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I’m Graduating Medical School Now, AMA
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bruriyah




 
 
    
 

Post Wed, Apr 21 2021, 4:37 pm
amother [ Powderblue ] wrote:
Wondering the same. A quick google search came up with this:

Can the Op weigh in with the facts?


This video is both false and extremely misleading. Yes, we absolutely learn about vaccines. Will post a longer answer soon!
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bruriyah




 
 
    
 

Post Wed, Apr 21 2021, 5:37 pm
Addressing the video:

So false and misleading I don't even know where to begin.

1. That whole pile of textbooks they throw at you-- med school is not done that way today. Most of our resources are electronic. We might use textbooks to reference things and create study materials, but you don't learn to become a doctor by reading books. People only remember ~20% of what they read so it's a very very inefficient way to learn.

We master information with questions that are based on a a scenario (for example, someone walks in with a fever, low blood pressure, and fast heart rate, what is your next step?) and for brute memorization of facts (pharmacology, anatomy, immunology) we use flashcards. Then, after we pass our first big board exam, we enter clinical rotations in person and our we learn hands-on AND are TESTED hands on. For example, a psychiatry rotation might look like this:
-spend 9-5 on the psychiatry ward of the hospital
-carry ~3 patients (a resident would be carrying up to 10-15)
-come home and do practice questions and flashcards for the big exam at the end of the month-long rotation
-"carrying" a patient means you are acting like their doctor, but with supervision of course
-in the middle of the rotation you will get feedback about how you are doing and how to improve (maybe you do a great job talking to a patient, but your notes need work, maybe you really know you pharmacology, but your knowledge of physiology has gaps)
-during the rotation you will be "real-life" tested many times, for example, you need to do a full psychiatric evaluation on a patient, you need to come up with a medication plan for a patient, you need to present a brand new patient to your team etc...
-then, at the end of the month, you take a "shelf" exam on the topic of psychiatry. You will seldom see a question like this: "Drug X has which side effects?" rather you will see: "Patient started drug X a month ago and now presents with symptom Y. What do you do?"Notice the difference?

2. As for how much time is spent learning about vaccines, well, not 4 grains out of 6000. That's just a lie. The first two years of medical school is where the heavy learning is done (not in person) and I took say about 16 courses total. 4 of them covered vaccines in depth - Molecular and Cellular Biology, Immunology, Infectious Disease, and Pediatrics. That's 25% of our courses. The main understanding of vaccines is in molecular biology - as in, how vaccines work on a molecular level.

The main topics we cover when learning about vaccines are who should be getting them, who should not be getting them, how effective or ineffective are they, and what the goals are. For example, congenital rubella can cause deafness so that is one goal of the MMR vaccine is to prevent deafness in newborns. Another example would be avoiding live-attenuated vaccines in immunocompromised people like HIV. We also have small group discussions about vaccines. For example, in one small group discussion we discussed a meta-analysis (a meta analysis is a research study that looks at many research studies together) about the efficacy of the flu shot, which, it so happens to be, isn't one of our best vaccines. The conclusion was that the flu shot prevents about 1-2/10 people from getting the flu but may mitigate it in people who do get it.

Something important to understand about the study of medicine is that we spend more time learning common things and less times learning less common things. For example, we spend a lot of time learning about diabetes, heart disease, and common infectious diseases because these are so so common. Less time is spent learning about rare diseases, say, Marfan Syndrome and Creutzfeldt-Jacob disease (google if you haven't heard of those!). Vaccine side effects happen, but they are not common, and we therefore don't spend that much time covering those. That's not to say they aren't covered, but they are covered less, in the same way that rare diseases are covered less.

Another things to keep in mind is that doctors tend to think in number and statistics, because as humans, we need context for our knowledge. Let me explain what I mean. If we learned about every single way a disease presented in history, it would be impossible to learn medicine. What we do is create a pattern of the MOST COMMON way a disease presents. That way, we learn to recognize MOST of the cases. But there will always be outliers. Think of a bell curve; as doctors we are trained more in the 95% and less in the 2.5% outliers on each side. I think this is the issue with vaccines. Doctors will sometimes dismiss possible side effects or ineffectiveness of the vaccine because they are too focused on the 95%. But when that side effect happens to YOU, the other 95% is irrelevant; this is something doctors can forget. I think this is something we need to improve in as doctors.
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bruriyah




 
 
    
 

Post Wed, Apr 21 2021, 7:13 pm
andrea levy wrote:
Mazal Tov! If this was thirty years ago, I too would be doing what you did( getting on a path, upgrading my undergraduate studies - I have a BA IN English) and aiming towards medicine. At 53, my chances of ever getting in to medicine are slim to none. Especially in Canada where tuition is about $25 k a year. I’m sad that I did not figure it out sooner, but so happy for YOU!

My dream job would be in metabolism or endocrinology. I hope you remain happy and fulfilled in your future! Rooting for you!


Thank you, you’re very sweet. Here in the US tuition is considerably higher, about 35k/year for state schools and 60K/yr for private school. It is quite expensive. There are some lucky ones out there who have parents able to finance medical school, but thr vast majority need to take out loans.

Medical school can be so grueling that we sometimes forget what we wanted in the first place. But like I mentioned before, I have no regrets.
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bruriyah




 
 
    
 

Post Wed, Apr 21 2021, 7:22 pm
amother [ Forestgreen ] wrote:
Congrats and Hatzlocha!!
Regarding the curriculum-
How long did you spend learning about vaccines- thier contents, potential adverse events, what to look out for, how to report an adverse reaction, what subgroups are vulnerable to adverse events, what ongoing research is going on given the expanding childhood and adult schedule?
Because parents do a lot of research on this and many feel their children have been harmed by the expanding vaccine schedule. However, most are told by their doctors " I went to med school", so stop researching...
Sorry to put you on the spot. Just so relevant


I think I addressed a lot of your questions in my previous long post. But I want to address the “I went to med school and therefore know better” part.

This is not unique to vaccines. In virtually every specialty you will have doctors playing the “I went to med school and therefore know better card”. I don’t think it’s professional or good practice for doctors to speak this way. I would guess most of these types were trained a while ago. Our job as a doctor is to give you facts, risks vs benefits, and let you make a decision. This is a concept called “patient autonomy”. At the end of the day, it’s your life to live. There are exceptions to this, though. In the case of children <18, if parents want to deny a child life-saving treatment (vaccines would typically not fall into this category) then the law is to override the parents’ wishes and provide treatment. Another example would be certain infectious diseases that pose a risk to the public. Some would argue that this applies to covid. To get back to your point, you aren’t bound to your doctor and if you don’t like the one you have, you can find a doctor who resonates with you more.
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bruriyah




 
 
    
 

Post Wed, Apr 21 2021, 7:53 pm
amother [ Purple ] wrote:
I’m also curious about vaccine education in medical school . I will wait for a response from Op. I think the pharmaceutical reps are educating the doctors.


I have never, once, been instructed by a pharmaceutical rep. And every single lecturer we have must disclose any conflicts of interest. Every year, every single medical student and faculty member must fill out a form disclosing conflicts of interest and then you have to mention it when relevant. If you are caught lying about this you risk expulsion or being fired. Plus there may be legal action. So, if , for example, one of our instructors worked as a consultant for a pharmaceutical company and would potentially gain by marketing a drug, they would have to mention this at the beginning of every single lecture they give. I have to say that out of all the lectures we had this happened maybe once or twice-that someone had something to disclose. And it wasn’t something like: I have stocks in this drug that I’m going to talk about. It was something rather tangential. Can you please explain why you think pharmaceutical reps teach medical students?
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bruriyah




 
 
    
 

Post Wed, Apr 21 2021, 7:56 pm
amother [ Powderblue ] wrote:
Can the Op or anyone else that has gone through medical school share their experience? I was curious and just asked my friend who is a PA. She admitted me they had one lesson on it. Was about vaccines are safe and effective, and how to deal with hesitant and concerned mothers. Nothing about side effects.


PA’s, I would guess, have one lesson about everything. They need to cram everything into 1.5 yrs of learning. So I wouldn’t use that as a gauge.
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bruriyah




 
 
    
 

Post Wed, Apr 21 2021, 8:32 pm
lovingmommy3417 wrote:
Did you have children while in med school? I know it's not the same but I'm in nursing school and really want to have more kids and grow my family now but terrified that I wont be able to do it all. I feel so stretched as it is.


I had two children during medical school. I did med school in 5 years bec I did a research year in middle.
If you are young, why not wait? If you were 35, then perhaps it’s a different story.
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bruriyah




 
 
    
 

Post Wed, Apr 21 2021, 9:07 pm
amother [ Purple ] wrote:
I’m also curious about vaccine education in medical school . I will wait for a response from Op. I think the pharmaceutical reps are educating the doctors.


I want to add another point to this discussion. The bulk of our studying is done through question banks that ask you about real case scenarios. One section is called “ethics” where they will ask you things like: “a patient wants to express gratitude and gets you a gift. Are you allowed to accept it?” Yes, these are actual test question. The answer is, btw, that you are only allowed to accept gifts of low monetary value. What that threshold is can vary by locality, but something like >$50 is probably not ok. Still, they encourage you to not take an gifts. I’m just bringing this example to show you that there are ethical standards doctors are expected to follow.
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amother
Lime


 

Post Wed, Apr 21 2021, 9:16 pm
I'm curious how many hours you spent learning about nutrition and its role in preventing disease
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amother
Forestgreen


 

Post Wed, Apr 21 2021, 9:19 pm
bruriyah wrote:
I have never, once, been instructed by a pharmaceutical rep. And every single lecturer we have must disclose any conflicts of interest. Every year, every single medical student and faculty member must fill out a form disclosing conflicts of interest and then you have to mention it when relevant. If you are caught lying about this you risk expulsion or being fired. Plus there may be legal action. So, if , for example, one of our instructors worked as a consultant for a pharmaceutical company and would potentially gain by marketing a drug, they would have to mention this at the beginning of every single lecture they give. I have to say that out of all the lectures we had this happened maybe once or twice-that someone had something to disclose. And it wasn’t something like: I have stocks in this drug that I’m going to talk about. It was something rather tangential. Can you please explain why you think pharmaceutical reps teach medical students?

If you look into it, the CDC owns vaccine patents.
The question is about who is forming the curriculum, not who is directly teaching the classes.
I read your answers and it seems that you believe there are very few side effects of vaccines. You are taught about benefit/risk analysis. You are given a scenario and asked what to do next.
I do suggest looking into Dr Lawrence Palevskys work. Hes taught Med students for many years.
He says there is actually a lack of critical thinking when it comes to vaccines.
It's not only about what to do next, but what came before. When you say there are not many effects, how is data collected?
Do doctors know what to look out for and carefully record what happens after vaccination. What if it is months later? Have these things ever been followed?
When you learn about how vaccines work in molecular biology, what about the non specific effects that are simply not accounted for?
Do doctors look up the ingredients and understand the effects?
I taught biology.
I taught from the book which said a pregnant woman should never take formaldehyde into her body.
Formaldehyde is in vaccines.
Now they are being given to pregnant woman, after years and years of doctors saying not to take them when pregnant. They are probably taught that the benefit/risk analysis has been evaluated and its beneficial, statistically.
But are the effects being ignored, because doctors take for granted that the science was done? It seems that way. Doctors are very busy people.

Do doctors understand that all liability was removed from vaccine manufacturers in 1986 after which the vaccine schedule exploded? And that there has been no accounting for the cumulative effect, rather they seem to say that if there was an issue "we would know".

These are things that if you are not looking for independently you may not find.
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bruriyah




 
 
    
 

Post Wed, Apr 21 2021, 9:47 pm
amother [ Lime ] wrote:
I'm curious how many hours you spent learning about nutrition and its role in preventing disease


I get this question a lot. A lot lot. So I suspect that someone out there in some book, blog, or in the ether is saying: “medical students don’t learn anything about nutrition”. I have to tell you that whoever is saying this is being totally dishonest. Or went to school a long time ago. Long enough that they are not up to date with current medicine. What we learn absolutely covers nutrition and it’s role in preventing disease. I’ll try to calculate an estimate of the hours if you’d like. But it’s late and I need to go to sleep. So I will address this fully tomorrow.
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amother
Vermilion


 

Post Wed, Apr 21 2021, 9:56 pm
bruriyah wrote:
I get this question a lot. A lot lot. So I suspect that someone out there in some book, blog, or in the ether is saying: “medical students don’t learn anything about nutrition”. I have to tell you that whoever is saying this is being totally dishonest. Or went to school a long time ago. Long enough that they are not up to date with current medicine. What we learn absolutely covers nutrition and it’s role in preventing disease. I’ll try to calculate an estimate of the hours if you’d like. But it’s late and I need to go to sleep. So I will address this fully tomorrow.


The q is what you're being taught. Are you being taught that fat is bad and grains are good? The food pyramid which is totally outdated? Look I'm not saying you're not an amazing student who spent tons of time learning subjects. But like someone said, who wrote the curriculum? Essentially you're just parroting what the system wants you to.
Signed someone who's been burned by the medical system
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shirachadasha




 
 
    
 

Post Wed, Apr 21 2021, 9:56 pm
bruriyah wrote:
Addressing the video:

So false and misleading I don't even know where to begin.

1. That whole pile of textbooks they throw at you-- med school is not done that way today. Most of our resources are electronic. We might use textbooks to reference things and create study materials, but you don't learn to become a doctor by reading books. People only remember ~20% of what they read so it's a very very inefficient way to learn.

We master information with questions that are based on a a scenario (for example, someone walks in with a fever, low blood pressure, and fast heart rate, what is your next step?) and for brute memorization of facts (pharmacology, anatomy, immunology) we use flashcards. Then, after we pass our first big board exam, we enter clinical rotations in person and our we learn hands-on AND are TESTED hands on. For example, a psychiatry rotation might look like this:
-spend 9-5 on the psychiatry ward of the hospital
-carry ~3 patients (a resident would be carrying up to 10-15)
-come home and do practice questions and flashcards for the big exam at the end of the month-long rotation
-"carrying" a patient means you are acting like their doctor, but with supervision of course
-in the middle of the rotation you will get feedback about how you are doing and how to improve (maybe you do a great job talking to a patient, but your notes need work, maybe you really know you pharmacology, but your knowledge of physiology has gaps)
-during the rotation you will be "real-life" tested many times, for example, you need to do a full psychiatric evaluation on a patient, you need to come up with a medication plan for a patient, you need to present a brand new patient to your team etc...
-then, at the end of the month, you take a "shelf" exam on the topic of psychiatry. You will seldom see a question like this: "Drug X has which side effects?" rather you will see: "Patient started drug X a month ago and now presents with symptom Y. What do you do?"Notice the difference?

2. As for how much time is spent learning about vaccines, well, not 4 grains out of 6000. That's just a lie. The first two years of medical school is where the heavy learning is done (not in person) and I took say about 16 courses total. 4 of them covered vaccines in depth - Molecular and Cellular Biology, Immunology, Infectious Disease, and Pediatrics. That's 25% of our courses. The main understanding of vaccines is in molecular biology - as in, how vaccines work on a molecular level.

The main topics we cover when learning about vaccines are who should be getting them, who should not be getting them, how effective or ineffective are they, and what the goals are. For example, congenital rubella can cause deafness so that is one goal of the MMR vaccine is to prevent deafness in newborns. Another example would be avoiding live-attenuated vaccines in immunocompromised people like HIV. We also have small group discussions about vaccines. For example, in one small group discussion we discussed a meta-analysis (a meta analysis is a research study that looks at many research studies together) about the efficacy of the flu shot, which, it so happens to be, isn't one of our best vaccines. The conclusion was that the flu shot prevents about 1-2/10 people from getting the flu but may mitigate it in people who do get it.

Something important to understand about the study of medicine is that we spend more time learning common things and less times learning less common things. For example, we spend a lot of time learning about diabetes, heart disease, and common infectious diseases because these are so so common. Less time is spent learning about rare diseases, say, Marfan Syndrome and Creutzfeldt-Jacob disease (google if you haven't heard of those!). Vaccine side effects happen, but they are not common, and we therefore don't spend that much time covering those. That's not to say they aren't covered, but they are covered less, in the same way that rare diseases are covered less.

Another things to keep in mind is that doctors tend to think in number and statistics, because as humans, we need context for our knowledge. Let me explain what I mean. If we learned about every single way a disease presented in history, it would be impossible to learn medicine. What we do is create a pattern of the MOST COMMON way a disease presents. That way, we learn to recognize MOST of the cases. But there will always be outliers. Think of a bell curve; as doctors we are trained more in the 95% and less in the 2.5% outliers on each side. I think this is the issue with vaccines. Doctors will sometimes dismiss possible side effects or ineffectiveness of the vaccine because they are too focused on the 95%. But when that side effect happens to YOU, the other 95% is irrelevant; this is something doctors can forget. I think this is something we need to improve in as doctors.

Thank you for taking the time to write this. This was clearly 4 years well spent!
I'm so curious about your specialty- when you're ready to divulge.
Wishing you much hatzlocha.
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DrMom




 
 
    
 

Post Wed, Apr 21 2021, 9:57 pm
mirror wrote:
Thanks for coming forward.

I'm at a loss and maybe you can help me. My friend's 17-year-old daughter never watched any movies or television, yet she was exposed to whatsapp chats and youtube videos. She is now convinced that vaccines cause cancer and kill people. The reason we don't know about this is because the media is covering it up. She saw a video of a doctor who claimed... What can I possibly say to her? Why aren't our schools teaching kids to be wary of anyone claiming to be a doctor on youtube?

What would you say to parents who think it's okay to let their kids spend hours watching educational videos on youtube without supervision?

Tell the parents that in a few years her DD will B"H get married and be able to join imamother, where she will have many like-minded women with whom to share her theories.
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amother
Black


 

Post Wed, Apr 21 2021, 10:27 pm
Congrats Op! You sound like a very though out and knowledgeable graduate.
Sounds like you have been working very hard!
Were you always a hard worker? When did you know that you wanted to be a DR?
Are you planning to work in your community of origin?
From the responses you got seems like there is an element of mistrust between some people in our community and medical doctors. Does that bother you?
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chmom




 
 
    
 

Post Thu, Apr 22 2021, 2:57 am
Dear OP
Fellow doc here
Welcome to the sisterhood, I am always thrilled to see more frum women take this career path.
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browser




 
 
    
 

Post Thu, Apr 22 2021, 3:41 am
bruriyah wrote:
I want to add another point to this discussion. The bulk of our studying is done through question banks that ask you about real case scenarios. One section is called “ethics” where they will ask you things like: “a patient wants to express gratitude and gets you a gift. Are you allowed to accept it?” Yes, these are actual test question. The answer is, btw, that you are only allowed to accept gifts of low monetary value. What that threshold is can vary by locality, but something like >$50 is probably not ok. Still, they encourage you to not take an gifts. I’m just bringing this example to show you that there are ethical standards doctors are expected to follow.

Thank you for sharing your knowledge and experience with us.
Question regarding the quote above-
What's up with all the ads in the pediatrician's offices. I've noticed ads all over the walls for Tylenol and other drugs and I'm thinking what are the companies paying for this, why are they advertising on the walls?
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amother
Vermilion


 

Post Thu, Apr 22 2021, 6:37 am
browser wrote:
Thank you for sharing your knowledge and experience with us.
Question regarding the quote above-
What's up with all the ads in the pediatrician's offices. I've noticed ads all over the walls for Tylenol and other drugs and I'm thinking what are the companies paying for this, why are they advertising on the walls?


Were you on Twitter after the super bowl? Ppl from other countries writing how they can't believe meds are advetsided on TV in USA.
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amother
Jade


 

Post Thu, Apr 22 2021, 6:52 am
amother [ Vermilion ] wrote:
Were you on Twitter after the super bowl? Ppl from other countries writing how they can't believe meds are advetsided on TV in USA.


Only because it 'feels weird' because they aren't used to it.

Its prohibited in many countries. Its not prohibited in the US..... land of the free.
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Fave




 
 
    
 

Post Thu, Apr 22 2021, 7:12 am
Hi. Mazel Tov on this amazing achievement!

I’d love to hear more about the financial investment (if you don’t mind sharing).

By the time you enter the work field, how much student loans will you owe in total?
What is the average annual salary in the field that you will be practicing in?
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