How Can I Handle a Shortened Preclinical Curriculum?

Daniel J. Egan, MD


September 06, 2011


I'm nervous because my medical school has shortened the preclinical curriculum. How am I going to learn everything?

Response from Daniel J. Egan, MD
Assistant Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons, New York, New York

Fear not because you are not alone. You have entered a medical school that has either created a movement or is following a movement calling for a changed layout of the traditional preclinical education. Schools are shortening the basic science years in exchange for more clinical time, and we are seeing this trend around the country.

I can remember back to the preclinical years -- although that time is getting more and more distant -- and feeling completely overwhelmed about the amount of information that I was expected to learn. I am sure that with the years that have passed, the amount of information that we are expected to know is increasing as research tells us more about pathophysiology, immunology, genetics, and the long-term trajectory of different disease processes. I have a difficult time imagining trying to learn everything in a shorter amount of time. I guess that is what you are feeling as well.

The first lesson is that regardless of whether you have 1.5 years or 2 years, you will never be able to learn everything. There is fundamentally too much information to completely master during the preclinical years. Each course carries with it a certain amount of detail that is important for a very brief period of time, and this information will likely not influence your practice in the future. I am sure that this knowledge has played a role in the movement to shorten this portion of medical education. However, in terms of your assessment at the completion of your basic science training, the licensing exam (US Medical Licensing Examination [USMLE] or Comprehensive Osteopathic Medical Licensing Exam [COMLEX]) governs the expected knowledge base. You will be held against this standard compared with the other students in the country. So how are you going to learn everything?

To repeat, you are not going to learn everything. It is impossible. However, you do need to know the basics for each class. I suspect that this will require more self-directed learning and force you to school yourself as you move through your curriculum. To do this, you should be clear from the onset of your class about the goals and objectives of the course directors. You should also try to establish what you will be tested on so that you be sure not to miss those key components. Depending on your school, the preclinical years may have a grade or may be solely pass/fail. This will likely help guide how much you "learn for the test."

Beyond the specific test, you should then take the opportunity to learn more about what interests you. This is one of the few times in your training when you will have time to really embrace a new topic or read more just because it intrigues you. Residency will strip away time, and then you will become more focused on your specialty. Second, you should get an early start by looking at a guide to either the USMLE or COMLEX. As you move through a course, you may want to cross-reference the guide to identify the key information that will be covered on the exam in order to try and learn it in the appropriate context as opposed to learning it later.

I always say that it is worth getting tips from students who have gone before you. People who have experienced the same curriculum as you will likely have pointers to help you figure out how to prioritize and manage your time. I would also recommend that you take advantage of your classmates. Studying in groups or just getting together to discuss topics always adds more to your learning. By teaching something to a classmate, you will likely retain that information better. Also, different ways of approaching a topic may help you process it differently. I remember often taking an exam and hearing in my head the voice of my classmate explaining something to me as opposed to having read it in a textbook.

All in all, fear not. People who are much smarter than you and I about principles of education and adult learning have decided that shortening the preclinical years is appropriate. As a result, you will have more time to truly develop your doctoring skills and become a better clinician.


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