Jason Ryan
@jasonryanmd
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Creator of Boards and Beyond. Author of the best-selling medical satire, the Gunner. Cardiologist. Teacher. New England Patriots. Boston Celtics.
West Hartford, CT
Joined September 2008
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I sold my company to McGraw Hill today. It’s been a wild ride the past eight years. Never thought I’d start a company, run one, or sell one. Life takes you to strange and interesting places.
Today, McGraw Hill announced that it has acquired
@boardsandbeyond
, an on-demand video platform for medical students. The acquisition expands our position as a leading provider of trusted medical learning resources to students and professionals. Read more:
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Med school now is much different from med school when I graduated in 2001. More competitive. More assessments. More work required just to be average. Do all you can in training to take care of yourself. Cut yourself slack and remember that you earned your way in and you belong.
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If Trump were presenting on rounds: “This patient was sick, sicker than you’ve ever seen, some say sicker than anyone in the history of this hospital. A lot of people are saying that. I’ve heard it many times. You wouldn’t believe how sick this patient was. But I saved him.”
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When I took Step 1 (1999), it was a very hard test. Since then 1000s of new drugs/mechanisms have been discovered. All have been added to the test, nothing removed. First Aid for the Boards is now 848 pages up from about 200! When does it stop? No one can know all this stuff.
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USMLE scores have very little to do with being a good doctor. Get the exams behind you then focus on taking great care of your patients. Outstanding patient care defines a great doctor, not board scores.
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I was bad at anatomy. Also bad with microbes and neuroscience. I was often outperformed by my peers. Still made it through medical training. So can you.
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So many students/residents with research publications actually hate research. They’ve done research because it’s obligatory for matching into competitive training programs. We are turning off a generation of trainees to scientific inquiry. Time to stop the insanity.
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That med students have to memorize these antibodies is a great illustration of the silliness of medical training. These can be looked up in seconds. Zero reason to have them committed to memory.
ANTIBODIES!
dsDNA -> SLE, sensitive
centromere -> CREST
mitochondrial -> PBC
smith -> SLE, specific
RO/SSA -> Sjogren's
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When I took Step 1 the treatment for heart failure was beta blocker and ACEi. Now it’s BB-ACEi-ARB-ARNI-SGLT2-Ivabradine-ICD-BiV pacer. Students today have to MEMORIZE it all for the test plus the outdated stuff like digoxin. And that’s just one disease. Result=burnout.
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Don’t lose site of how hard the Step 1 exam is. It is arguably the hardest written exam on the planet. Just passing is a MASSIVE accomplishment that few could achieve. If you took it and pased, no matter what you scored, BE PROUD and celebrate your hard-earned success.
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I met a student today who scored a 310 on USMLE Step 2! I have never seen a score that high. His only prep material was a 1957 copy of NEJM.
Also, don't believe things you read on social medial about USMLE scores. A lot of people make stuff up.
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To appropriately test medical learners on their ability to apply knowledge, all tests should be OPEN BOOK but TIMED. In modern practice you can look things up but you can’t take forever to do it.
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A student of mine sent this to me today. Someone mapped all the B&B videos to UWorld questions. I’ve had requests for this over the years, but never found anyone with time to do it. Shout out to u/InvisibleDeck for putting in the effort.
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If you’re a medical student who is “not good” at reading EKGs, you are totally normal. Can’t get good at this until you do it regularly as part of your job. Same for lots of things in medicine. Don’t beat up on yourself.
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Most truthful answers at a med school interview that never get stated:
"So, why do you want to go to medical school?"
"To become a doctor and help those who are sick."
"Don't want to do research?"
"No. Just want to help the sick."
"What about community service?"
"Nope. Just
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I can remember two times when I asked a med student why their patient took coumadin, and the student didn't know the answer. First student shrugged and said, "He probably has Afib." Second said "I don't know, but I'll find out right now." Be the second student.
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I think the field of medicine might improve if we 100% stopped considering research when selecting candidates for med school and residency. Those who love research would keep doing it (good). Those who don't love it would stop doing junk research (also good). Research might go
It's really sad that so many young people who want to go into medicine get tricked into working for pipetting laboratories. Then we make them lie and say they enjoyed the pointless hazing that has nothing to do with clinical medicine.
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There are so many things we teach M1-M2 students that are not relevant to 99% of patient care. These things could be cut from M1-M2 cirriculums and deferred to teaching in residencies or fellowships if relevant. I’ll start by listing topics in my own field of cardiology…/1
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Use UWorld (or any Qbank or NBME) as a learning tool. Pay no attention to your overall percent correct, or how you stack up with others. If you are learning from the questions you are better prepared and that's all that matters.
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Almost every day in medicine I’m faced with something I don’t know. This happens even in my area of expertise: EKGs, echos, cardiac disease. I often have to ask for help, look stuff up. Not knowing in medicine isn’t a weakness, it’s normal.
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Huge McGraw-Hill Boards and Beyond booth at the MLA conference in Detroit. It’s surreal to see the little company I started by myself in my office now being sold to schools across the country by a major publisher.
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Some students gave feedback that in my videos I “just read the slides” and it’s boring. So in all my new, updated videos I will be including dragons, zombies, light sabers, love scenes, car chases, drug dealers and Taylor Swift cameos. The module on gluconeogenesis may win an
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Med students are supposed to learn all preclinical stuff, pass Step 1, shelf exams, Step 2, and rotate in a dozen specialties. Who can do serious research on top of all this? It’s not realistic. Don’t burn yourself out trying to get a publication. Most applicants don’t have any.
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Anyone smart enough to get into medical school is smart enough for any specialty. If you can’t match in derm and instead go into something else, you’re not dumb. And if you do match in derm (or rads or ophtho or whatever elite program) you’re not smarter than everyone else.
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To perform well on clinical rotations, med students should “know their patients.” But what exactly does this mean?
A thread…
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It's time for the USMLE to authorize medical schools to administer the Step 1 and 2 exams themselves with local deans-faculty-administrators ensuring question security. Schools have lots of space for students to take the exam safely. Enough with the Prometric cancellations.
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Questions you must be able to answer for interviews:
1. Why did you choose this speciality?
2. Tell me about an interesting case you saw.
3. Where do you see yourself in 5/10 years?
4. Tell me about this study listed on your CV.
5. What do you like to do for fun?
/1
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Any passing score on Step 1 is an AMAZING accomplishment. That test is ridiculously hard. You studied, you passed, you are another step closer to your dream of being a physician. Bask in your achievement.
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The overwhelming content on Step 1 needs to be addressed. Every year drugs are discovered, genes identified, diseases characterized. All are fair game plus the old stuff. Bright students are failing, deferring or burning out. We are crushing the spirit of the next generation.
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You can’t teach professionalism to medical students unless the faculty are held to the same standards. So long as attendings arrive late, leave early, skip meetings, miss deadlines, etc., professionalism won’t be taken seriously.
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I'm updating the cardiology videos for Boards and Beyond and I feel so badly for you medical students out there who have to learn all this minutiae for Step exams. It really is crazy that the test requires EVERY medical student to memorize super granular details about the heart
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Any passing score on Step 1 is an AMAZING accomplishment. That test is ridiculously hard. You studied, you passed, you are another step closer to your dream of being a physician. Bask in your achievement.
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USMLE scores have little to do with the kind of doctor you will ultimately become. These tests do not assess listening skills, empathy, kindness or compassion. Plenty of doctors with low scores are beloved by their patients.
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My 14yo son: “I don’t want to be a doctor when I grow up.”
Me: “Ok fine. How come?”
Son: “Too much school. And I don’t want to get woken up at night.”
Tough to argue with this.
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Ran into a med school friend who I remember barely passed step 1 and almost didn’t match. This person is now a partner in private practice and has a great reputation among colleagues. Also married, two kids, a house, even a dog. Medicine can be a great career no matter ur scores.
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I see so many students worn out by the competition in medical school. Seems so much worse than when I was in school. I wish it could be different. Wish students could learn to look after their patients and not worry about honors, evaluations, class rank.
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Oppenheimer was a good movie but looooong. Like DVT prophylaxis long. Take a shot of lovenox before you go.
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Your colleagues may judge you by your board scores but your patients will judge you by your kindness and compassion
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Students preparing for Step 1 memorize that treatment for atrial flutter is ablation of tissue between the tricuspid valve and IVC. I didn’t learn this until fellowship. Why are we torturing students in their first two years with such advanced stuff? Plus it’s easily looked up!
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Mentors are important in medical training but so are Anti-Mentors! The people you meet in medicine that you NEVER want to be like. There are SO many. Try to figure out how they got to be as they are. This can shape your career in more ways than you know.
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Secret way to earn honors according to one of my students: find out your attending’s age, then determine what year they turned 15. Search top songs/shows/movies from that year. Then casually mention them in conversation. Must admit this would totally work on me.
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Don’t let UWorld and any Qbank determine your self-worth. Wrong answers do not mean you are a bad student or destined to become a bad doctor.
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Almost all preclinical coursework for medical school (biochem, physiology, pathology) could be learned in college or online. Then in medical school you could move straight to clinical rotations, finish faster and have less debt.
#imagine
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@UmojaProtocol
@Chain_GPT
@GameSwift_io
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Claim your share of $COOKIE tokens for on-chain rewards.
Act quickly, since the airdrop quantities are limited.
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Students with low Step scores can still become great doctors. Never lose hope. You can make a huge difference in the lives of others no matter your scores.
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On of my motivations for selling B&B to McGraw Hill was to increase the number of schools buying subscriptions for students. We need to maximize institutional sales so the burden is not on students to purchase their resources. MH has an enormous sales team to make this happen.
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Met these two terrific students at the AMEE conference from the West Bank in Palestine who use Boards and Beyond.
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A lot of students starting medical school this time of year. Do all you can to ignore competition with your classmates. Don’t worry about what others are studying, their grades, etc. You’ve entered an amazing profession. Soak up all the knowledge you can. Enjoy the journey.
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Your happiness in medicine will be be determined by so many things beyond your Step 1 score.
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I hope the students I teach reach their goal Step score, but more importantly I hope they become great doctors that patients love and respect.
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Which is the best way to learn the treatment of diabetes?
A. Harrison’s
B. Boards and Beyond
C. UWorld
D. AMBOSS
E. See 10 patients with DM in clinic
Answer E >>>>>>> A/B/C/D
True learning/mastery comes from experience
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If your attendings were forced to take a UWorld block or NBME they would all bomb. No one practicing medicine knows the full breadth of material on Step exams. Remember that next time you struggle.
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For any medical board exam, you should be able to review questions you answered incorrectly. After all, you could make a patient care error identical to a mistake on the exam. Why isn’t this allowed? Probably because errors in questions would be identified.
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Remember it’s REALLY hard to get into medical school. Everyone who gets in is smart. Whether you got your first choice or didn’t match,you’re an exceptional person with a bright future.
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At the graduate education level (med school, other grad school), I don't think lectures/conferences should be mandatory. The students are adults. Tell them what they must learn and later assess their knowledge. Offer them ways to learn, but let them choose their own path.
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The low point of all medical training for me was the period just prior to step1. It gets SO much better once that test is behind you.
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There’s an old saying about diagnostic testing in medicine: “Ask yourself what you will do if the test is positive. Ask yourself what you will do if the test is negative. If the answers are the same, don’t do the test.”Best examples I know of where this principle applies are
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Self-forgiveness is essential for happiness in medicine and life. It’s okay to make mistakes. It’s okay to struggle on tests. It’s okay to not be “the best.” These things will not keep you from making a difference in the lives of others.
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Someone should make a short documentary on the USMLE during COVID.
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At an interview, don’t say you want a career in research unless you REALLY want a career in research. It’s okay to say: “I don’t want a career in research but I want a program that will give me strong training in research methods so I can use the literature to help my patients.”
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I recently met a neurosurgery resident at a Harvard program who failed Step 1 three times, got a 198 on Step 2, had zero honors in clinical rotations and 19 professionalism violations. She matched because her personal statement was so good it brought the PD to tears.
Also,
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Maybe residencies/fellowships should only consider ONE research activity per applicant. You could still demonstrate your aptitude for scientific inquiry, but the arms race for publications would stop.
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Every year, thousands of students match into competitive programs with zero research publications. This is a highly overrated thing in applications. Honors, board scores, class rank, strong letters of recommendation - these are what matter most.
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Here’s something I’ve learned from talking to Gen Z medical students: textbooks are dead. Once the younger generation runs academia, textbooks will hardly ever be used by students. Video learning is how young people acquire knowledge.
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Reminder: all the % correct numbers in UWorld are artificially high because many students do the questions multiple times. Never feel badly about yourself based on your performance in a Qbank. Just learn.
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Many students do UWorld with their browser open (or notes or books) to look stuff up. Don't compare yourself to the masses answering questions under widely varying conditions. It's a learning tool not an assessment tool.
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In Dubai, me these two awesome students from Sudan who use Boards and Beyond videos.
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You can’t be “humbled” if you’re announcing your achievements in public or on social media. That is the opposite of humble.
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Board scores can get you an interview, but nothing helps you match better than consistent evaluations in all specialities saying you work hard, care deeply for your patients, and are a team player.
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Athena and RRR are the two best movies on Netflix now, nothing else even close.
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When I was a student, I thought the attendings knew everything. When I was an attending, I thought I was the only one who didn't know everything. Then I realized no one knows everything. Wish I had discovered this much, much earlier.
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Seems to me that medicine is changing from where the doctor knows everything (true decades ago) to where the doctor can’t possibly know everything. But we still teach that failure to know things is bad. And we dont teach when/how to look things up effectively.
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Tom Brady is 45 years old. Things he needs to do this year: (1) win his 8th super bowl (2) get a colonoscopy (new guidelines say screening starts at 45)
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Another year passes, another bevy of new drugs is developed and new disorders/mechanisms defined. All are added to Step exams with nothing taken away. Medical science grows and its all thrown at students to learn no matter how impossible learning it all may be. The result:burnout
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Never get worked up when you get a UWorld, NBME or B&B practice question wrong. These questions are just for learning. Many do not meet board standards. So long as you learn something, you're doing well. Lots of students score poorly on practice questions and ace the test.
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I’d say 90% or more of trainees I have worked with (fellows, residents, students) do nothing extraordinary that I can put in a LOR. This is simply the nature of medicine. Lots of stuff is routine and opportunities to standout are rare. So, don’t feel bad if you can’t find a
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Pro tip: if you get little or no sleep on call, take a shower. It’s scientifically proven as equal to a one hour nap. (Reference: Journal of Dr. Ryan’s anectodal medicine, 2001; vol 2)
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If you could monitor med student laptop screens during lecture, you could easily assess quality of faculty teaching. Good lecture: screens open to slides/syllabus. Bad lecture: Instagram, Anki, Google, Reddit, Assassin’s Creed, etc.
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I sometimes wonder why so many things in medicine require a fellowship. For areas where specialists are lacking, is there no way for a physician to acquire advanced skills without leaving practice for 1-3 yrs? What if they could pass the boards by learning at their job?
Today is Match Day for internal medicine and pediatric subspecialties.
Here’s how things shook out for programs.
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Many students do UWorld with their browser open (or notes or books) to look stuff up. Don't compare yourself to the masses answering questions under widely varying conditions. It's a learning tool not an assessment tool.
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I worked in engineering before med school. Many people unhappy/burned out. Also worked as a bank teller and shoe salesman. Plenty of grumpiness there, too. Medicine has burnout, but so does every field. Focus on the good parts of your job and you'll find satisfaction.
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At the end of an interview, you will often be asked if you have any questions. Make sure you have at least one! A great question is to ask the interviewer about themselves. Why did you come to work here? What’s the best part of your job? People love to talk about themselves.
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If you are studying for Step 1, don't waste time comparing yourself to others or trying to predict your score. Many students exceed expectations. If you are learning every day, you are doing it right.
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My son has a “Strawberry tongue.” But it’s not from Kawasaki disease or Scarlet fever it’s from fruit punch.
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Boards and Beyond promotional materials in Arabic for the Arab Health week conference.
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Get lots of practice questions wrong when you’re studying. Lots. When you are wrong, you’re learning and that’s the point. And don’t worry AT ALL about whether other students get things wrong too. That doesn’t matter. That won’t help you learn.
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You can choose what to focus on during medical training. You can focus on where you stand compared to others, and where you fall short. Or you can focus on all the amazing things you will see and learn, and all the good you can do for others as a healer.
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When I applied to med school (1995) several docs told me NOT to do it. Said the field was doomed (HMOs were on the rise). Twenty five years later it’s still a great profession. Ignore the doomsayers. Medicine will always be in demand.
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Never tell a patient you disagree with another physician. Instead say, 'Let me talk to Dr. X about this and get back to you." Get everyone on the same page and then present it to the patient. Nothing stresses patients more than hearing doctors disagree over their care.
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High carb is bad, high fat is bad, now high protein is bad. I'm just going to eat what tastes good and hope it all works out
Too much protein in the diet may carry a risk of heart disease secondary to leucine's effect. An important report considering recent advocacy for very high-protein diets.
@NatMetabolism
@RazaniLab
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Also BTW, this was a very bright student with an outstanding Step 1 score. The issue was fear of saying, "I don't know." We used it as a teachable moment and the student got a good eval for showing improvement. Take-home lesson: Don't be afraid to not know stuff!
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Med student numbers going into primary care have been down for years. Now, EM applications are down, too. These are critical fields in medicine. We need to attract good candidates. One way to do this: shorten training (med school, residency or both). Seven years is a long time.
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Medical training could be cut by years if we focused on patient care and stopped forcing trainees to learn things not relevant to their ultimate field of practice. This would decrease stress and debt burden immensely. It could even make learning more fun - imagine that! /3
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Practice questions like UWorld or NBMEs can’t make you feel bad. That is your internal voice of doubt making you feel bad. Remind yourself you earned your way into med school. You deserve to be here and will make a great doctor. Then just learn from the questions and move on.
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This is Ziyaul a medical student from Nepal who crushed his Step exams using Boards and Beyond with UWorld. He told me I’m invited to Nepal anytime and I’m gonna take him up on that offer someday. Most rewarding part of teaching is seeing students learn and succeed.
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Taking Step exams soon? There’s an easy way to boost your score. Morning of the exam, play any song by Guns n Roses or Rage Against the Machine. Not sure why this isn’t listed in prep books. Tried and true.
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I’d love to see a medical show where a person collapses in public and a bystander doctor thinks: “Oh crap I have no idea what to do. I haven’t done CPR in 20 years. I work in outpatient clinic and prescribe pills/order tests all day.” That would be a GREAT storyline.
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