From Boston, happy autumn! Here’s a picture near my house.
Around this time of the year, squirrels should have already built their nests, and premeds are getting interviewed at medical schools. Third year medical students no longer exist, and fourth year medical students are taking care of their residency process. For me, I’ve just past the midway point of my second year of medical school and board examination. A few weeks ago, I started to prepare for the boards. When people decide to prepare for the boards is up to them, each medical school gives their second year students time off before their examination to dedicate their time to it. However, due to the high stakes of your permanently recorded score, must students start preparing for it earlier — some students have started studying since last year, some started this summer, the large majority seem to wait until fall or winter to start thinking about it — it’s a personal choice when you decide to start it. For myself, I have a hard time evaluating what I do and do not know, so answering questions works for me whilst taking the same course: I do psychiatry questions during the psychiatry section of class. In essence, I’m trying to eat my cake and have it too, I’m trying to use the boards as an adjuvant to class or vice versa.
If you’re not familiar with the boards, and most notably the question style, this succinct best flow chart below explains the situation the best…
Here are the resources (besides lecture material) I use, so far:
- Goljan (high yield notes) – there’s a mix of materials, written and audio, you can choose what works for you.
- Board Review Series (BRS) – I supplement this when needed. The lecture notes will be more detailed, but BRS is best used IMHO to get the big picture.
- First Aid (notes) – I’ve started to just take notes straight into it. When I get questions wrong (any question bank), I just look up the topic in First Aid, see if it’s a fact that I never heard of or not, then I finally just annotate straight into the book.
- Sketchy Medical – this is a must have for all second year medical students. You will feel absolutely ridiculous using this in public, but your blushes are worth the pay back. I watched the videos and used the provided PDF ‘images’ as Anki (flashcards). Thankfully, they’re coming out with a Pharmacology series, I will definitely pick that up.
- UWorld (question bank)- the school strongly suggested we just stick to UWorld and some other materials they’ll update us about later, they also told explicitly told us to avoid a certain company. We were told they ask the appropriate level of third order question that we should see on our boards. I started with just doing 3 UWorld questions a day, I started only within the same subject as I was learning. Now, I do 6 in-subject and 4-5 previous subject questions. Afterwards, I just review what I got wrong and annotate that into First Aid.
- Anki – I’ve used it intermittently. It can get sort of boring to do, but it does help a lot if you just have to remember a lot of details. For myself, I’ve learned the simpler and less “busy” the card the better and faster I’ll memorize the card duo. The trick to making Anki useful is to speed up the rate it takes you to make cards. If you have a diagram, table, or image to memorize then use image occlusion. To my knowledge, and at least on my Mac, image occlusion is either missing or obscured away in the Apple compatible version. If you’re using an Apple, then you can install Wine. The Wine program will allow you to run windows programs on your Mac. If you design a two-item table in Excel (both Windows and Mac), then you can save it as a .CSV. A lot of people don’t like using Anki because it takes too much time to make cards. I remember, in my first year I’d spend hours making cards, now it only takes about 20-minutes to do the same amount of work to make them. For me, it was just important to not try to make a card for every little detail and not lose focus of the medium and big picture.
- Doctors In Training (DIT) – I just received a confirmation order, and I should be receiving it soon. I’ve heard very positive things online, especially last year when second year students were tweeting about their board results. When I get some time to sit down with it, I’ll update this blog with a review of how it worked for me.
- Pathoma – it seems like I’m the last person in my class to use this, but I just started to try it out this week.
- PubMed – often, a handful of lectures can be summed up by a short well written paper.
Anyways, that’s what I’m doing for the boards. I really don’t like adding new things into my study schedule — the more wonderful the tool the more time it usually takes to learn how to use. For this, I use First Aid as my nexus of information by taking notes into it. If I see an article on PubMed that explains it the best, then I write down a couple of words plus the PMCID so I can look it up later. So, for any source of information (especially when using multiple) I find it’s important for me to keep good track of references. I’ve even found it useful to cite First Aid pages within First Aid itself, for example at times where two concepts go together seamlessly (in my mind). If you’re in the gallows of the first year, hang tough, when you finally figure out how to juggle flaming sharks as a MS1 you’ll be able to transfer a lot of the skills over to MS2.
I use my course grade as a barometer of how well I’m balancing my position as a medical student, research, volunteering (mentoring), shadow, clinical duty, board studying, and personal life. To pass each module you need to have an average equal or greater than 72%. This year, I follow the suggested set-point given to us by our academic advisors, I try to keep my average around 85% — I’m willing to miss a few points on a written exam if it means doing the things I like. Anecdotally, I’ve heard striking a balance is key:
- I’ve heard of a minority of students going hard on board studying, but neglecting the grades, and they had to remediate courses and lose time studying for boards anyways.
- I’ve heard of a minority of students going hard on course work (nearly achieving perfect scores), not studying for the boards until the last minute, and ultimately having to retake the boards to get a score a more representative score.
- On the flip side, I’ve heard of a smaller minority who by virtue of doing nothing else but study successfully destroy the boards and the coursework, but then had to take a gap/research year to become more competitive in terms of extracurricular — this is obviously a very specific case, and really only something worth thinking about for extremely competitive specialties. Though, in the scheme of things, this is the best of the three problem situations to have.
Anyways, have a great weekend!
on Wednesday Yesterday
We’re well into half of the first semester. This block of courses was Pulmonary (finished) and Cardiovascular. Mixed into our ‘classroom’ time we’re also scheduled for didactics training, and interspersed among everything we have workshops on medical imaging (X-rays, CT scans, etc). It’s our last year of ‘classroom’ time, from next year we take the boards and hit the wards and pretend to be doctors — I keep using the parenthesis with “classroom” because I don’t actually go to class unless it’s a discussion, skills training, or seminar. I spend most of my time studying like I did for the MCAT, at a cafe with headphones — I find studying in public really helps to break up the monotony, and it’s nice to strike up a random conversation with a stranger (I’m Californian).
In the summer between MS1 and MS2 I had a project in the cardiology department. In the project I made new friends, and I even gained a role model. With that project completed, and classes ongoing, I received an email asking to help with another project. I like having projects, it keeps me busy and out of trouble — idol hands. Monday, I traveled to pick up the proprietary software/laptop I’ll be using for the project. A week ago I received a batch of portal ECG device I’ll use with patients, and from today I started on recruitment. It’s going to be a tough schedule for the next few weeks, this pilot project should be done in two weeks. The neurology part of this block also has its exam in two weeks. There is free time in medical school, I’ll just have to use it judiciously in the next few weeks. Anyways, I’m really excited I get to help with this project because I believe the results will be generalizable. Selflessly, a large bonus is that I believe this project’s scope will help my own parents health. I want to talk more about it, but half of the project is still proprietary and the hard work didn’t come from me.
I believe it was around this time, two years ago, that I interviewed at my program. Because cardiovascular disease has literally plucked those I care about away, I ended up dropping all interests of PhD programs to become a MD. I have no idea if I’ll be a cardiologist, if I’m qualified to be one, or if I’ll still be interested when it comes time to apply for that fellowship. But, what do do know is that I’m grateful that I even have that as an open possibility.
I hope everyone reading is doing well. Right about now, premeds are applying to medical school. Good luck! In the end, whether this cycle yields an acceptance or not, remember to take a wellness break. New medical students are starting up, hopefully you had that wellness break. The more people you’re friends with the easier first year will be — don’t forget about that wellness and time for yourself.
Medical School Stuff
For me, my second year of medical school just started a couple of weeks ago. If you’re interested in the schedule, you can read it here. After about two weeks into the semester we had our first exam, it covered 43 lectures including group discussion material. During this time you practically breath Power Point slides as you have to go through a couple thousand in a few weeks. Though, it’s not as bad as it sounds as the material is more clinically relevant, it’s more interesting than the first year. It’s a lot of material, but if you make a daily effort to keep up it’s rather manageable because we no longer have to juggle disparate courses like in the first year. This is also the year that we have to take our first board exam, but I won’t have much to say on that subject for a couple of months. By the way, my first exam on pharmacology, pathology and some infectious disease went fine.
Found A Place to Live
So, several weeks ago, the house I live in was sold. As you may have imagined, this created quite a predicament for your author because housing in Boston is ridiculous. We are somewhere near 3rd in the country for cost of housing — if you’re living in SF and reading this, you have my condolences. Here, it’s not just the prices, the finding roommate process can be a little daunting and even sometimes ridiculous. One advertisement demanded a Linkedin profile be sent, another explicitly said “wealthy applicants only”, and yet many others asked for short essays of “why do I want to live with you”. Other potential places were a little too eclectic: some demanded you participate in a commune (no sarcasm), posts that had 2-3 paragraphs about their cat were ignored. In the end, I found a place just a block or so from my current one. Somehow, the price ended up being slightly cheaper than what I’m paying now, and my new roommates will be a post doc and a graphic designer. I had a big goal of staying in my area, because it’s right outside of greater Boston — it’s a little oasis away from the hectic blazing sirens near our hospital (and student housing).
Finally, I just have to say thanks for reading and keeping me in your best wishes!
Well, the summer is almost over, and it’s just about been a year since I moved to Boston from Southern California. Boston is still going through a latent US speculative property inflation trend — fancy talk for “the rent is too damn high”.
Anyways, second year starts this Wednesday. My summer is coming to a close. I spent most of my summer at an ambulatory cardiovascular clinic, with occasional visits to various inpatient cardiology rounds, and topped off with a random visit to a level 4 bio-safety lab (the places where they make zombie viruses in movies). It was an awesome opportunity given to me by the American Heart Association and NIH for a proposal I was working on with my PI last winter, and I’m very appreciative of this formative paid experience to work with patients (extensively), nurses, EPIC (our EHR), and physicians every day. From patients I’ve received lots of enthusiastic handshakes, a few hugs, and even a drawing. Best of all, I gained a physician mentor and made really close friends.
In the first year, it’s easy to drown under the tsunami of one-off facts you’ll need to have in your back pocket at any given time. Though, I suppose, they’ll always be a new tsunami to worry about. Speaking of that tsunami, the first years students will be starting soon. I’m not an authority on how to best first year, in fact, I struggled like many others did just to get through it. I expected medical school to be hard, and honestly it’s a little gratifying to see that it’s just as hard as quoted. I’ve enjoyed my humble pie. There were classes I did great in, some not so well, and I learned a lot in the process. Hopefully, I’ll be able to use those lessons wisely in the second year and onward.
Our schedule is going to be very different than the first year. Incidentally, we’re the last to have that 1st year schedule at our school as they’re changing the curriculum. The first year was a traditional system, you have a lot of disparate courses at once: have biochemistry, anatomy, neuroscience/anatomy, public health, and the list goes on and on. A lot of schools are moving towards “integration”, i.e. the very opposite of the traditional system where students were tasked with forming their own euphonies on the connections between disparate courses. Hopefully you did, some surely didn’t. Here, second years have more of a systems based approach, i.e. we’ll have a pulmonary block, cardiovascular block, hematology block. The big difference, so I’ve been told, is that we’ll now focus more on the disease and treatment than the science (first year work). For all intents and purposes, one could argue we’re learning more practical things — probably with an immeasurable amount of things I’ll need to unlearn/relearn properly later in our careers.
In case you’re curious about the schedule for our second year medical school here’s a non all inclusive list of modules, our school year ends April 1st of next year giving us time to focus on our board exam (Step 1):
– Pharmacology and Infectious Diseases (affectionately called “Bugs and Drugs”)
– Renal (The Kidneys Strike Back!)
Good luck incoming students, and current applicants! I’m going to get back to work, i.e. eat, go through some patients’ charts, and drink lots of coffee.