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Patient Encounter

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A senior couple came in escorting their elderly mother with chief complaints of uncharacteristic lethargy and recent unwillingness to ambulate or leave the house. Although she appeared disengaged with the world, the meek and non talkative patient her standard of self respect and posture as she frequently readjusted her repeatedly slipping hijab as she sat quietly as her family spoke on her behalf. The son-in-law was on the side of my attending physician, always nodding in agreement and countering his wife’s arguments when she disagreed with the physician’s diagnosis of depression — depression in general is fairly prevalent, the elderly are especially susceptible when and if they lose their physical or mental independence they once enjoyed. The visit ended with the daughter in denial that her vibrant mother could ever be depressed, despite all the evidence to the contrary, and ultimately refused having a counselor coming to meet her mother. But, denial is the first step that hopefully eventually follows acceptance.

After each patient visit the attending and I have a quick de-briefing where I can ask questions, offer up an amateur differential, and learn more about the patients. My question for the physician this day was about the social history of the son-in-law. The husband seemed unusually knowledgable, and malleable to medical opinions. The doctor then responded:

“The person I’m worried about actually is him. He used to be a doctor in his country, so he understand what I’m talking about because of his training. But, he’s actually the one who really needs counseling, he’s seen a lot of traumatizing things. He used to complain of having nightmares of seeing corpses strewn about on the streets as wild dogs gnawed at their bodies”

The husband was a physician, an Ophthalmologist, in his country during a time of civil war. Often, the rebels would come into the clinics with a wounded comrade and demand their friend be saved. For the rebels, being an Ophthalmologist this wasn’t an adequate excuse for not knowing how to pull out shrapnel or mend a lacerated femoral artery from a gunshot. Doctors who refused or hesitated were executed on the spot, as was this person’s colleagues — though, on other war fronts the aggressors in this story just could of easily have been the political regime.

Eventually, he doctor fled with his family to the United States and has never returned. Despite earning a scholarship to train in Italy where he completed his clerkship and later returned to his country to gainfully practice medicine the post traumatic stress drove him away from medicine.

I couldn’t help but reflect on the gentleman throughout the day, as I still do now. I wonder what other horrible things he may have seen, seen other doctors be forced to do, or worse become accustomed to doing. I am fortunate to be in a position where people share their experiences with me, sometimes it seems it’s the only chance they get to.

 

 

First Semester of Medical School is Over — A Wounded Survivor’s Tale

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“But, for better or worse, in medical school you don’t have time to really “deal” with how you feel or else things would never get done.”

Yes, it’s finally over and I get a break from medical school. I have a few days off, though I trauma duty this Friday night on Black Friday (this is more of a treat for me than anything else). I wanted to update you on what’s going on, it started off rather short post and then expanded into a meandering account of my brief foray in medicine white a short white coat.

It’s only been about 3.5 months since medical school has started, but as many medstudents would admit, looking back it feels like a year has elapsed. In 3.5 months we’ve crammed a year or more worth of graduate education. But, the course that stands out the most to me was gross anatomy. Yes, the human body is interesting, it’s probably the best example of organized chaos leading to something good.

Gross Anatomy

The poster child for medical experience is Gross Anatomy & Dissection. As a person, you change a lot after Gross Anatomy, it’s practically a rite of passage for almost all MD (and DO) candidates. I still remember the emotional experience we had the week before our first “cuts” into our donor. We were hesitant on the first day of dissection, that is to say no wanted to make the first “cut” into the person laying on a slab of lustrous aluminum table. You see, whatever excitement we had about the process was taken to another level when we learned more about the donors as we watched one speak on video about why she decided to donate her body. Seeing her, I couldn’t but help think how much I’d of enjoyed meeting her. After all, she seemed rather friendly, quick witted, and rather friendly. So, on the first day when we dissected, I couldn’t help but wonder what the woman lying in front of me was like. Did she have a sense of humor, did we like the same movies (Groundhog’s Day, or anything with Bill Murray), did she have good stories to tell? But, for better or worse, in medical school you don’t have time to really “deal” with how you feel or else things would never get done. Then 3.5 months later, we’ve done a lot more in dissection I’d ever imagined possible or feasible — I also have a lot of new funny-awkward, and likely for you, disturbing stories and sights. It’s an experience.

The Struggles

The biggest shock about medical school isn’t how hard it is —  well I take that back, it feels like we’re in mental medical school bootcamp. It’s a new experience for most people in medical school, how hard it is and what it takes just to get an “average” score.  No matter the institution, compared to their peers in college, most people who made it into medical school probably were on the right side of the bell curve academically. In medical school, that changes rather quickly and at best you’re like everyone else. That can either be intimidating or motivating depending on how you choose to see it. Conceptually, the course work isn’t very difficult. Instead, it’s just that you’ll cover a ridiculous amount of material in even one day, and you’re responsible for a ridiculous amount of more (but ‘different’) information the next day and so forth. Unfortunately, understanding will often take a back seat until you’ve remembered a large heaping of information that you must have ready at a moments notice for regurgitation. Then, if you’re lucky it’ll somehow all become clear before the exams, typically though as fate would have it expect it to be after the exams. I don’t have any grand stories to tell you about how to make this process easier, it’ll get easier because you’ll grow accustomed to it because of the consequences of not.

Clinic/Hospital Duty

The biggest shock isn’t the difficulty of medical school, after all there’s rays of sun in back of the clouds. Instead, it’s the level of responsibility and trust thrusted upon us. Before, as a premed in the hospital, the most that was expected and allowed of me as to perhaps fetch water and if I’m lucky bring a stool sample to a lab. As medical students, one classmate has already intubated someone under supervision, another has done CPR for 15-20 minutes until the patient was announced deceased. Besides trauma, many of us spend time with either inpatient or outpatient hospitals or clinics around Boston, I’m placed at a community hospital and clinic. I suppose my capstone experience for this “course” was when the doctor just gave me her new patient, said get “Get a health history, after that we’ll do a physical” and left the room leaving only me and the patient. You may wonder why, out of all the things I spoke of being trusted with a history is so important. Well, it’s often said that perhaps 2/3 of all medical diagnoses can be correctly deduced from a good “health history”. It’s an interesting experience, while having a conversation with a patient, you try to extract information that might be pertinent to their health. This often means you, underhandedly, lead the conversation into a direction where the mountains are rich with information. If someone comes in with back pain, you lead the conversation in a way that their history might give enough clues to both elucidate and eliminate possible causes. If you ask too many questions in a rapid fire fashion the patients won’t communicate with you, or might just eject you out of the room. For example, here’s a typical exchange with patients as I go in blindly without seeing their history:

As introducing myself, and asking a few probing questions

Me: do you have any health issues or diseases?

Patient: no.

Me: sorry, maybe I’m mistaken but when I asked about medication you said you’re taking X medication?

Patient: yes, I have diabetes but I’m healthy.

Me: oh okay (writes down diabetes)

Often a patient will just misunderstand what I’m looking for, or in this last case perhaps misinterpret the difference between having your diseased being properly managed and being free of disease. There’s insider information in medicine, just like how there’s insider information your car mechanic knows because of their trade. There’s also two of my favorite typical exchanges:

Me: do you smoke?

Patient: smoke what….?

Me: ….tobacco?

Patient: oh, NO.

Me: so, what do you smoke?

Protip: to those not in medicine, your doctor or the medical student working with you doesn’t care about what you decide to inhale, or stick into any orifice. We care about you and we care about your problems and health, but learning of your addiction to prostitutes or meth isn’t a black eye in our book, it’s simply part of the puzzle of trying to get patients healthier. Fortunately, most patients are rather frank with the drug and sexual history, making presenting and giving a differential diagnosis easier to my attending (thank you), as long as they tell the right stories and we ask the right questions. You’d also be surprised to learn that the most important part of the visit is likely the last few minutes:

Me: okay,..(recite history back to them), do you have any questions?

Patient: no

Then as I’m walking out the door

Patient: actually, there’s one more thing…

As a rule of thumb, patients postpone the most embarrassing questions for the end, i.e. genitals not in tip-top shape, or the real reason why they likely visited that day. So, during the history, if you can help get this information from them earlier you can both save time (after all there’s a waiting room full of patients waiting) and that person may even receive better treatment. Once you realize that you’re wearing a white coat and a stethoscope therefore most people trust you with it gets easier to just ask someone about their safe sex practices, depression issues, or the hue of their bloody poo. Red feces means the bleed is more distal, i.e. near the anus, whereas dark (tarry) colors infer an upper GI bleed. Red feces is typically more innocuous than darker stools, and therefore all of my follow up questions are different. If you had fresh red blood in you toilet, I’d try to ask questions to eliminate dehydration for example — but the trick is that I can’t use the word dehydration in my questioning otherwise the patient would likely just respond “No” because their definition of dehydration isn’t the same as the medical one. At first doing all of this is really hard, to keep track of things so that you can lead the conversation towards trying to obtain a differential diagnosis, but it’s fun and we’re all getting better at it and I’m sure we’ll continue to. I’ve heard amazing things about some my classmates as well, and we usually swap our horror stories or goofs.

Some days are less fun, for example being there as you watch a physician try to communicate that maybe the patient won’t be okay, that cancer has moved faster than expected. Interestingly, you’ll have to move room to room and patient to patient, while not bringing the weight from each patient with you.

Differential Diagnosis Training

You may have wondered I brought up “differential diagnosis” as a new responsibility. One thing we learned really quickly is that the peking order goes, from highest to lowest: attending, resident, medical students. But, while being at the bottom of the totem pole, it’s still a team, and you’re expected to contribute a quick witted input or two from time to time. No, you don’t need to try to diagnosis someone with Kuru, but you should be able to understand that the bladder cancer patients cancer has grown and is now likely impinging on the nerves in the ischioanal fossa based on what the patient has recently told you about pain while sitting. You should be able to understand how the patient’s refusal to take Vitamin D while still taking their prescribed dosage of calcium explains why they’ve gone from osteopenia to osteoporosis. We have a course on how to do this, we learn how to research on diseases and how to integrate so that we may differential diagnose, it’s not a set of skills you’re expected to walk into medical school with. In fact, our final exam, was similar to an episode of House (without the grumpiness) where we got a brief paragraph and lab results and tried to differential diagnose a mock patient, our tools being a white board and a few other medical students for brain storming.

Overall

So, my first couple of months of medical school has had ups and downs, a lot of difficult times and exceptional ones. But, I enjoy the experience more than I’d ever imagine, because if anything my worst fear is abated: I’m never bored in medical school. As a classmate said today after we finishes our first semester, “I feel like a different person than when I started”.

Still Surviving Medschool

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Boston Public Library

“Success is a lousy teacher. It seduces smart people into thinking they can’t lose.” ~Bill Gates

As of late, like the other thousands of medical students in the country I’ve been busy. Too busy to even post as much as I’d like, but here are some updates on what medical school life is like for me. I’ve recently just finished battery of tests.

During orientation week we were told “A lot of you will fail exams and classes for the first time. In fact, what may shock you is that you’ll actually be trying and still fail”. This have proven to be true.

I’ve heard about a 1/5th of the class may have failed one particular exam we just had, I was fortunate to pass that one. We’ve had 4.5 courses, and here and there people are a good number of people struggling to adjust to what medical school requires. We’ve had at least two students leave, one on leave of absence to restart next year and one person just decided medical school wasn’t for them. However, I wasn’t so lucky on the second biochemistry exam however, I’ve passed the first exam, failed the second, a fail in that course is a B- mind you. Currently, I’m making some adjustments so I can hopefully defeat the last exam coming up in a couple of weeks. Interestingly, the hardest part of medical school is trying to zero in on how you should study, especially as a battery of professors teach the course and write the test, so it’s hard to figure out what style you should use. In general, we’re learning that the rule of thumb is to ‘simply’ know everything that’s ever uttered — unless the professor concretely states “This will not be tested”, and even still take that with a grain of salt. After the exams I had a good friend stop by from California, I took him on a three day tour of Boston including the public library. Every medical student needs time to unwind.

In our program, we round on patients during our first year. I signed up to work with outpatients, so I flip flop between urgent care and family medicine to learn what “normal” patients will present like. Later, I’ll switch over to inpatient hospital rounding to get used to what a “normal” inpatient is like. Clinic rounds are a great break from studying, and it’s a great chance to try to make links between course material and patients. It seems almost divine that things I learn in class end up presenting themselves rather frequently in clinic: during the “back and limbs” section of anatomy I saw patients with rotator cuff injuries, when we started the cancer lectures in biochemistry I had to work with a physician while he tried to discuss the patients prognosis (and unfortunately, neither prognosis was favorable). While discussing bad news with patients (cancer) I’ve learned they expect physicians to be understanding of their situation, but at the same time it’s important to be the “strong one” in the relationship, especially when they’re already scared. It’s odd to think that I just started a few months ago, and merely while merely dawning a ceremonial white coat and a stethoscope people, namely patients expect and admit so much to me. I’ve learned about people’s fears, ambitions, secrets, I’ve seen burly tattooed men cry because they’re in chronic pain, a pregnant mother who tried to commit suicide after her boyfriend ditched her after learning about the pregnancy. People really do tell their ‘doctors’ anything, it’s quite a position of trust. We were told that we’d encounter these scenarios during the first couple weeks of school, but we thought as infant medical students they were just trying to “scare us straight”, but they weren’t kidding.

You hear a lot of painful stories, physically and emotionally, but you maintain a calm and caring face while listening and maybe later you have time to reflect on how you really felt — scared, but that’s okay.

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In a few hours I have clinic duty again, I will put on my white coat and engraved stethoscope and put a smile on my face to project confidence while I interview patients. I will get a history as usual, present it, and the results will be added to the electronic health record. After that, I’ll go to school and study for several hours, head to anatomy lab (we bisected the head yesterday) and study some more. I’ll return in the evening, perhaps after 9-10 PM, eat and study some more, then go to sleep to wake up and study again.

Study hard premeds, medical school is wicked hard, but it’s also an unforgettable experience.

3 Myths About Medical School

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1. You’ll never have time for anything else but studying.

Don’t get me wrong, there will be periods in your medical school career where it’s not reasonable to do more (studying for exams, boards, 3rd year), but so far everyone I’ve talked to at my program still has a life and are getting things done with their education. People in my class run half marathons and other random events, go to theatre, coach soccer, married and some have children. For myself, I still have time to schedule in events (saw Atul Gawande speak last week) and crank out a post or two, go out for walks around the park etc.

Though, medical school was giving me a good stomping at the beginning with the course load (had 4.5 courses at the beginning plus out patient clinic hours) you eventually learn how “you” can get on with it, and well you just get on with it. This isn’t to say medical school is easy either, it’s the most challenging thing I’ve ever attempted, but it’s certainly doable without ruining your personal life. Some parts of medical school are difficult because of the conceptual parts, but some most of it is just knowing when you have to brute force learn concepts in order to make the conceptual part intelligible — and you have to learn to find the balance between it all and your time.

2. Medical school is full of gunners, waiting to slash your brake lines so you don’t make it to the final on time…or at all and will ruin your life.

Whereas, some people adopt a definition of the person who wants to be “the best”, I believe a gunner is someone who while trying to be “the best” while hoping everyone else is beneath them is rubbish. If there is anyone in our class like that, they’re doing a stellar job at hiding it. Usually, people post/share their own study guides and charts, or useful links for the whole class to see. There are study group cliches, but it’s pretty easy to get invited, make, or to crash any study group you see. Maybe different programs will have different experiences, but most of my friends at other medical schools feel the same way about their class in general. The gunner talk is a sticky subject, by definition being the best means you’re better, but in a team (medicine) being the best individual is less important than the team being at it’s best. Wanting to be at your best, that is being better than you were before, is what I think most medical students strive to.

If anything, I feel people were a lot more Lord of the Flies tribal in undergrad than now in medical school.

3. You’ll never use that premed stuff in medical school.

You’ll never sit down and calculated a long winded titration problem again, that much is true. Nor will you try to figure out the coefficient of friction between the IV lines and the hospital bed pulling the line tout. No, you won’t sit down and calculate how many ATP and FAD molecules will result from burning 90 grams of sucrose, nor will you ever be asked again to show the conjugation on retinol. But, it’s tacitly expected that you could understand the concepts (or main ideas) in all of your first year of medical school and into the future. I don’t need to write out each molecule’s Lewis structure in metabolism, but understanding Lewis structures and organic chemistry make the information easier to digest conceptually while I brute force memorize steps. You’ll definitely never be as detailed orientated with the steps, but you need to have a broad understanding — it’s all about the basics. Le Chateau still comes back as the Bohr Effect in blood as does ferromagnetism when talking about oxygen carrying ability of heme. You’ll never really strip away the science from life, because life is science in action.

So, to pay homage to all of those hard working premeds: all of your hard work is for not. But, don’t worry if you’re admitted into medical school you likely have the skills and dedication to finish it even if you have an eternal hate for the prerequisites. In fact, most of the things you’ll need to be a good doctor will likely be much later in medical school and into residency. So, on one hand in the scale won’t play out day to day in our futures — no one calculates the amount of joules imparted into the cyclist who was struck by a trunk in trauma, but understanding the concepts makes it easier to explain to the cyclist he’s lucky to be alive because doubling his speed quadrupled the punishment on his tattered body as raced down the hill. If anything, your understanding of science will always carry you on the concepts and being able to explain things to others effectively (assuming you also have communication skills).

With that said, back to studying for me (see the first myth).

Rapid Fire Q & A: MCAT Questions

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Hello!

I’ve been browsing the search terms people use to find my blog, and I decided to answer some common questions that seem to come up through people’s search or stuff people ask me a lot. This will be a quick rapid fire Q & A, this time I’ll focus on the MCAT. Though bear in mind the scoring system and the subjects will be changed on the new MCAT, in general the test represents the same idea i.e. part of your application to enter medical school:

1. [Is there a difference] between the AAMC practice tests vs the real MCAT?

Yes and no, but mostly no. The AAMC practice tests are representative of what you should expect on the MCAT. If you’ve taken enough practice AAMC tests you’ve probably noticed there’s some relative variability in perceived difficulty — some tests you’ll think are easy, some you’ll think are less so. In general, the core material doesn’t change much, instead it’s how they ask you that may stump you on a particular test. For myself, while self studying my practice scores varied in the last month from 32-36 and I was averaging about a 33 on practice exams (my first practice score was about a 22). But, I ended up with a 30P on the real exam which I suppose isn’t that bad considering how bad my personal life was on test week (family issues) and the night before the exam was. The key to these practice tests is to establish a range, and know that you may either score within that range or about 2-points below it. Why 2-points? Well, that’s within the confidence interval stated by the AAMC, if you score a 29 then a 27 or a 31 were in your range in theory. I can’t promise you that every school is open to the AAMC interpretation of scores, but that’s actually why the new MCAT is coming out with a new scale to further enforce this point and make it easier to interpret. This may also be why applicants who underperformed on their MCAT with a 28 or so are surprised to find that the bulk of their interview (if invited) isn’t spent on defending their MCAT score, this is probably especially true if everything else in the applicants file suggests they could have done better.

The biggest difference however will be in how anxious you feel about the exam, or at least it was that way for me. The good news it’s a good feeling to think that with each question you attempt the closer you potentially are to not seeing the MCAT ever again (hopefully).

2. Is it bad to take a MCAT practice test twice?

There are two skills you pick up while studying for the MCAT:

- 2.1. Getting better at the content on the MCAT

- 2.2 Getting better at taking the MCAT

You’ll definitely get the most value the first time you take the test to see how well you know the content. However, reviewing your past exams is part of the process of getting better at taking the MCAT. The first pass through the test is the easiest, you just take the test and do your best. But, reviewing the exam is a skill all in itself. For that part you want to ask yourself the following questions:

A. Why did I get this question wrong, or why am I getting these types of questions wrong? — separate the material into: 1) I had no idea how to even approach it, 2) I sort of knew it, and 3) I should of gotten it but misread etc. The last one, 3, is the easiest to fix as you just need to start annotating things better to make sure it doesn’t happen again. The first part, 1, is probably the most time consuming as you’d likely need to do a targeted content review on that subject (or that subject’s foundation). The middle one, 2, is the trickiest because it’s easy to fall into false comfort of classifying things as “I sort of knew it” and not dedicated enough time to these issues. In other words, you either know it (3) or you didn’t (1,2).

B. If I got this question right, was there another way to arrive to the same answer? — knowing alternative ways to answer a question is not only good conceptually, it may save you on the next exam. For example, if you’re given the answer choice of:

a. 9.21 E-23

b. 4.21 E-26

c 9.21 E-18

d. 4.21 E-34

You might have arrived to the right answer, let’s say it’s C, by crunching the numbers. But, likely in these types of math problems you could have arrived to the same answer by just evaluating the powers without doing any of the math that made the 9.21 part. This is because as long as you do the powers correctly, the max you can be off without fully evaluating the problem is by a factor of 10 (i.e. you’ll either come up with E-17 or E-19). So, sure, if you had answers within a factor of 10 you’d then need to do more math, but in this case you likely wouldn’t and it ends up being a very quick calculation.

C. Make a plan of how to NOT miss these types of problems again, though except for discrete questions never expect to see the duplicate permutation of the same question again.

3. Are there miracles on the MCAT?

Probably not, in fact you should expect just the opposite. This is why you need to practice and attempt to overshoot during practice because on the real test, for various reasons, it may not go so well. One person I interviewed with told me on their test day there was obnoxious construction going on across the street, another talked of an equally annoying fellow test taker, mine had a character that apparently was into keyboard S&M. Though, I do know a person who felt the test they received was everything they happened to be strong at, and she did better than any of her practice exams. However, realistically don’t expect a match made in heaven for your exam.

The biggest mistake you can make on the MCAT is expecting a miracle, you’ll probably score somewhere around your practice scores  — maybe you’ll do a little better, maybe you’ll do a little worse. The practice tests aren’t trying to scare you into studying, if you find the practice AAMC impossibly difficult then there are no miracles to be had on test day.

 

Joined Student Mentor Network

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Applying to medical school is confusing and understandably unfamiliar process, this is where hopefully this blog and your mentors with first hand experience come into play. Unfortunately, not everyone is lucky enough to have a mentor lying around at their disposal. I recently joined the ranks of Student Mentor Network, an advising service created by medical students to help soothe the fierce impact of applications on premeds. As some of you already may know, I was editing and critiquing student’s personal statements (and some secondaries) pro bono this year. Last year I offered to edit/critique medical school personal statements and about 6 people opted in. This year I worked with about 40 people (and a few last year), each person was given three edits maximum, and it worked out fairly well. A large bulk went onto apply to medical school and a fair chunk (statistically speaking) are now interviewing this season. The unfortunate part is that it’s not realistic that I can read over 100 renditions of personal statements while in medical school, not to say it wasn’t enjoyable to see the papers mature — in fact, I asked one applicant to write a guest post after their interview dust settles. After this last wave was over and I started medical school I was certain it wasn’t realistic to keep pumping out edits. After apologizing to future applicants, I asked a few people on Twitter who follow my blog how to make the process more sustainable both for myself and those who wanted to submit. Some suggested I charge with a sliding scale, do crowd sourcing, or other types of creative things.

I procrastinated on a solution for several months as I languished at the thought of charging those who couldn’t afford to apply to medical school never mind another fee stacked onto their plate. A timely email fell into my email box from Student Mentor Network asking if I were interested in acting as a mentor, after I scoped out the site for a bit I noticed the rates were comparatively lower as most advising services charge a few hundred hourly whereas their site ranged from ~$30-$45 per hour. This is not to detract from all services, some services are worth every penny despite being expensive, especially compared to the cost of re-applying. I was intrigued, but being my usual skeptical self, I was not completely won over. So, I exchanged numbers with the owner of the company and we agreed to talk over the phone about the concept. On a weekend between tests we found time to talk, and he explained how he was initially rejected by all schools he applied to despite having competitive stats. He described this experience as eye-opening, learned “how to apply to medical school”, and was subsequently accepted into Johns Hopkins. We both agreed that the medical school application process is rather daunting, what some perceive to be mysterious. Though, once you understand the process it’s rather intelligible, the problem is most people only gain an understanding of the proper way to apply after they’ve already been rejected after a cycle and have forfeited several thousand to application process. So, the setup of Student Mentor Network is that you only receive advising from medical students (those who know what the current application ecosystem is because they just went through it).

So, my plan on how to handle editing/critiquing personal statements will be different from my previous rounds. This year, I will still take some personal statements (with three edits) for free, first come first critiqued. I’ll give priority to those who follow my blog and/or Twitter account. But, this year and from now on I’ll have to cap the number of essays I review depending on my predicated schedule — this next cycle, I’m shooting for 15 people for free and this may expand in the summer. I’ll also still respond to quick questions or lengthy emails as usual, regardless. The rest, or people who want more help can rent my undivided attention per hour via Student Mentor Network. There, we can talk about anything:

  • Personal statements
  • Building a resume (CV)
  • Interviews
  • Taking a gap year
  • Obtaining letters of recommendation

But really, I encourage you to try to align yourself with a mentor that fits you, maybe I’m not the fit for you. Even if it’s not me you decide on, I’d suggest considering using this website because investing less than 50 bucks is a lot cheaper than finding out you made a fatal mistake upon applying the first time without empirical based advice.

You can find me under Deandre K.

 

 

 

What Weekends Mean as M1 – A Study Break Entry

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No new material to stuff into my brain, that is what weekends mean to me now. Yes, this still means I study on the weekend; but instead of studying while being swamped with new information, on the weekends I can finally come up for air because there is no new material being added to my “study list”. But, medical school isn’t all work and no play, today I went to an 3D printing fair at MIT. I saw a couple of cool things while I was there, I found a few objects crafted from the 3D printers and decided to make a display for your viewing pleasure:

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But, the weekend doesn’t mean it’s time to slack off either, most because I can’t afford to. I spend less time studying on the weekends than during the weekday, except a week or two before the exams. On average though, I spend about 6 hours a day studying during the weekday and 4-6 hours on the weekends. Typically, Friday is making a game plan for the weekend, the weekday is surviving getting hosed by new material. Getting into medical school is analogous of thinking you’ve just climbed Mount Everest, but you find out quickly once you start medical school you’ve only reached the first base camp; and not only that but the mountain is growing each day. Those hours of studying also don’t account for the time spent watching and attending lectures. All in all though, I say things are working out for most of our class — we’ve only had one person drop out of the program thus far (they decided they would follow other goals). For myself, I’m doing what I can do to not only learn the material but to also get better at getting the material to “stick”. After all, studying endlessly sounds noble but it’s not that efficient, and time management is the name of the game now.

The trouble with the first year is really figuring out how to retain information efficiently, this will be easier or more difficult depending on your classes. We are the last year to not have systems based learning, and we are doing the traditional format, so we have seemingly disparate courses that somehow weave together as you slowly gain epiphanies by endlessly working on your general base of knowledge. I’m not sure if the more archaic way is for everyone, but it’s pumped out exceptional doctors those far so I’m okay with it (power to you systems based people!). With that said, each course here takes a different approach to how I should study. For anatomy, it’s mostly change into those dingy scrubs and spend more time with my donor — it’s faster then trying to imagine what it should look like. Sometimes, I prefer a library or coffee shop over than dissection lab, go figure, and at those times I use a combination of Netters (illustrated gross anatomy), Color Atlas of Anatomy, and now like everyone else in my class 1 mm axial cross sections of cadavers. Netters is very good for seeing the ideal form of how things should be because everything is rendered. The Color Atlas of Anatomy is a book full of prepared cadavers, so you’ll see the more visceral things you should see in real life. But, when I don’t have those at my disposal, or want a break from that type of studying I try to draw or make diagrams:

Heart
Heart

When I need to understand minute differences, I’ve always find that drawing made me spend more time conceptualizing the object that I’m sketching. So, this is how I studied the heart, and made a lot more sense after one drawing without looking at the real image. Another thing I used drawing for was the lungs, to capture the differences in relationship between the pulmonary arteries and the bronchi. Though, I still need to study a lot of things more to become more confident in my answers:

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Sometimes, watching videos on Youtube and using Anki cards are the way to go for learning things I need to both memorize quickly and understand — tonight it’s cardiac embryology. About Anki cards, I’ve found that just taking notes almost straight onto Anki cards is more efficient then having to make them later. I’ve also try to make a variation of primary to secondary type questions for some of the content I understand less, for me, it’s important to spend more time with material that I don’t like and keep up with stuff I’m okay on to keep on schedule.

For some classes, you just need to discuss it aloud and you’ll understand things more. For example, if you’re having problems conceptualizing an ethical question or law, some times a conversation is a lot more effective than flash cards. The only important thing, for myself at least, is to have a decent foundation. That’s a fancy euphemism for memorizing a plethora of nouns and simple ideas. After I have those things, I can hopefully both understand the language of my classes and build a higher performance level of understanding from my foundation of memorized knowledge. I’m not saying this is the most ideal way to study, in fact, I’m sure others study differentially in my class and probably get scores and maybe with less effort. But, for me it’s how I pick up things besides reading it.

Medical school is very interesting in that there’s a lot of ways to get it done, even though everyone takes essentially the same courses — and you’ll be astonished at how each person in your class who makes it will work hard to make things work. And now, my study break is over, and I must go back to my studying. Good luck if you’re interviewing for medical school, I’ll see a fresh batch of applicants on Monday as usual, I’ll be sure to try to calm any nervous one I see — for me it’s back to work!