The Path To Take

By Dr. Lisabetta Divita @ Studentdoctor

Premedical students are, understandably, focused on getting into medical school. They shadow physicians and have an idea of what being a physician is like.  However, many don’t have an understanding of what life at medical school is like.

Medical school is a place in which you will grow as a person and as a professional. You will be challenged to study more than you thought possible and pick yourself up when you fall down.  The massive amounts of knowledge you need to learn in a short period of time makes medical school one of the most challenging professional schools out there.

I like to think of medical school as a roller coaster. Each medical student who enters is happy and even eager to study but as the months drag on, the studying gets old and you say to yourself, “I cannot wait until all this studying is over!“

As a new physician, I have experienced the sleeplessness, the long arduous hours of studying, the multiple stops at Starbucks and more.  Here’s my overview of the realities of attending medical school.

Types of Schools

Two types of medical schools exist: Allopathic Medical Schools and Osteopathic Medical Schools.  Allopathic medical schools confer an M.D. degree and Osteopathic medical schools confer a D.O. degree.  Both schools train its students to become fully licensed to practice medicine and prescribe medications. Both doctors see patients and become investigators of the body as they try to find out why their patients are sick.

What’s the difference? Osteopathic Physicians learn osteopathic manipulative treatment, using their hands to help diagnose and treat different diseases.

Class Structure

The typical medical school focuses on a combination of lectures and problem-based learning modules. Imagine sitting in class, listening to lectures, taking notes and then taking Scantron or even computerized tests. This is the standard way in which medical school builds and tests your knowledge. In fact, medical school literally feeds your brain with first, basic sciences and then, clinical knowledge.

The problem-based learning method consists of a group of med students working together to solve a patient case. For example, you are presented with a hypothetical 45 year old man with a history of heart disease and high cholesterol. He travels from New York to California on a business trip. Upon landing he experiences excruciating right leg pain. Problem-based learning focuses on exploring this case and diagnosing this patient. A physician-moderator typically sits in to guide and create the dynamic of the group.

Schools may have a traditional or system-based curriculum.  A systems-based curriculum means that all your classes are divided up by body system. For example: Month one may be about the cardiovascular system, month two may be about the gastrointestinal system and month three may be about the reproductive system and so on.

Classes

YEAR 1
Your MS-1 (Medical Student 1) year will be your most difficult year of med school.  Year one of medical school consists of mostly basic sciences courses, which means LOTS of memorization. I detail the major classes below, but medical school also consists of medical ethics courses, OSCEs in which you learn the physical exam and more. OSCEs refer to Objective Structured Clinical Exams in which you are presented with various hypothetical patient scenarios. An actor portrays a patient with a certain clinical disease and you are expected to obtain a thorough medical history and physical examination in the allotted time period.

GROSS ANATOMY
In year one, you are presented with one of the most challenging medical school classes known to humankind: gross anatomy. For many of you, gross anatomy conjures up images of cadavers and the smell of formaldehyde. Gross anatomy has two components: lecture and lab. Lecture is typically lasts for an hour while lab is typically about four to five hours long.

Different medical schools structure their gross anatomy courses differently: Some medical schools have gross anatomy every day while other medical schools opt to hold the course three times a week. The course itself can last three months to one year.

Here, you will learn the wonders of the human body from the cranial nerves, brachial plexus and mediastinum to the femur, humerus and orbicularis oculi muscle in your eye. I’m not gonna lie, gross anatomy is a tough class. You have to keep up with the reading or else you will be behind. Study in groups if you like learning with a group of people.

HISTOLOGY
Histology is the study of cells in the human body. This, too, consists of a lecture and lab component. Oftentimes, you will take histology and gross anatomy together, especially if your medical school is systems-based.  Lab consists of looking at slides in the microscope. I loved histology but didn’t appreciate gross anatomy until I was done with it!

PATHOLOGY
Ever watch Dr. G Medical Examiner? Pathology class in medical school is similar to pathology seen on Dr. G Medical Examiner. You look at histology slides of, for example, an infarcted heart (heart attack) and know by inspection that it is a damaged heart. This, like histology and gross anatomy, consists of lecture and lab.

BIOCHEMISTRY
Biochemistry is similar to organic chemistry but better. Don’t panic, you don’t have to distill any liquids in lab or draw any funny structures as this class is primarily lecture-based. You may have to memorize the Kreb’s cycle and glycolysis cycle.

YEAR 2
Year two of medical school is typically clinical-based. Here you will learn a handful of the diseases you will encounter in the hospital, such as:

• Myocardial infarction (heart attack)
• Pulmonary embolism (blood clot in the lungs)
• DVT (deep vein thrombosis )–blood clot in the leg
• Rheumatoid arthritis
• Congestive heart failure

and the list goes on (and on and on…).

This is when medical school turns to real medicine.

YEAR 3
Year three consists of clinical rotations. Here you will become part of the medical team. A medical team typically consists of an attending (senior doctor), residents (doctors-in-training) and interns (first year residents). As a medical student, you are at the bottom of the totem pole. Some doctors will make that well-known while others are very nice.

You will rotate through the many clinical specialties of medicine, such as Internal Medicine (adult medicine), pediatrics, ob/gyn, psychiatry, etc. Here, you will get a taste of what kind of doctor you will become.

Your team will grade you on your performance during your rotation. As with any work environment, this can be a bit biased. However, national tests are administered at the end of your rotations. Some medical schools require you to pass this exam to receive a grade at the end of your clinical rotations. Sometimes, the percentage grade is even factored into your final rotation grades.

YEAR 4
Year four of medical school is much like year three but a bit more specialized. You can delve into the specialties of medicine even more. For example, if you liked internal medicine, you can elect to do a gastroenterology, cardiology or rheumatology rotation. Grading is the same as in year three.

So this piece hopefully gave you a good overview of the nuts and bolts of medical school. Congratulations on your recent admission – or good luck with your applications – and best wishes for your future plans!

Improve Your Memory With These Great Tips

By Kendra Cherry @ About.com

Before you study for your next exam, you might want to use a few strategies to boost your memory of important information. There are a number of tried and tested techniques for improving memory. These strategies have been established within cognitive psychology literature and offer a number of great ways to improve memory, enhance recall, and increase retention of information.

1. Focus your attention on the materials you are studying.

Attention is one of the major components of memory. In order for information to move from short-term memory into long-term memory, you need to actively attend to this information. Try to study in a place free of distractions such as television, music, and other diversions.zSB(3,3)

2. Avoid cramming by establishing regular study sessions.

According to Bjork (2001), studying materials over a number of session’s gives you the time you need to adequately process the information. Research has shown that students who study regularly remember the material far better that those did all of their studying in one marathon session.

3. Structure and organize the information you are studying.

Researchers have found that information is organized in memory in related clusters. You can take advantage of this by structuring and organizing the materials you are studying. Try grouping similar concepts and terms together, or make an outline of your notes and textbook readings to help group related concepts.

4. Utilize mnemonic devices to remember information.

Mnemonic devices are a technique often used by students to aid in recall. A mnemonic is simply a way to remember information. For example, you might associate a term you need to remember with a common item that you are very familiar with. The best mnemonics are those that utilize positive imagery, humor, or novelty. You might come up with a rhyme, song, or joke to help remember a specific segment of information.

5. Elaborate and rehearse the information you are studying.

In order to recall information, you need to encode what you are studying into long-term memory. One of the most effective encoding techniques is known as elaborative rehearsal. An example of this technique would be to read the definition of a key term, study the definition of that term, and then read a more detailed description of what that term means. After repeating this process a few times, your recall of the information will be far better.

6. Relate new information to things you already know.

When you are studying unfamiliar material, take the time to think about how this information relates to things that you already know. By establishing relationships between new ideas and previously existing memories, you can dramatically increase the likelihood of recalling the recently learned information.

7. Visualize concepts to improve memory and recall.

Many people benefit greatly from visualizing the information they study. Pay attention to the photographs, charts, and other graphics in your textbooks. If you don’t have visual cues to help, try creating your own. Draw charts or figures in the margins of your notes or use highlighters or pens in different colors to group related ideas in your written study materials.

8. Teach new concepts to another person.

Research suggests that reading materials out loud significantly improves memory of the material. Educators and psychologists have also discovered that having students actually teach new concepts to others enhances understanding and recall. You can use this approach in your own study by teaching new concepts and information to a friend or study partner.

9. Pay extra attention to difficult information.

Have you ever noticed how it’s sometimes easier to remember information at the beginning or end of a chapter? Researchers have found that the position of information can play a role in recall, which is known as the serial position effect. While recalling middle information can be difficult, you can overcome this problem by spending extra time rehearsing this information or try restructuring the information so it will be easier to remember. When you come across an especially difficult concept, devote some extra time to memorizing the information.

10. Vary your study routine.

Another great way to increase your recall is to occasionally change your study routine. If you are accustomed to studying in one specific location, try moving to a different spot to study. If you study in the evening, try to spend a few minutes each morning reviewing the information you studied the previous night. By adding an element of novelty to your study sessions, you can increase the effectiveness of your efforts and significantly improve your long-term recall.

_{References:
Bjork, D. (2001, March). How to succeed in college: Learn how to learn. APS Observer, 14(3), 9.}

@Amazon

How to succeed at medical school is one of the book that I’m reading in preparation to med school. It has a nice concept of the learning type in med school. How to cope up with the needs and with the requirements in med school. Must read for pre-med students.

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Originally posted on 21 February 2010

By Dr. Lisabetta Divita @Studentdoctor.net

If you are considering medical school, it is important to realize the commitment of time, energy, and money this represents. While being a physician has countless personal and financial rewards, the path to achieving that goal is fraught with trials of different sorts.

The decision to become a doctor should not be made without significant thought and personal reflection—you should be honest with yourself when you arrive at this decision. Also, you should be fully aware of what is involved in medical education, particularly medical school.

If after careful thought you still strongly desire to wear the long white coat, you should steel yourself for a bumpy ride. You should also acquire as many tips and tricks that you can—and implement them—starting on the very first day of classes.

MS-1 and MS-2

The first realization that needs to be made, essentially from day one, is the sheer quantity of facts that will need to be committed to memory. While you certainly had challenging classes as a premedical student, most college classes pale in comparison to the enormity of material presented in preclinical courses.

Take a good, hard look at the way you studied in college. What worked? What did not? Do you study best alone or in a group? Could you benefit from studying a little alone and in a group? Do you get more from a lecturer or from reading notes/books? You need to know what works for you and then do it religiously starting on the first day of classes. If you did not need to study too much during college to get great grades, good luck to you. There will be little time to experiment with different study styles once classes start.

The best approach is to assume that the volume of material conveyed in medical school will far exceed your experiences in college. Therefore you will need to develop new and reliable study habits within the first few weeks. Organization is a top priority. Make sure that you have a copy of any material that could be asked on an exam. This could be slides, notes, lectures, and required reading. These things do not need to be purchased in all cases, but if you are going to rely on community or free resources, you must be able to guarantee that they will be there when you need to study them.

How will you know what could be asked on an exam? Obtaining exams from previous years is perhaps the most important investment you could make. Get copies of previous exams. Old exams give you the best idea of the style and scope of questions that will be asked. There is simply too much information not to focus; the best way to focus is to get a feel for how previous classes were tested.

Remember, too, that each preclinical course will be taught by dozens of faculty. Each faculty member may lecture as little as one hour to several hours, but the material will be presented by several. Therefore the questions that faculty submits for the exam will be of different styles and degrees of difficulty. Individual faculty lecturers are mostly the same from year to year (as are their lectures) so their questions will be similar from year to year as well.

Everything that was uttered during lecture and contained in the syllabus or notes is fair game for the exam. The lecture and notes should be the starting points for each course and then work your way out from there. If the notes are thin or the lecture was a bit rushed, make sure you consult a book or study guide to fill in the material. Often a lecturer will provide the primary literature from which the lecture was drawn. If you can manage it, take at least one look at this material. Many times, this is what the lecturer would have said if there was more time. This material is also likely to be the source of exam questions. It takes legwork on your part but it can be very worthwhile.

There will be plenty of resources at your disposal; too many, really. For instance, many MS I students buy a copy of Harrison’s during first year. This is a very, very dense book and not a very efficient way to spend your limited study time. Likewise, most first year students will diligently buy all of the required textbooks without delay. You will learn that this is not always necessary or a good idea.

Realize that your primary goal during years I and II is to get A/Honors/Pass on your medical school courses. Preparation for Step I of the USMLE or COMLEX will come later. In the first two years, it is all about the grades. Study time should be about the exam and learning the content that will be tested. Sure, the interesting stuff may beckon you to read further, but make sure not to substitute depth for sufficient breadth. Read it all once (or thrice) and come back for the interesting stuff if there is time.

Even if you are a “solo study” type, it is best to have a core group of classmates that you can count on for notes/study materials/borrowing books/crying fits. This relationship is a give and take, so be there for the group when needed and they will be there for you. Organize your studying such that you are a valuable resource to them as well. Being aloof with your peers can really cost you at test time. Reach out to your classmates early so you have a network in place when you need it.

Recommended Books for the first two years of medical school

Note, these are just suggestions and not something you have to rush out to the bookstore and buy.

• Atlas of Human Anatomy by Sharon Colacino
• ŸGross Anatomy, Board Review Series by Kyung Won Chung
• Lippincott’s Illustrated Reviews, Biochemistry by Denise R. Ferrier
• ŸTextbook of Medical Physiology by John E. Hall
• ŸRapid Interpretation of EKGs by Dale Dubin

MS-3 and MS-4

Preparation starts before the first clinical rotation. Ask students transitioning from third to fourth year what is required on the wards. Learn about a SOAP note and how to write one. Learn about a third year’s place on a medical or surgical service. If you can, find out which attendings like to teach, which attendings are “good” and which attendings are “malignant.” Some attending physicians are very particular—learning about their quirks ahead of time can save you when you present patients.

Also, get the practical things in order before the first day of third year to the extent that you can. If your hospital uses paper charts, know where they are and what they look like. Open one up and see how it is organized. If the charts are computerized, make sure you have adequate access (usernames and passwords). You will be running to the clinical lab and radiology a lot during third year, know how to get there quickly and where the respective staff members usually hang out. Get a handle on the nursing station and key staff on the floor/unit. You should have a vague sense of the different job titles and functions.

Your goals during third and fourth year expand a bit. Grades are still important, but learning how to take care of patients is really the top priority. If your focus is to always provide the best care of your assigned patient, the learning and grades should fall into place (with hard work and effort, of course).

You will probably have one or perhaps two patients at a time while on the wards. Those patients are also cared for by an intern, primarily. You should try to take ownership for your assigned patients as much as possible without stepping on the intern’s toes. You should know darn near everything there is to know about your patients, which can be a challenge when you are “sharing” with an intern. The intern will be writing orders, getting study results, doing procedures, and making calls of behalf of the patient at lightning speed. Many things will be happening that you never know about until they are old news. The intern will move faster than you (get used to it), especially when you are new to the clinical years.

• DO NOT slow the interns/residents down
• DO care for your patient whenever possible
• DO assist/perform as many procedures as possible (IVs, central lines, arthrocenteses, paracenteses, etc.)
• DO get all labs/study results as soon as they are ready
• DO personally experience all interesting physical findings (your patient or not)
• DO ask the senior resident/fellow general questions
• DO ask the intern questions about your patient (that you cannot find out yourself)
• DO NOT switch these last two items. In other words, DO NOT pimp the intern and DO NOT ask the resident/fellow about lab results

Also make sure that you know how to present patients. This skill will serve you for the rest of your career and it will be used to determine your clinical grade. Medical students like to include everything in the H&P during the presentation. This is painful for the attending and the team. Alternatively, if you do not mention the pertinent negatives along with pertinent positives, your attending will wonder what was omitted. Perfect patient presentation is not something you can do right away—however you can certainly practice it. Listen carefully to everyone that presents patients. What causes the attending to interrupt? What causes the attending to zone out or look exasperated? What questions does the attending ask and when? Adjust and improve your presentation accordingly.

Some attendings are impossible to please and are maliciously rude—the so-called malignant attendings. These unique individuals need to be taken with a respectful grain of salt. It is the (bad) luck of the draw if you find yourself with one of these attendings. If you do, keep in mind that 1) your rotation will be over in a few days/weeks 2) what the attending wants, the attending gets 3) your performance in the clinical years and in your career will be based on the input and training of hundreds of doctors (and patients). Do not let a few malignant attendings spoil your clinical experience. Simply cater to their capricious whims for a few weeks and write an appropriate review once the grades are submitted. Malignant attendings are a sad fact of life, but over time they seem to get relieved of most teaching responsibilities, which was probably their goal anyway.

Recommended Books for third and fourth years

• First Aid for the USMLE Step 1 and 2 by Tao Le and Vikas Bhushan
• Maxwell Quick Medical Reference by Robert W. Maxwell
• Tarascon Pocket Pharmocopeia by Steven M. Green
• Blueprints Obstetrics and Gynecology by Aaron B. Caughey
• Step up to Medicine by Elizabeth A. Darby
• Surgical Recall by Lorne Blackbourne

These are just some tips to use during your journey in medical school. Don’t be discouraged throughout your first two years of medical school and patiently wade through the massive amounts of material. Learn as much as you can in during your third and fourth years and do not become discouraged if you encounter a malignant attending. Best of luck on your medical school journey!

Dr. Lisabetta Divita is a physician, medical writer/editor and premedical student mentor.

This is a blog of a nurse and his passion of becoming a Medical doctor in the field of Cardiac Surgery.

Started of what he called as “possession” instead of passion. He step up from high school to college to become a nurse. Doubting the odds and adversary of him becoming a nurse, he still believes that being a nurse is a way for him to what many called as the GREEN LAND. Earning dollars, to have a BIG HOUSE, shiny CAR and LUXURIOUS living. But what seems a dream of possession turn out to be a dream of passion, becoming a healing hands to people and a voice of hope for the kingdom of GOD.

The reoccurring dreams and the desire to touch people push him to enter med school. Even if he sees nothing, but he makes a step of faith. As John Mason says “Faith sees the INVISIBLE, believes the INCREDIBLE, and receives the IMPOSSIBLE.”

As currently (March 2010). He is still a trainee nurse of a hospital. Without any possibility and out of adversary of becoming a medical doctor due to financial problems. He still hope that one day he will be a medical doctor in the field of cardiac surgery. Not by might, not by power but by the spirit of GOD.

The fears of the wicked will be fulfilled; the hopes of the godly will be granted. (Proverbs 10:24)