Medicine’s Netflix: Subscription Video Services Are the New Medical Education Format

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This is part one of a two-part series discussing disruptive changes occurring in medical education.

Medical education is a rapidly evolving landscape. Elite medical schools in the United States are continuously revamping curriculums in a combined effort to both provide their students with a comprehensive education, as well as prepare them to become competitive applicants for residencies. While many may debate what defines a “competitive applicant,” the most cited factor by program directors for selecting an applicant to interview in the 2018 NRMP Program Director Survey was ‘USMLE Step 1/COMLEX Level 1 score’. Thus, many schools and students have focused their education on Step 1 preparation.

Medicine has become obsessed with Step 1

One of the most significant trends in medical education in the past decade is the abandonment by many schools of the classic medical education model –two years of pre-clinical work in the classroom, then taking Step 1 prior to starting clinical year.

Instead, many schools are opting for an accelerated curriculum consisting of a year to a year and a half of pre-clinical work, followed by clerkship year and then Step 1. This model allows students to get the benefit of “practicing” taking clerkship shelfs before Step 1 and creates more time after clerkship year to devote towards electives or research. A study by a cohort of top medical schools’ experiences with switching their curriculums to this format demonstrated most schools experienced an increase in their aggregate Step 1 scores.

Comparison of the classic curriculum model with two years of pre-clinical and two years of clinical broken up by Step 1, with the newer model in which pre-clinical curriculum is shortened to 1–1.5 years and clerkship year directly follows it. (Image: Drexel Neumann)

While systemic changes by medical schools’ administrations are one way to improve scores, many medical students have begun taking matters into their own hands and are purchasing subscriptions to external education sources.

Consider Signing Up For Online Video Subscriptions

Subscription services are not new to medical education. Kaplan, Inc. and The Princeton Review have dominated the MCAT preparation market, and each year thousands of students shell out thousands of dollars for access to courses, videos, and questions from these companies to prepare for the MCAT. Kaplan continues to have a foothold in Step 1 preparation, but, for much of the past two decades, this market has been dominated by USMLEWorld, colloquially known as UWorld.

Online video subscriptions are relatively new to the medical education and the test prep market. This model provides consumers access to a video database covering a set of medical topics. The most renowned of these is Pathoma — a service covering all aspects of pathology and narrated by Assistant Professor of Pathology at the University of Chicago, Dr. Husain Sattar. Dr. Sattar’s videos are known for their occasional distinction of “high-yield” topics.

Following the widespread success of Pathoma, several other video services have emerged covering all topics in medical education. Many of these services have been started by medical students (Osmosis, Pixorize), residents (SketchyMedical), or instructors (Online MedEd). However, according to the AAMC, the mean indebtedness of medical school graduates in the class of 2017 was >$190k — so why are students increasing the cost of their education by purchasing subscriptions to these services?

Perfectly balanced, accessible, and organized. As all things should be.

A subscription service has many advantages over traditional classroom learning. First, their interfaces are more user-friendly and provide an organized collection of topics as opposed to folders of miscellaneous Powerpoints on a laptop.

Additionally, online services allow greater universal access for the student. As long as you have an internet connection, you can access your curriculum. That means no more lugging around textbooks or emailing yourself Powerpoints if you’ll be away from your main study tools. Further, the teaching is more consistent. Videos are narrated by a single or small collection of individuals in a uniform style and format. Students don’t have to worry about sitting down for an hour-long lecture only for the speaker to go on a tangent about his or her own research for forty-five minutes. Lastly, the videos are “high yield” –the authors distill topics into what is essential to performing well on board exams and clerkship shelfs.

“There is only one way to avoid criticism: do nothing, say nothing, and be nothing.”

These services do not exist without their critics. Their costs can be prohibitive to some students, placing them at a disadvantage to their peers. This criticism should not be trivialized, though it is is hardly unique to board preparation. Further, the cost of these services is minuscule compared to medical school tuition.

The most popular argument against these services is there is too much focus on exam preparation, which detracts from producing a ‘well-rounded’ physician. While this may be true, it’s important to note there already exists a growing obsession with Step 1 preparation (see image below). These products have not driven preoccupations with board scores but rather have developed in response to them. Rather than criticize these service’s models, perhaps the medical field needs to examine what is driving the cultural focus on Step 1 scores and work towards fixing the problem at its source.

Google searches for “Step 1” over time. A cyclical pattern of search volume corresponds to summer when most students sit for the exam. However, the magnitude of this interest has increased with time. (Image: Drexel Neumann)

The impact of subscription video services on the medical education landscape is not yet known. While they developed in response to an obsession with board scores — perhaps they will be this obsession’s undoing. The importance of board scores is often tied to them serving as a benchmark from which to compare students from different schools. If all students are learning from the same small set of videos, concern regarding knowledge may lessen, and the focus can return to the other aspects that contribute to a well-rounded candidate.

Drexel Neumann (@DrexelNeumann) is an Ohio native and M.D. candidate in Weill Cornell Medical College’s Class of 2019. His interests include health trends and technology, medical education, and the outdoors.

Drexel reports no conflicts of interest.

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