2012 December 23 Sunday
NYU Medical School Offering 3 Year Path To Degree
America's elite institutions are slowly but surely coming around to my way of thinking about education. NYU and a few other medical schools are going to start offering faster paths to an MD.
But now one of the nationís premier medical schools, New York University, and a few others around the United States are challenging that equation by offering a small percentage of students the chance to finish early, in three years instead of the traditional four.
How to build on this: Put all the courses and their tests online. Let undergrads study medical classes in their spare time. So when they go to apply to med school they can even get tested to see how much they already know. An ambitious undergrad could easily learn first and second year med school material before getting a bachelors. Then that summer learn more and get thru the rest of the material in another year. A 23 year old could graduate from medical school.
Throw in the ability of teen kids to take college courses at the age of 16 and it is not unreasonable to expect 21 year olds to graduate from medical school. Big money savings, less debt going into adult life, longer working life with more services provided to patients, taxes paid to government, earlier entry into family formation.
By Randall Parker at 2012 December 23 07:51 PM
Also less profits for the schools, less staff, fewer administrators.
They'll have to be dragged into this kicking and screaming.
Notice the subtle framing: 3yr degree if you go into primary care. *Primary Care*. Now, this does make sense, as the "primary care" provider is there to recognize and diagnose, not to perform complex procedures or innovate new cures, both of which require a *thorough* mechanistic understanding of disease and treatment.
Of course, as noticed elsewhere: if the primary worry is tuition cost...why not just decrease the cost of tuition? This method ensures that the 'cheaper' tuition [cost to institution] is minimized by going only to students who enroll in primary care programs. For the majority of students, they will be choosing between a 50k upfront savings or lower long-term wages by focusing on primary care as opposed to specialty.
In the end, I think for this very reason, it ends up failing. I believe cost and access issues will open up primary care clinics to be staffed almost entirely with non-MD personnel (NPs, PAs, etc.). The more driven, intelligent MDs who strive for specialties will still maintain a decent lifestyle. The primary care MDs will be left holding the bag as they're too costly to staff clinics, and not adequately trained to be specialists. Thus, fewer and fewer MDs will apply to primary care residencies (as they are already doing).
Of course, this is all an appropriate outcome IMO. Primary care physicians need to be able to recognize and diagnose. These skills value experience and attentiveness moreso than knowledge. The PCP (primary care physician) does not need to know the cellular milieu involved in the wound healing process, just that it should take 5-7 days. They do not need to know the mechanism of hydrochlorothiazides as diuretics, just that they're the first drug to try for hypertension. Training = cost, and overtraining = high cost. With the direction the USA is trying to go (centralized health systems), any high costs without accordingly high rent-seeking abilities will be the first on the chopping block. PCPs beware.
My guess is the limitation to primary care paths is just a stepping stone. The article describes other universities trying out 3 year paths thru medical school. I doubt every one of them will limit the enrollees to only those on a primary care track.
I also expect we'll see eventually what I'm suggesting: let students earn credit toward an MD before they even show up for their first day at med school. This is already done with AP tests for undergraduate degrees. A kid in high school will be able to watch med school lectures. Someone who wants to devote their life to medicine starting at age 14 is going to have plenty of stuff to study 365 days a year before they get to traditional college age.
Primary care clinics: I also expect software will take over a lot of initial diagnosis. People will get blood tests at home or pharmacies with microfluidic devices and by the time they show up at a clinic they'll have been thru 1 or 2 rounds of tests. Pharmacies will have something like the old photo taking booths but for medical diagnosis. The booths will scan eyes, tongues, infrared for skin temperature, have a place for the arm for blood pressure, and do other assays.
In many countries Medicine is an undergraduate degree.
In Australia Medicine and Dentistry used to be an undergraduate degree but many universities
especially the top tier ones are changing this to match the US.
Many claim this is to increase student debt and many welcome this move for reducing the
stress pressured on highschoolers, giving them the opportunity to mature and have a greater chance at entry.
Get rid of your undergraduate degrees. You dont need a literature degree to be a doctor, you dont need an engineering degree to be a lawyer. Plenty of countries have medical degrees starting right after high school, and their doctors turn out just fine and much cheaper.
There are a couple dynamics you need to consider when looking at MD training:
1) More students "plan on" becoming a physician than actually do. Probably 10% of each matriculating university class has aspirations of becoming a doctor. Out of 100 pre-med students in Chemistry 101 (freshman year), only 20 or so will actually end up in medical school. So the undergraduate training is actually a valuable tool, as it strongly winnows the pool of competitive applicants. There are roughly 15,000 medical school seats, and 15 million undergraduates. If 10% of those students were to apply to medical school right off the bat, you'd have 1.5m applicants for 15,000 spots. Compare that with ~30,000 applicants total in the current system. The sieving problem becomes too complex and prone to patronage/fraud when you're looking at a 1000:1 ratio of applicants to spots. Hence, the importance of a separation period like undergrad. All that said, a separation period shouldn't cost 25k/yr. Undergrad tuition schemes are fraudulently high. Problem 1: adequately sorting 999:1
2) Owing to the diversity and general clusterf*ck that is undergraduate "education", it's difficult to 'test out' of core courses unless you're talking about creating/expanding a current standardized testing regime. While much of 1st year medical school feels redundant (the first year is mostly basic science at many institutions), you'd be surprised how many students arrive without knowing the functional importance of an enzyme. I kid you not, I've actually had medical students *avoid* taking biochemistry because "it's hard and has no relevance to medicine". Yes, biochemistry - the *basis for life* - apparently has no relevance to medicine. That this idiocy actually made its way through undergrad and ended up in a [admittedly low-level] medical school is worrisome. I'd estimate a good 20% of medical students would not be able to handle 2nd-4th years if not forced to learn the basics in 1st year. This is particularly relevant in "diversity" admissions. Problem #2: consistent training.
I know, I've gone through the whole thing (undergrad/applications/medschool). I think it's a horribly run process and extremely wasteful. But in the absence of *massive* structural changes to higher education, it's the best we can do right now. Ideally you could apply yourself to several training modules in lieu of a traditional undergraduate degree, and find the best match before embarking on that career. Technology affords that, but good luck getting the entrenched university industry to allow it.
"NYU Medical School Offering 3 Year Path To Degree"
Oh my god, that's really frightening. Medical practice in America is already poor compared to other countries, even third world countries. I wouldn't want to be diagnosed or operated on by a 23 year old.
Sorry, I'd rather be treated by a Cuban doctor without hesitation.
Some other Western countries do not even require a bachelors degree before going to medical school. In fact, the Latin American School of Medicine in Cuba does not require a bachelors degree for admissions. So they've got to spend part of med school that would be learned by undergrads in the US.
The 3 year degrees can be done with summer classes and heavier course loads. The smartest med students will do fine with a 3 year program. They've still got to pass state boards and do further training beyond med school.
"Some other Western countries do not even require a bachelors degree before going to medical school. In fact, the Latin American School of Medicine in Cuba does not require a bachelors degree for admissions. So they've got to spend part of med school that would be learned by undergrads in the US."
That's because high school in those countries really IS high school. Students take up to 13 topics in high school, while in the U.S. public schools there's generally 6, including P.E., Wood Shop, Pottery, etc. Latin American students have their "Bachillerato" during high school which is the major area of preparatory studies for the university, which means Latin American students ARE ready for med school right after high school, while American students are not, and therefore require a bachelors degree to make up for the Latin "Bachillerato". It's very simple really when you know about the educational systems of other countries. Third world countries doesn't mean stupid countries, you know. Third world countries doesn't mean lands of idiots you know...
But hey, it IS true that Cuba holds the best medical practice in the Western Hemisphere, and failing to see that because of stupid national pride is willful ignorance. Read about the medical programs Cuba has for its citizens and foreigners, FOR FREE, particularly all those "miracle" sight recover programs. It is true. Half of the world knows about it. It is a fact, and before FACTS, there are really no ARGUMENTS that stand, right? Right!
This also happens in Venezuela, Randall, but I know you won't even look at the site.
A snarling posting tone does not make your arguments persuasive. You did not supply as much facts as you supplied attitude. I'll give you facts.
Latin American high schools: If they were working miracles this would show up in international comparisons of student performance. Well, this does not show up in such comparisons. Try again. Chile is best of Latin American countries on PISA tests and yet it still scores low:
Yet from the very beginning, American students have generally performed below average compared to students from the richer countries that comprise the OECD countries. In 2009, the average American student did a little better on the PISA tests: they were much above students from the great majority of the 65 countries that participated, and were at, but no better than, the average level of OECD countries.
The American students who did poorly are black and Hispanic. American whites score very high in international comparisons. You can find that out without much Google searching. So on to Latin America where you imply their high schools are doing a great job teaching what is college-level material in the US. Er, no.
Another interesting case is that of Chile. Some critics have used Chileís below average performance on the PISA tests to oppose Chileís extensive use of school vouchers. Chileís performance may be disappointing, but in 2009 Chile did the best of all Latin American countries (Chile was a little behind Uruguay in math), and much better than Brazil, Argentina, and Mexico (except again in math where Chile did about the same as Mexico), even though Argentina has a much longer tradition of emphasizing education.
IQ comparisons across countries suggest why the PISA results line up as they do:
The rankings tend to be interpreted as measures of the quality of a nationís pre-collegiate school system (primary and secondary education, since primary education influences performance in secondary schools). But this may be a mistake. Schooling is only one, though doubtless an important, input into performance on the PISA tests. Another is IQ. There have been some efforts to compare IQ across countries, notably by Richard Lynn and Tatu Vanhanen; see their 2006 book IQ and Global Inequality. Their results cannot be regarded as definitive, given significant limitations in the data, but they are suggestive. The authors find that the East Asian countries, which generally rank highest on the PISA tests (including readingónot just math and sciene), have the highest average IQs; the average IQ of Americans is lower because of our large black and Hispanic populations, which have lower average IQs than whites and Asians.
IQ is understood to reflect both genetic endowment and environmental factors, particularly factors operative very early in a childís life, including prenatal care, maternal health, the educational level of the parents, family stability, and poverty (all these are correlated, and could of course reflect low IQs of parents as well as causing low IQs in their children). The case for very early intervention in childrenís development, powerfully urged by the distinguished University of Chicago economist James Heckman, can be understood as an effort to lift IQs in the black and Hispanic communities and by doing so improve the educational performance of black and Hispanic children, including performance on the PISA tests. It is true that Heckman emphasizes noncognitive skills that facilitate learning, but these skills could also increase performance on IQ tests, indicating a positive effect on IQ.
National average IQ is the strongest predictor of national average per capita GDP. That's a fact.
Oh f***!, here we go again with the IQ complex. Randall you're obssessed with all that IQ crap, just like a midgets get obssessed with finding someone shorter than they. Please, just ease down on all that trash talk. It was not my intention to insult you or anybody by preferring a Cuban doctor than an American one, nor did I care about McNeil or anybody else agreeing with me, but you go off on IQ again? again? yet again? Take it easy man. I simply said that I wouldn't want to be diagnosed or operated on by a 23 year old, and that I'd rather be treated by a Cuban doctor without hesitation.
Now, McNeil only spoke about something I -and many of us here, probably- didn't know about Latin American high schools, not "working miracles" as you deceitfully imply he did. He also pointed out at what seems to be great medicine in Cuba and Venezuela. At this point, instead of all your typing trying to persuade how McNeil or I are so stupid, I -on the other hand- am curious to know more about this apparently wonderful Cuban and Venezuelan medical program and if it is really true, that's all. Let me emphasize the word apparently, so that I make it clear that I also doubt McNeil's claims, but wish to verify, that's all. But if it turns out that McNeil's comments are right and you're just being emotional, you're going end up embarrassed by yourself alone. So yeah, I've just watched McNeil's link suggestion, and now I'm curious, because if I find out it's true, my very, very low IQ preference is going to seem very sensible compared your super high IQ's dogmas. If McNeil is proven to be a f*** lier I'll chase him like a hound, but he seemed to be explaining and making a point on verifiable things, while your IQ and superior race post seem to be just out of topic trash talking. I admit that I'm ignorant in many regards to the point of mockery and derision, and also that my IQ might be rather low, but I really doubt your IQ is that much higher.
Bye for now.
If Latin American high schools were graduating people with the equivalent of college-level educations they really would be working miracles.
I'm the one making the claim that the Cubans accept kids out of high school to go to medical school. I got that info from the Wikipedia page that I linked to. My point is that the Cuban doctors are graduating from medical schools at much younger ages than American doctors. Yet McNeil says Cuba has the best medical practices in the Western Hemisphere.
IQ talk: IQ is a very powerful predictor of performance.
Cubans still live in poverty, but Cuban medicine is really good, nobody doubts that.
Randall, respectfully, what McNeil has claimed is a well-known fact by those who are informed on that issue and perhaps you should be aware of it if you are to argue in favor or against it.
Let's take a look.....