Current MS3. There's a lot to unpack here so this is gonna be extremely long, TLDR at the bottom:
The thought was to cut out the waste and focus on the key topics, I can say without a doubt this has been a colossal failure. The residents and faculty I work with have noticed a dramatic decrease in the knowledge of the medical students since this change.
This is mostly accurate – I only take issue with saying its been “a colossal failure” – you would think from this post the UCLA students on clerkships don’t know the difference between major organ systems or something. However, the description of the thought process behind the curriculum change is accurate, as is the fact that they cut too much content, sending students to clerkships with content gaps. How significant those gaps are depends on the student.
UCLA decided to cram the two years of pre-clinical courses into one year. Then the 2nd year students do their clinical rotations, the third year is an “discovery year” where students can do anything they want and then they return as 4th year students for the typical 4th year rotations.
This is accurate, but not entirely unlike what Duke, Vanderbilt, etc. have been doing for years. The method honestly may be sound, but UCLA is implementing the method incorrectly.
I was not part of the committee that decided to make this change but I have a theory as to why the made a change in the curriculum. Before the new curriculum, every year 5-10% of the UCLA medical students struggled to pass step 1. Prior to this change many of these students were advised to take a year off to study exclusively for step 1.
This is not accurate – UCLA’s step 1 pass rate has met or exceeded the national average in the past. In addition, 5% of the class would be around 8-9 people out of 175, which IMO is not significant enough to base your theory on. Furthermore, the curriculum change was made based on Duke, Vanderbilt, and most prominently, Harvard’s model, which I honestly think was a complete mistake (why copy Harvard? Because it’s Harvard?) – regardless though, the curriculum change was absolutely not due to previously-existing issues with step.
I have mentored a bunch of UCLA students who did this and it hurt their residency applications because programs wanted to know why they took this year off. I suspect that one of the reasons UCLA created this new curriculum is to provide that year for the students who can’t pass step 1 otherwise.
This is partially true but requires context –
- Of course residency programs will scrutinize you if you took a year off to study for step. This faculty member has mentored “a bunch” of these students under the LEGACY curriculum, which was traditional, and avoids the apparent pitfalls of the new curriculum.
- If 5-10% of the class failed to take Step 1 on time under a 2-year preclinical curriculum, that is their failure to bear, not UCLA’s.
- Every school with a 2-year preclinical, other than bulletproof institutions mentioned earlier in the thread, has an issue with students failing to take step 1 on time and needing an extra year. It’s ridiculous to suggest that 8-16 students doing this in a class of 175 represents some colossal failure of the legacy curriculum.
- It is true that one reason for the curriculum change was to avoid Step 1 failure, but not because there were SO MANY students failing or taking LoAs previously. The change to P/F step 1 immediately led to a massive drop in passing rates across the country. Research found failure rates go down if you wait until after clerkships to take Step 1. This research was one of the reasons for UCLA to make the change.
While this might sound like a good idea the end result is the UCLA students are trying to learn everything in the pre-clinical classes in one year. It’s been awhile since I was in medical school but I remember the two years of pre-clinical courses I took were extremely difficulty and they took endless hours of studying to learn the material.
This is accurate. At other schools on 12-month preclinical systems, the content has been implemented with Step 1 and critical basic science knowledge in mind, acknowledging the reality that we need to pass that exam and understand basic concepts to truly excel in medical school. E.g. Students at other schools with condensed curricula take NBME-style exams.
This is not the case at UCLA. From what I can tell, the prevailing mentality is to genuinely not care about Step and just focus on what they deem important, which is very often either not important or an incomplete picture of the science.
This is by far the most problematic aspect of the new curriculum.
My sense from talking to the UCLA students is there is so much material to learn in one year that it is overwhelming so many students just don’t even try. When you add in that none of the preclinical courses are graded it is easy to understand why the majority of the UCLA students don’t study because there is no obvious need to open a text book. The end result is many students don’t learn the basics in their preclinical years.
How can you gloss over this?: “so overwhelming
so many students just don’t even try”
This is medical school. It is overwhelming at times. This is true everywhere. The only difference is that UCLA admits students (not the majority, but they are here) who would blatantly and shamelessly admit they don’t bother to try at all. Wouldn't you know it, these are the same students who don’t know anything on clerkships. The preclinical courses are P/F and I wouldn’t have it any other way, but UCLA coddled its students too much with an extremely lax exam policy under which students could get a 45% on an overly-easy exam and never remediate. Those same students went onto wards 2nd year and got annihilated.
The current MS1 class apparently has to retake exams if they fail. I think this change was made by clerkship directors and faculty like OP who were tired of seeing completely incompetent med students on the floor. It stands to reason the current MS1 class will exceed the classes before it in terms of clerkship performance.
I think this explains why we have such a high failure rate on the step 1 exam at UCLA currently. For example I am mentoring several 3rd year students this year and two has failed step 1 and several other MS3s haven’t taken Step 1 yet likely because their practice exam scores are so low. I don’t mentor many students each year, so to have so many 3rd year students who are having these struggles with step 1 is shocking. I have heard from multiple students that about 50 MS3 are planning to take a one year leave of absence to study for and try to pass step 1. This is in addition to the discovery year so they have take 2 years away from clinical rotation to study for step exams. I have never heard of this many students needing to take a leave to study for a fairly easy exam. Another issue is for these 50 students, how in the world are they going to be successful when they return to the MS4 year and try to be successful on sub-internships rotations. The performance on these rotations are extremely important for matching into residencies and with a two year gap from clinical work the students are going to struggle greatly.
There’s a lot of hearsay from students here. You do not have the actual numbers for failure or LoA rates. Also, you are shifting too much responsibility away from the students. IMHO a discovery year and dedicated study period is enough time for almost anyone to learn enough from 3rd party materials to pass step 1. I know students doing dual degrees were uniquely F'd, but idk what happened with the rest. UCLA does not hide the fact that its curriculum demands a great deal of self-directed studying and learning. I honestly think the issue is in admissions; they should really start screening for people who want to learn a lot on their own. Many students here have a particular mindset towards learning/medical education and it's not one that will make you successful in this curriculum.
In most medical school you take Step 1 at the end of your preclinical classes and before you start your clinical rotations since Step 1 tests topics covered in your preclinical classes. Recently the administration of the medical school made a presentation to the faculty and only 49% of 3rd year UCLA students have taken Step 1 as of January 2024. This is a shockingly low number and it suggests that a large percentage of the class is worried about failing the exam. This is even more concerning since it is a pass fail exam, a school that is supposedly a top 10 medical school should have an extremely small number of students who can’t pass this exam which has a high pass rate.
I agree that this is a disaster. I believe it's happening for the following reasons:
- The points I mentioned about student attitudes and the lack of accountability with the exam failure policy of the last 2 years.
- The profound lack of basic science knowledge (immune, micro, etc.) that UCLA thinks will somehow diffuse into our brains by seeing it a few times scattered around MS1 year and on wards
- This stuff is easily attainable from 3rd party resources, although admin is so deep in their own BS that they detest 3rd party resources
- The severe lack of spaced repetition, which you and others mentioned. Admin hilariously throws around the term "spaced repetition" seemingly having no understanding of what it is. Mentioning E. coli in the context of diarrhea and then again 5 months later for UTIs is not spaced repetition, nor is it a substitute for a proper microbiology education.
- This can be fixed with Anki and other self-studying methods
- The failure of people in my class to defend themselves against the gaps in the new curriculum because they placed too much trust in the school to educate them appropriately
- This is the most tragic and detestable cause of Step issues, and, in a sane world, the school would reimburse students who now need to take an LoA because they bought the garbage UCLA was selling.
Note that, like all of these issues, I think this will improve over time as students know from day 1 they need to use 3rd party materials to "fix" the curriculum for themselves although it's insane that this is necessary.
Even more concerning is their performance on the shelf exams during the clinical year. After every rotation (ie peds, surgery, IM) the students take a national exam that tests the material from the rotation. To pass this exam you need to score in 5% of all students in the county who take this exam. It is a fairly low bar that one would think everyone could pass. I was shocked to see the data recently from the medical school, close to 50% of UCLA students have failed one of these exams. In addition 24% of the current 3rd year UCLA students have failed one of the shelf exams more than three times. For these 24% of students this will show up in their deans letter that is part of their application for residency programs. This one issue will prevent these students from matching into a specialty that is even remotely competitive or even in a less competitive specialty at a good program.
He is referring only to data from the very first class to go through this curriculum. But I agree these numbers are abysmal. Again: these students were failing very easy in-house exams, never remediating, and then taking NBME internal medicine shelf exams out of nowhere. They should have never been in the hospital.
This information is getting out to the residency programs and one of the local residency programs who used to take the less competitive UCLA students has stopped interviewing our students because they have had negative experiences with the poor performance of some of the UCLA graduates recently who matched into their program. This is becoming a problem for even our top students because since UCLA is a pass fail school the top students can’t distinguish themselves from the many students who are struggling, so residency programs just have to assume every UCLA student is struggling.
The first class to go through the new curriculum hasn't even applied to residency yet.
Many residency programs use Step 2 scores as a screening tool to decide who to interview. This presents a problem for many of the UCLA students that I mentor because the questions for step 2 are the exact same questions as used in the shelf exams that many of our students are failing. So for the 50% of UCLA students who failed one of the shelf exams, it is going to be close to impossible to get a high score on Step 2. There are other areas that I think the school is failing the students.
I agree that UCLA needs to wake up and acknowledge the reality that their students will eventually need to take step 1 and 2. It really seems like these crucial exams were an afterthought for administrators, and they continue to brush off their importance, their content, and timing considerations. I'm very curious to see how many people in my class will be forced to LoA at the end of the year. Although I seriously doubt it will be anything close to 50%.
It has gotten to the point that many faculty members have told me that they have stopped speaking with the students because their knowledge is so poor. Recently a surgeon was telling me a story, he said he will never talk to a UCLA student again and will just have them stand in the corner and watch because it is not worth the trouble. This surgeon used to teach multiple courses in the medical school and he used to tell me how he loved teaching students. The fact that he has stopped teaching course entirely and now will not even talk to the students in the OR shows how bad things have become.
If faculty members have “stopped speaking with the students” because of a bad curriculum change,
they are terrible faculty members and should be ashamed. If a student has abysmal content knowledge, do your job and help them. Please pass this message on to your colleagues who apparently care so deeply about the school.
Be careful looking at the UCLA match list. I believe it is intentionally deceptive. For example about 7 UCLA students didn’t match into residency programs this year and their names don’t show up on the match list so no one knows they didn’t match.
This is absurd. Please find me a medical school which lists the names of students in their match list who didn’t match anywhere.
Even more concerning is I suspect a fair number of other students didn’t match into their chosen specialty.
This is irresponsible to speculate on.
So my primary motive of posting this is I hope to publicize these issues with the hope of getting the attention of the administration at the school. The Faculty Executive Committee is an elected body of faculty at UCLA that have oversight over the medical school. This committee has been trying to address this issue for the last three years because numerous faculty are as concerned as I am that a school that we all love is falling apart. The administration has ignored the concerns of the faculty who actually work with their students in the hospital and this change has been highly detrimental to the UCLA students. It hurts me greatly when I meet with a UCLA student and I have to tell them they will never match into my specialty. When they came to UCLA they were told it was a top school and it would open doors for them, usually by the time they figure it out that it is not true, it is too late.
This is almost entirely true. For the past 3 years, administration has often refused to listen to reason. Students and faculty have repeatedly raised the same issues and nothing significant has changed. They make minor adjustments each year but when people sound the alarm about the entire system needing to be fixed, it’s always dismissed.
I don’t think it’s out of malice or "corruption from the health system" as someone else suggested. I think it might be a sunk cost fallacy, or arrogance, or incompetence, or data misinterpretation, or willful ignorance, or some combination of all those things. As
@Med Ed noted, they refuse to admit defeat. One hope moving forward is that the vice dean of education who was a major architect of this mess left his position in December. Hopefully positive changes and decisions are coming soon based on common sense, rather than random research papers and sociological positioning.
What I don’t think is accurate here is the implication that UCLA med students “can’t match” whatever this guy’s specialty is. Our optho match is great, for example, despite being hypercompetitive. That said, my class’s match will finally shed light on how much has potentially gone wrong. Or it will be fine and the world will keep spinning.
TLDR for applicants: you must be a self-directed, disciplined student to do well here. There is a lot of truth in what this person is saying, but it is almost entirely based on the first cohort of students to go through a new curriculum. Things have been improving, and they will continue to improve. UCLA's curriculum grants a lot of freedom (too much for some), but
you need to use that freedom to use 3rd party materials to fill in the gaps they're leaving in many content areas. Notice in this thread that everyone saying they made it through the curriculum relatively unscathed attribute their success to 3rd party (as do I). But also keep in mind this is the case at tons of schools. I'd also reiterate the point another student made: if you think you need a good deal of forced structure in your preclinical education, this is not the school for you.
Hold yourself to a high standard here, as the school will not. Work extremely hard, and your 3rd and 4th years of school will be great. You will work with amazing physicians at great clinical sites and have more research opportunities than you can imagine. But if you come here and sit on your hands you're going to have some serious issues.
