a medical researcher (which should be a distinct profession), yet the system falsely increases the number of requirements to keep people in school longer and maintain control. It's a corrupt system In my eyes, and people fall for this bullshit that it's so difficult to be a practicing doctor... it only is when you add extraneous stuff that is not necessary in the practice of medicine. Most doctors aren't researchers. You don't need that much education to practice medicine and fit the role of what people need when they seek a doctor. It has to change, because the current state of affairs is out of control. People are losing all that they have to the raping of the medical industry.
EamonnMR 8y ago
I think the main failure to use technology is actually in communication, specifically in handoffs, communication with patients, etc. Paper records exist even though the infrastructure to make paper records work (including a population of young people willing and able to make this system run) is largely gone. Practices need to write referrals, and will try to fax documents over which then need to be re-entered. HIPPA, rather than encouraging EMR systems, makes professionals skittish to put anything into a computer. Rather than medical information breeches, we suffer from the medical information not getting to the right people.

actualdc1 8y ago

You fail to appreciate that there is quite a bit of skills development and problem solving training. The first two years are more memorization heavy, as you have to learn the language and basics. Years 3 and 4 are more focused on navigating the health care system, interacting with patients, performing technical skills, physical examination, use of imaging, diagnosis, etc. Memorization is only a fraction of what you do to become a competent physician.

Ericson2314 8y ago
I take this as: 1,2: memorize 3,4, residency: poorly compensated labor
- assblaster 8y ago
  Medical school is 4 years, pre-medical school is 4 years, internship is 1 year, residency is 2-7 years.
  - Ericson2314 8y ago
    Is that contradictory to what I wrote? Also note that EU combines premed and med school into <8 year bachelor degree.
    - assblaster 8y ago
      First two years of medical school are in classroom, second two years are clinical rotations. Residency is after medical school, and that's the first time you start earning a meager paycheck. In medical school, even when you're "working" with patients, you still pay tuition.
      - Ericson2314 8y ago
        Yeah exactly. And at the very least an EU 6 year med bachelor model would pay you something for years 7 and 8 (counting feom high school).

riahi 8y ago

You have to build the background knowledge to even be able to speak the language of medicine. This is not difficult "just because", it's difficult because it's a huge amount of baseline knowledge that must be assimilated, before you can even begin to think critically. This is like telling someone "we need to figure out how to use technology to prevent people from spending years of rote memorization before they can speak <X_foreign_language>!"

Retric 8y ago
The problem with that analogy is Med school treats medicine like speaking English. But you can simplify the material and treat it like teaching a constructed language. For example if you named the bones in the fingers as left, thumb, two then it’s little effort to recall. Instead people need to recal the stuff like distal phalanges. Math is arguably worse with redundant notations for the same thing. So, I see the benifit of avoiding creating multiple systems.
- nradov 8y ago
  I don't think that's a good example. There are only 206 bones in the adult human body. It doesn't take very long to memorize those. The real memorization time is spent on other stuff for which we don't even have common English names. You could invent new, simpler names for every anatomical part, every disease, every symptom, but that would be a huge undertaking and would only make memorization marginally easier.
  - Ericson2314 8y ago
    Yeah the idea is skip names as the foundation altogether. Instead characterize the spaces by their properties and symmetries, and when there's an exact number of things (like bones) use a GUI (body diagram, decision tree) to air recall so people can just learn the names on the job.
    - assblaster 8y ago
      >so people can just learn the names on the job Ah, yes, the best way to learn all the intricacies of a human: osmosis. Good luck attaining knowledge that takes 8+ years of focused study in medical training today through osmosis over 30 years of "on the job" training, being paid $0 because you are still "learning" and can't contribute to anyone's actual medical care during that time unlike a resident physician.

jacques_chester 8y ago

> The medical profession needs to figure out how to use technology more effectively in its processes. Med students are probably the most numerous users of spaced repetition tools like Anki. The rest of us are doing it the inefficient way.

Ericson2314 8y ago
Good tool wrong objective! OP means use technology to skip up-front memorization.
- assblaster 8y ago
  How do you acquire knowledge without memorization? What technology do you anticipate using? Johnny Mnemonic neural implantation?
  - Ericson2314 8y ago
    All learning requires some memorization. That doesn't mean all memorization is equally good. Memorize that which is hard to look up. And compress what you need to memorize as much as possible; the compression process itself is intimical to understanding and generalizing. Medical school today would be like learning programming by memorizing the x86 ISA spec.
    - jacques_chester 8y ago
      The x86 ISA spec is a doddle compared to organic chemistry. Which is a pre-med subject. There is a minimum amount of material in any subject that needs to be available for rapid recall in order to be an expert in that subject. A wide variety of different areas have been studied to relate performance to level of learned information. Linguistic fluency requires easy recall of vocabulary. High rankings in chess depend on the recognition of thousands of distinct patterns. Musical improvisation requires thousands of hours of tedious repetition and practice. Effective programming requires a body of knowledge encompassing a variety of topics, a lot of which will be memorised as a side-effect of repeated exposure. But if you think you can be a better doctor than a doctor by scanning the indices of medical textbooks -- realising a little late that you are unfamiliar with a lot of the terms and also unsure in what order the concepts need to be assimilated before you can apply them -- then at least make sure your will is up to date.

GarrisonPrime 8y ago

>Med school -> Memorization school At a bad medical school, maybe. Pretty much anything can be taught as blank facts, versus a method that stimulates critical thinking. Programming, for instance. ;)

assblaster 8y ago

Yet another person with no experience in medicine, finally figured out how to "disrupt" medicine with technology. You can't practice medicine without knowledge. You can't learn how to practice medicine without knowledge. What knowledge is required? Physics, inorganic chemistry, organic chemistry, mathematics, microbiology, cellular biology, biochemical biology, molecular biology, developmental biology, physiology, pathophysiology, human anatomy, pharmacology, histology, gross pathology, statistical analysis, internal medicine, paediatric medicine, general surgery, orthopedic surgery, neurologic surgery, urologic surgery, gynecology, obstetrics, outpatient medicine, cardiology, pulmonology, nephrology, hepatology, radiology, neurology, psychiatry, critical care, healthcare economics, medical ethics, et cetera. If you don't have a knowledge base, you simply can not practice medicine because you don't understand how things actually work... Critical thinking without knowledge isn't critical thinking, it's ignorance.

analog31 8y ago
How does the brain work? Okay, that was sarcastic. But in my view no doctor knows all of those subjects in depth. Pre-med students take the basic STEM courses in order to pass their MCAT's, and then forget most of what they learned, and those courses were all just superficial intro courses anyway. To be fair, the same can be said of most engineers. Many med students (wisely) major in a STEM subject, so they may get into more depth than someone who majored in some kind of "studies." But what they know is a function of what they actually studied, learned, and kept up with after college, which does not make me super optimistic.
- assblaster 8y ago
  Since you haven't been through medical education and training, you wouldn't understand that while certain details are forgotten, the core knowledge that serves as the basis for further learning is retained. Do you remember every detail of your first grade education? Probably not, but it has served as a foundation for everything else you learned in life. How do you learn calculus if you don't learn numbers and letters?

Ericson2314 8y ago

As you conclude with, this is really a social/economic problem mascarading manifesting as a technical one. The problem is doctors (and lawyers) are the best unionized workers in the country. I'm all for unions, but when a certain group of laborers is much better protected than everyone else, and their work legally distinguished creating extra monopoly power, the asymmetries erase the benefits to society. 1. All the memorization acts as gatekeeping to tighten supply. This is in addition to other explicit quotas. 2. Young post trainees (residents, young associates) do the boring drudgery (and in medicine are under-compensated relative to later). This internally is a hazing ritual, pure and simple. Externally, this is again terrible for productivity. Reducing the drudgery at the top of the food chain removes the psychological yearning for improvement from those with more power. And in the resident case exacerbates the lack of competition which would force change. The long hours of residents + stigma talked about here also exposes the rank hypocrisy.

bookofjoe 8y ago
My three-year (1977-1980) anesthesiology residency at UCLA Hospital was wonderful. Loved almost every minute, including the all-nighters. And no, I wasn't on antidepressants or stimulants other than occasional coffee.
- Ericson2314 8y ago
  How long were your shifts?
  - bookofjoe 8y ago
    Final year of residency — schedule as senior resident in the house overnight: Day 1 (weekday): Report for duty at 3 pm, take over from the day team with night call team. Try to send everyone on day team home by 5 pm. Cover hospital and all services for Code Blues; emergency intubations; difficult catheterizations/IVs; patients who arrived late and required pre-op history & physical before next day's surgery; anesthesia for deliveries in OB; anesthesia for cases ongoing from day plus emergencies from ER and in-house. Done at 7 am the next day (Day 2). So 16 hours. No sleep as a rule. Day 2: Off (home to sleep during day to make up for missed night; to bed that night as usual. Day 3: Report for work at 7 am; light duties such as pre-op workups of ambulatory patients; start IVs/arterial lines in pre-op area; Code Blue coverage of hospital and all services. Off at 3 p.m. Day 4: Repeat Day 1. This schedule applied for six months. Note: If Day 1 fell on Saturday or Sunday or a holiday, report to work at 7 am (rather than 3 pm), otherwise identical to weekday. Off at 7 am the next day, so 24 hour shift. Sometimes a nap or two.

SkyPuncher 8y ago

> The medical profession needs to figure out how to use technology more effectively in its processes. My wife is in med school. It has nothing to do with technology. It comes down to an insane risk aversion present throughout all of medicine. If you can't prove an alternative method is empirically better, it won't even get tried. If it's not tried, you can't get the numbers. Even when things are obvious improvements or carry limited down-sides, the whole medical field is hesitant to pursue them.

kendallpark 8y ago

You can't really get around the drilling. Medicine is fundamentally different than programming in this regard. You have to know the names, not just the concepts, and there are a TON of names. There IS technology that does help with memorization. Many, many students use Anki for spaced repetition. Most subscription study sources offer some kind of spaced rep (USMLERx Flash Facts, Firecracker, etc). There is also Sketchy and Picmonics for pictorial memorization of microbes and drugs.

BucketSort 8y ago
You can't get around the drilling in anything, but the point is that students do an OBSCENE amount of it, and forget most of it. Also, as other's have said, most material is totally irrelevant to the actual practice of medicine and will be forgotten quickly. EX: You don't need to know organic chemistry to be anything but a medical researcher (which should be a distinct profession), yet the system falsely increases the number of requirements to keep people in school longer and maintain control. It's a corrupt system In my eyes, and people fall for this bullshit that it's so difficult to be a practicing doctor... it only is when you add extraneous stuff that is not necessary in the practice of medicine. Most doctors aren't researchers. You don't need that much education to practice medicine and fit the role of what people need when they seek a doctor. It has to change, because the current state of affairs is out of control. People are losing all that they have to the raping of the medical industry.

EamonnMR 8y ago

I think the main failure to use technology is actually in communication, specifically in handoffs, communication with patients, etc. Paper records exist even though the infrastructure to make paper records work (including a population of young people willing and able to make this system run) is largely gone. Practices need to write referrals, and will try to fax documents over which then need to be re-entered. HIPPA, rather than encouraging EMR systems, makes professionals skittish to put anything into a computer. Rather than medical information breeches, we suffer from the medical information not getting to the right people.