As far as your targeted questions, yes, I do think I would pass a cellular biology test from medical school. I wouldn't get 95%+ but I would expect myself to get at least 80% correct.
I'd estimate the overwhelming majority of practicing physicians would pass the USMLE if they took it cold. They probably wouldn't do as well as they did after many weeks of dedicated study, but they would be above the minimum threshold.
It's not because you can't start on the path without going to medical school. And you don't need medical school to start learning radiology. I messed up my elbow in high school. They showed me the x-ray and said this is a fracture, this is a chip, etc. It wasn't difficult to understand and with enough time and practice I'd be able to see them in other x-rays. I don't see where something like Organic Chemistry comes into play.
>As far as your targeted questions, yes, I do think I would pass a cellular biology test from medical school. I wouldn't get 95%+ but I would expect myself to get at least 80% correct.
So ~20% of what you learned in cellular biology isn't needed as a radiologist assuming you only remember what you've actually needed.
From what I can tell in this exchange is that you have an innate distrust of credentialing, because you think because there is some excess therefore the entire system is wasteful. I’d argue that this is the DunningKruger effect in action.
And claiming that 20% of cellular bio is unnecessary is a silly metric when in the US 70% is passing... I don’t think that logical conclusion applies.
Yes we have more tools to look up information that we have forgotten, but as another poster here says “we aren’t bootstrapping the search each time”. If there’s something we’ve forgotten, it’s much more effective knowing where to start the search.
I agree there’s a lot wrong with our current training paradigm; the cost of medical school education is #1 with several terrible downstream effects.
However, there are no shortcuts. You have to put in the time to master the material, else you are doing your patients a disservice.
>And claiming that 20% of cellular bio is unnecessary is a silly metric when in the US 70% is passing... I don’t think that logical conclusion applies.
You're saying that you don't know 20% of cellular biology that they teach in med school. You are a practicing radiologist. Therefore, 20% of the cellular biology they teach is not necessary to be a radiologist.
I have certifications in my field. Developer, Senior Developer, and Lead Developer. If I were to retake the tests, I'd get a 100% on the Developer and Senior one without studying for a minute. Those are good tests. They reflect what you need to know to be effective. The Lead one isn't. I'd probably not pass if I took it today even though I've worked several years as a lead developer since I passed it. So despite actually working in the field and becoming a better developer I'd do worse on the test. That means it is a bad test.
So when you say that the overwhelming majority "wouldn't do as well as they did after many weeks of dedicated study" that makes it a bad test. It means that a good chunk of it is meaningless hoop jumping irrelevant to practicing physicians. A competent practicing physician should breeze through a well designed certification exam.
>I agree there’s a lot wrong with our current training paradigm; the cost of medical school education is #1 with several terrible downstream effects.
>However, there are no shortcuts. You have to put in the time to master the material, else you are doing your patients a disservice.
If someone who wants to be a geriatric doctor skips pediatrics I don't see the disservice. Or take someone like a registered Nurse Midwife. Someone with 20 years experience delivering babies. The only way for them to become competent to prescribe pitocin, antibiotics, or use forceps is 4 years and $200k worth of school? It doesn't pass the smell test.
>While specialization is coming to all of Medicine, we tend to cluster by body region/disease state, rather than by modality.
These are contradictory statements. If Doctors typically go:
No Training -> Trained in everything -> Specialized in body region/disease state
You can easily go:
No Training -> Trained in body region/disease state -> Specialized in body region/disease state
So even if we assume it's not possible to specialize radiologists any further than they already are we can still cut the training time and difficulty.
>We have to know how referring clinicians will treat disease, and know the major complications to look out for on imaging. We discuss their treatment plans during tumor boards and need to speak the language of the treating teams so we can tailor our interpretations to be useful. We need to know both physiology and pathophys when interpreting imaging to know how disease manifests and what is abnormal versus post therapy related change.
No one is denying that there are things in medicine that are complicated and require very skilled people. What you describe is the end state of a fully educated and experienced doctor. Medicine is more or less the only field that makes you become that before you start working. Can you take a reasonably smart person off the street and have him designing plans to treat tumors in a year? No. Can you take that person and train them to identify normal appearing lungs vs cancerous ones in that time? Probably. And can that person learn on the job and develop the ability to design a treatment plan over the course of 10 years working? For sure. And they wouldn't learn everything taught in Med school. They would pick up only the things relevant to the job they are trying to perform.
>All of medical knowledge is iterative. Unlike programming, you can’t just abstract the low-level programming. The premedical curriculum provides the baseline knowledge to understand pharmacology, which is essential when trying to understand our interventions in physiology and pathophysiology. We need to know both physiology and pathophys when interpreting imaging to know how disease manifests and what is abnormal versus post therapy related change.
Going back to the comment that kicked this all off. If I handed you a cellular biology final from Med school do you think you'd be able to pass it? What about the USMLE?
>There are no easy shortcuts here. NPs and PAs are a living experiment at a shortcut, but what I see day in and day out is that the people they consult (radiology and pathology) need to know even more clinical medicine to help the inexperienced NP or PA in knowing what to do when something happens that deviates from the protocol. Many many many times I will call with a semi-urgent unexpected finding, and just get silence on the other end of the phone. They don’t know what to do, whereas on weekends or nights when I get residents or attendings, I don’t hear this complete absence of understanding.
Every other field has the ability to take inexperienced people and make them experienced. There's no reason medicine can't do the same. Your clueless NP and PA should have more experienced people to go to for help when they experience something new. The next time they get that call they wouldn't be as clueless.