Every year, many of my students start a new semester with the aim of changing anything that will make them more successful with their upcoming coursework. If there is one thing that you can change in the very next instant that will make the greatest difference in your performance, it can be that “inner voice” that tells you, “you are not good enough” or “this is a hard subject that I can’t do well in” or “I am not going be able to get all of this work done”.
It seems to be much easier to have an inner voice that is negative rather than positive. Many people are quick to employ the negative rather than the positive because the negative seems to be more believable. Most people are taught that a positive inner voice is the same as “patting your back” for non-achievement but the truth is that a positive inner voice is more about self-confidence than false self-aggrandizement. It is the confidence that one has to master in order to keep moving in a positive direction with any long-term goal. One has to believe that you will reach your goal in a series of small steps toward it on a daily basis.
Since you have total control over your “inner voice”, you can change anything that is negative such as “you are not good enough” to the positive such as “you are as good as anyone else” or make the change from “this is a hard subject that I can’t do well in” to “this may be a challenge but I will have small victories every day and get help the moment I need it”. In short, you can decide in the very next second that you will not listen to the voice that tells you what you “can’t accomplish” and replace that voice with one that tells you “what you have accomplished” and how you will keep accomplishing to meet any challenges head on.
Yes, students will fail exams and quizzes but learning from those failures will help make failing the complete course more remote. If you have never failed at anything in your life, you haven’t actually been tested. People who are untested do not develop the skills to learn from their failures and put them behind so that they can keep moving forward. If you keep spending precious time telling yourself what you “can’t accomplish” because of one set back, then you are likely to fulfill that negative inner voice that seems to be so tempting.
You can control how you react to a grade on a test or quiz. You can look at what you missed and make a careful assessment of what you need to work on so that you don’t keep making the same errors and master the material in a different manner. If you are only focused on the numerical score and not on mastery, you are likely to have difficulty integrating concepts and keeping concepts in your long-term memory (your goal for professional practice).
As I have stated many times on this blog, there has never been a course of study developed by one human being that another human being cannot master. Mastery of your studies does not take any super-human mental feats or membership in high-IQ societies but does take diligent and disciplined study for efficiency. If you use large amounts of time worrying about the rigor or the amount of material that you must master, you lose a great amount of efficiency. In the long run, your learning time for tasks and concepts becomes longer rather than shorter.
For example, as a junior surgical resident, I had to master many surgical procedures. If I had made a list of all of the procedures and cases that needed to be mastered, I would have been overwhelmed at the first case. Instead, I took each case as it came and worked on the fine points after I had mastered the major points. In short, by “divide and conquer”, I was able to master my procedures. I didn’t have the luxury to “think” about non-mastery as I ticked off things as they came under my review.
In residency, there is no person or class that pushes one to undertake daily reading and study. As the hours grow longer, it becomes easy to get behind unless one is vigilant. I set a goal of a minimum of 30 minutes of journal reading and 30 minutes of textbook reading per night with 2 hours on each Saturday/Sunday. I told myself, that I could get my goal accomplished and would get my reading goal accomplished. Like brushing my teeth, I quickly embraced my reading “habit” which meant that I was never behind when review for our yearly in-training exams came around. On same days, I did more because the habit made the task easier and more efficient.
During my residency research years, my reading schedule time tripled during the weekdays and was cut in half on the weekends because my time schedules changed drastically. When I went back to clinical work, it was difficult to stop reading and study because the habit had become so ingrained. I was amazed at the exponential learning that my solid reading schedule had afforded me during those research years. My reading and study efficiency had increased exponentially during this time which was the same exponential reading and study efficiency increase that I had experienced when I started medical school. In short, anything that becomes a habit becomes more ingrained/grooved and more efficient.
One can work on increasing confidence and from that one step, increase efficiency in almost any area of life that needs improvement. This improvement is invariably the result of one good habit leading to improvement in other aspects of one’s life. Just as when one starts a daily work-out program (can start with as little as 10 minutes per day), as the habit grows and becomes honed, other aspects of one’s life such as eating healthy and sleeping better start to improve.
What works for physical fitness can also work for mental fitness too. It always follows that people who are generally physically fit will experience less stress and more efficiency in their mental tasks. There have been plenty of scientific studies that show overall improvement in mood and health with increased physical conditioning. If you add mental conditioning in the form of adherence to a daily positive mantra, you are likely to see improvement in all aspects of your life too.You can start with one small change and keep reinforcing that small positive change on a regular basis. It only takes a change in the very next instant to embrace the positive and confidence that you can keep going which will keep you on the right track.
In 2015, the Medical College Admissions Test (MCAT) will undergo changes to reflect current needs and changes in medical education. While this exam in its current form has been in place since 1991, the new changes that are in the pipeline for 2015 will likely stay in place for 15 years or more. This means anyone who is beginning their undergraduate career (starting college) or who is targeting their application year for 2016 (Medical School Class of 2020) should be making sure that their coursework is reflective of the 2015 MCAT rather than the current exam.
In terms of preparation, what has not changed is the need for a medical school applicant to be well-prepared for a rigorous medical curriculum. This means that a high ability to rote memorize is not going to be of much value in preparing for medical school. Rote memorization of facts without regard to application of those facts is not going to prepare you well for either the current or future MCAT
If you are currently enrolled in courses that do not provide the critical thinking, problem-solving and scientific literacy that you will need as a modern 21st century physician, you will need to make some drastic changes in your college coursework to get the preparation that you need. These changes might involve taking additional coursework that will challenge your ability to critically analyze and read resource from a variety of disciplines (philosophy, social sciences, literature, and history). In short, just majoring in biology and staying away from the humanities is going to be detrimental to your preparation for the MCAT.
Currently, you still need to take and master the premedical science courses (General Biology, General Chemistry, General Physics and College Math/Statistics) but additionally you will need to be well-versed in analytical skills. Medical school is the application of scientific principles to patient problem-solving. If you do not prepare yourself for critical reading of the scientific literature and the practice of evidence-based medicine, you are not going to be able to have much of a medical practice in today’s world.
There is currently so much information at the fingertips of today’s physician, that one must make a concentrated effort to analyze and incorporate the best knowledge for patient care. If you are not able to do this and do not have a strong foundation in critical reading and analysis, you will be left behind very quickly.
Medical schools today rely less on rote memorization of PowerPoint lectures and more on challenging the student to integrate and build a solid knowledge base for application in patient care. This knowledge base is not obtained by memorizing a review book but by solid reading and integration of scientific concepts coupled with the incorporation of new research (clinical and basic science). The foundation for this integration and incorporation comes from an excellent undergraduate preparation for medical school which will be more tested on the 2015 MCAT.
As an undergraduate student, you will need to demand that your premedical coursework be of sufficient rigor to prepare you for medical school and future medical practice. By the time you are sitting in your pre-clinical coursework, you have to already have the foundations to understand medical literature. Medical school courses today and in the future will rely on you coming in with more academic/scholarship skills rather than attempting to teach you these skills. With the vast amount of knowledge that has to be assimilated and integrated with clinical skills coupled with less time in the classroom, you as an prospective medical student will spend more time preparing yourself for practice (life-long learning) than expecting a course to do the preparation for you.
The premedical coursework in many colleges and universities lacks the rigor that will be required for success in medical school or on the current (or 2015) MCAT. Too many courses place emphasis on rote memorization of facts rather than building a broad knowledge base and application of that knowledge base. Today’s physician needs to be able to understand how scientific principles are obtained (research) and applied along with scientific reasoning and critical thinking at every juncture of practice. Modern physicians do not just follow checkboxes or memorize an algorithm but have to be able to synthesize information across various technologies, disciplines and practices.
The changes in the pipeline are very exciting for those of us who are involved in medical education. We have looked at everything in our various curricula and have examined how materials are presented to our students. With this examination of curricula has come an intense examination of how students are prepared for medical education and how students are not prepared for the changes that modern medical practice will demand.
The most alarming trends have come in looking at how undergraduate coursework in some areas has lost rigor and the observation of how many undergraduates do not know how to propose research and query scientific databases. Pre-medical and medical students today have to be well-versed in the use of scientific and medical informatics as research in this country is relentless.
In addition to being able to utilize scientific and medical informatics, today’s physician needs to be able to evaluate new medical education and research for incorporation in to practice on a daily basis. There are many information systems at the fingertips of today’s physician but that physician needs to be able to understand the strengths and weaknesses of information systems and databases in order to make the best use of their data.
Medical education is far more uniform than divergent in today’s world which means that emphasis on strong scholarship, personal challenge and self-reflection in terms your preparation for medical school. Additionally, you have to be sure that your premedical coursework is worth every penny of tuition money that you have paid for it. This means that you have to challenge yourself at every class, every course, every semester and exam, to make sure that you have thoroughly mastered what you need in preparation for the rigors of medical school. These needs can be met and honed by a very broad but very rigorous education at the undergraduate level as anything less is not going to work on the 2015 MCAT.
It’s the middle of summer for most undergraduates, a time when most are on – or contemplating a much-needed vacation. While you are on vacation, this might be a good time to look at your past performance and tweak anything that didn’t allow you to do your best work academically. First, if you achieved all that you wanted to achieve academically, then congratulate yourself and keep up the good work. If you had some difficulties, it’s time to access what went wrong and do some preventive maintenance.
For most people, keeping up a long-term relationship with academics, especially the sciences, is a very difficult task. This means that while your colleagues who are studying business, social sciences and education are out partying during the week, you are going to be completing labs, preparing reports and keeping your knowledge base up to date. For most people, studying physical science is a daily challenge that needs daily mastery for the best long-term results. The emphasis here is on “daily” which means that if you had the idea that you were going to utilize the “last-minute” cram method of study, you likely fell far short of your expectations in your coursework. Make no mistake, the same study habits that bring the best results for mastery of basic science will bring the best results for mastery of medicine. Taking a long and objective look at what didn’t work for you in terms of daily disciplined study is a very sound strategy for getting ready to head into the next year of undergraduate work.
If you are expecting that your undergraduate coursework should be entertaining, then change your thinking here too. Higher education is not for entertainment but for intellectual development. While one needs entertainment and relaxation, don’t look for these things in your coursework. To be able to attend college in this time is a privilege which is becoming rare for many people who would have been able to afford college even ten years ago. Tuition is very expensive which means that one needs to get every dollar’s worth of learning out of each class. Rather than thinking of your coursework as drudgery or entertainment for that matter, think of your coursework as a valuable experience that can’t be repeated or duplicated. In short, you have one shot not to ruin your academics for any reason especially if medicine – medical school is your goal. Repeats and restarts in coursework are as costly as failures in this process which means that you need to get your mind ready to do everything in your power to master your upcoming courses.
Many students can’t take their eyes off of the “getting into medical school” mentality. In my day, we called this “pre-med” syndrome and it was a much a waste of time and energy then as it is today. If you get YOUR work mastered, it doesn’t matter what others in any class are doing or not doing. You can’t afford to get into the “someone ruined the curve” or “I was sick and couldn’t do my work” or any of the countless excuses that seem to abound when the grades do not come in as one would expect. You also need to stop trying to blame the professor for your poor performance as the professor is the most redundant element of any course. One needs to go into any class with the attitude that you will master the material regardless of classmates, professor or what you have “heard” from previous students. The material to be mastered is and always be the same material and will require diligent, disciplined and daily study. This is a good time to start planning how you will do this for the upcoming year.
The entitlement ego needs to go along with the valiant search for short cuts. I have seen too many students whose parents have filled their heads with how “bright” and “intelligent” they are so there must be something wrong with the school or the course when they bring home “Bs” and “Cs”. It doesn’t matter that their “bright” son or daughter didn’t keep up or didn’t master the coursework because they are “bright” and should be rewarded with a grade that reflects that “brightness”. In academia, you will receive the grade that you earn based on your mastery of your educational materials and not based on how “bright” you or your parents believe that you are. In short, the coursework (and your professor) doesn’t care about your “brightness” or your sense of entitlement. If you had all of those wonderful educational advantages that you parents spent loads of money to provide for you, use those advantages and do your best work without a sense of entitlement.
The “ego” like the entitlement needs to go by the wayside in the sense that you can be confident that you can do the work but bragging about your greatness isn’t confidence – it’s the opposite. Since I teach biochemistry on occasion, I can’t count the number of students who have visited my office to tell me how smart they are and how much they work and what grade they must have but have not demonstrated either their “smartness” or “work ethic” by a strong performance on an exam. They are very quick to point out how they were able to “ace” so and so’s course that they took previously but they aren’t making the cut in my course. To do well in my course is very simple, you have to study daily and systematically. Biochemistry is based on understanding and mastery versus rote regurgitation of what is said in lecture. If you are not mastering the concepts and putting them to use, biochemistry is not going to be an easy or pleasant course for you.
Getting to know yourself from an objective standpoint is a very useful exercise for the summer vacation. In her latest book, 89-year-old Betty White makes the case for being able to look into the mirror at yourself daily and for liking what you see. One has to come to terms with who is in that mirror and one has to like that person on a daily basis in spite of your faults and mistakes. One has to see that you are no better or worse than the next person that you will encounter because you are a human. Getting to know and like yourself is a very long process but well worth the effort if you are to have success in the most important aspects of getting your career underway. It’s not easy to admit that you slacked on some of your studies in the past but it’s worthwhile to acknowledge and to move past. If you can’t tell yourself the truth, then how are you going to be able to recognize what you need to progress past for personal growth.
Professional growth requires constant adjustment in personal growth. Continuing to do the same thing and expecting different results is an exercise in non-growth that few people can afford as any person can decide at the very next second that you will do anything differently. Professional growth will require constant examination of what works and what does not work. Utilizing this summer and your vacation is a great time to assess where you are and where you want to make improvements.
I was speaking with a group of undergraduate pre-med students who asked me when I thought someone should “give up” on seeking admission into medical school. My first inclination was to say that if medical school and medicine is your “dream” you should never “give up”. I thought a bit about what might be behind the question and I thought it might make a good essay topic for my blogs.
I have never been a person who dealt in “shoulds” in terms of what might be the best situation for anyone’s life and life pursuit. If you want something and if really desire something, then pursue that “something” and make sure that you are in the best possible situation to achieve your goal. Any realistic (and the emphasis here is on realistic) goal is achievable in taking small steps daily toward it. Certainly, you cannot possibly reach anything if you are not moving “toward” it.
The pursuit of admission to medical school and medicine is a bit like having more than 100 pounds to lose. You have to be consistent with your work on a daily basis or you are not going to see results. This means that everything “counts” and you can’t afford to “slack” or you won’t reach your goals. You can’t “let up” or you will find yourself behind quickly. Your undergraduate work is an opportunity to set yourself up with solid and disciplined study skills that can take you into medical school and beyond. It is also an opportunity to learn how to learn and master coursework. Just as daily exercise and diet modification will lead you closer to losing that 100 pounds (ounces at a time), daily preparation/study and mastery of your coursework will lead you closer to your goal (one semester at a time). As you have probably heard, this is not a “sprint” but a “marathon” and like a marathon, you can’t just lace up your running shoes and expect to finish a 26.2 – mile race without some daily training and preparation. If you are not comfortable with long-term goal achievement, then use your undergraduate to obtain the characteristics that will make you comfortable with long-term goal achievement.
There are plenty of physicians out there who didn’t start off strong as an undergraduate. Perhaps they had some maturity problems or perhaps they just didn’t have the academic skills for the pre-med coursework but the important thing is that they kept their goals in mind. If something is not working for you in terms of getting your coursework mastered, then change it. You can decide at this very minute -even if you are on the verge of dismissal- that you are going to turn your academics around “by any means necessary”. The process of doing this “turn-around” can be a huge asset in terms of making you competitive for medical school but you have to be successful. Just thinking about getting your academics together (like dreaming about losing 100 pounds) won’t make it happen but taking some active steps toward changing your methods will get results.
Many students have gone from extremely low undergraduate performances to getting themselves competitive but the process is not easy or short. Again, it’s back to the daily and consistent work with constant checkpoints to make sure that you are keeping on track. Enlist the assistance of any study skills courses at your school; enlist the help of peer tutors; enlist the help of a good academic adviser. In short, get help from any resources that you can find. Often, your school’s counseling service can help you identify resources at your school that can help you. You have to take the first steps and be willing to make some changes and stay with the changes that you have made. You also have to be willing to let go of your “ego” if it is keeping you from achieving your goals. Either your study (and mastery methods) work for you or they don’t. Everything in medicine is about new experiences and incorporation of those new experiences into your knowledge base. You can begin this process as an undergraduate and make this process as familiar as a comfortable pair of shoes. Just remember, undergraduate “GPA damage control” is a long and expensive process. If you know this going in, then you can prepare yourself for the long haul. Again, medicine is not a sprint, it’s a long-term goal. If you find yourself in need of “damage control” take action immediately and not when you find yourself in a situation that is too deep to “dig out of”.
There are some things that are very, very difficult to overcome. I place things like academic dishonesty, felony convictions and substance abuse problems. Most medical schools, even if you are sitting there with a uGPA of 4.0 and an MCAT of 45, are not going to be very interested in you with these things in your background. If you have a substance abuse problem, get it taken care of long before you anticipate entry into medical school. There are excellent substance abuse programs out there and you can’t hide from your problems forever. Medical school on any pharmaceutical substance (other than pharmaceuticals prescribed by a physician within the guidelines of established medical practice) is expensive and heading for a crash either physically or legally. Neither of these are things that a prospective medical school would like to deal with. In short, take care of what you need to take care of and educate yourself so that you can handle life without drugs of any kind. If you “think” you have a problem with tobacco, alcohol, uppers, downers and any other illicit substances, then you have a “problem”. Get your “problems” solved as soon as they are identified.
Living in the “Real “World
You are going to read (and hear) stories out there about John or Jane X who got into Medical School A or B with a GPA of 2.5 and an MCAT or 20. Those John and Jane X’s are very, very unlikely to be real people. The average uGPA for medical school matriculants in 2007 was around 3.65 and the average MCAT was around 31. This means that the further from those average on the low side that you are, the lower your chances of admission. Admission to medical school with a uGPA of 2.5 is not impossible but it is improbable since the uGPA averages have been increasing every year. Get your uGPA as high as you can period. Get the highest MCAT score that you can period.
There are also folks out there who would believe that if you are an URM (Underrepresented Minority) in medicine, that you can get into medical school with drastically lower GPAs/MCAT. This is simply not the case because you have to have something in your application that shows you are capable of mastery of a challenging medical curriculum. If you are a URM and far below the uGPA/MCAT averages, then you likely don’t have a competitive application. Do what you have to do, to make yourself competitive and be prepared to take some years to get this done. I don’t care what your ethnicity/race is, you still have to be able to get through medical school if admitted. Admission is no guarantee that you will complete medical school. If you uGPA/MCAT is low, get yourself competitive by whatever means you have at your disposal.
But when do I “give up”?
You must answer this question for yourself. Preparation, application and matriculation in medical school is a very expensive process. How much time and money do you have? If you are a re-applicant, what you have you done to significantly improve your chances of admission? Just reapplying to medical school to “show them that you really, really want this” is not enough. You have to make some improvements on your application before you spend that money to reapply. Again, take a realistic look at what might have kept you out and get it improved.
If your application didn’t work this year, rework everything that you can rework before you submit for a future year. If you are reapplying to the same schools, you especially need to change and improve everything about your application that can be changed. Get fresh letters of recommendation, rewrite your personal statement (I don’t care how wonderful you believe it is, it didn’t work) and take more coursework if your uGPA is very low. Retake the MCAT if that is holding you back. (Beware though, retaking the MCAT and scoring lower can be a death blow). What ever you do, be sure to make it an improvement and not a change for the worse.
Looking at other career options
Some people believe that if they explore other career options such as physician assistant, nursing or physical therapy, that they are somehow giving up their dream. Nothing could be further from the truth. Explore other careers and have a realistic appraisal of how competitive you are for those careers. You may find that one of those careers better suits you in the first place from the standpoint of time of schooling to what your actual interests/motivation for medicine might be.
I am not advocating for anyone to seek to be a physician assistant, nurse or physical therapist because they “couldn’t get into medical school” but I am advocating that you should have a career back-up that you can love and pursue. You may not be competitive for physician assistant, nursing or physical therapist or you may not be interested in these great careers but you can’t make an honest decision without career exploration first. You may find again, that these careers are a great option for you and a better option than medicine.
Finally, be willing to let any of your advisers take a long and hard look at your competitiveness for medical school. If you don’t get in, get input from any and every excellent resource that you can find. Your goal is success on reapplication and you want to do everything that is within your grasp to ensure your success. Only you can tell when it’s time to move on to another career option and it’s YOUR life to live as you wish. Enlist any and all help that you can to get what you both need and want out of life.
The pursuit of becoming an excellent physician is a long goal. There will be people along the way who will tell you what you “can” and “cannot” accomplish. If you know yourself, and have faith in yourself, you know that you can accomplish anything that you want. You have to be willing to “run your own race” and take care of your own “needs”. There are as many routes into medical school as their are medical students.
If you should decide that you don’t want to pursue medicine, then that’s the best decision for you. Don’t let your life’s dream be anyone’s other than your own. It takes a fair about of courage to stand back, take a realistic appraisal of where you are and make the decision to move on to something else.
The other thing to consider is that getting into medical school does not have an age limit. Just because you decide not to continue with the pursuit next year does not mean that you can’t do something else and revisit medical school application three, four or even ten years down the line. As long as you have the desire, the stamina and are willing to earn competitive credentials, then give yourself a couple of years to decompress before you dive back into this process. If something doesn’t “click” for you in 2006, it might “click” in 2009 because you are a different person with a different perspective.
For many people in both medical school, graduate school and undergraduate school, this is the beginning of the second semester (or quarter). If you are new to your academics, then you finished the first semester/fall quarter with some academic achievements (good or bad) and learned some things about yourself. Since this blog is about strategies for success in medicine (getting into medical school, staying in medical school and other things associated with medical school), I though I would post a note or two about making changes that can enhance your Academic excellence.
Doing well in academics is something that can be mastered with practice. It comes out of having a strong and solid approach to what you have to master in terms of knowledge and it comes out of having a high comfort level with the learning process. If you always feel that you are somehow “not going to be able to get everything learned” or that ” the course is too hard”, then your beliefs can become a self-fulfilling prophecy. There is no task, no matter how great or how formidable, that cannot be approached by taking small steps every day until it is conquered. You have to be willing to “chip away” on a daily basis and note your progress on a daily basis in order to see that you are handling the larger task in smaller steps.
Let’s take Organic Chemistry for as an example. At the beginning of the year, your professor hands you a syllabus that outlines the lecture schedule, laboratory schedule and exam dates in addition to what is expected in terms of how you will be graded in the course. Usually your grade is the result of your grades on some combination of exams and projects. Armed with this information, the first thing that you need to do is make a master subject calendar of lecture topics and test dates. Also include things like “one week to Exam 1 ” and “2 weeks to Exam 1″ along with “3, 2 and 1 week to project due” so that when you look at your calendar daily, you know exactly how much time you have to master the knowledge for the material on your exams/projects.
The next thing to do is look at your reading and problem assignments each week for your lectures/topics. Some topics have many problems and some don’t have so many problems. Divide and conquer here by looking at the amount of time alloted for each topic. This should give you a good idea of the importance of each topic. Your textbook is a good resource in terms of looking at how much time and space it devotes to a particular topic. For example, look at functional groups of organic compounds. This is a topic that can be divided into families with the simpler families being presented first and the more complicated families being presented later. You can use your text to add upon your knowledge base.
The other thing that you want to do is be sure that you are prepared for each lecture. Don’t go to class with the idea that you can sit there, listen to the lecture and learn what you need for mastery. You need to know something about the topic before you hear the lecture. The best way to do this is to read about the topic before you hear the lecture so that you know something about the items that will be presented. Don’t every walk into a lecture “cold” as 50% of your actual studying can be done in your preparation for you upcoming lecture. The other 50% comes in your digestion of both the reading and lecture in addition to any problems that were assigned.
A point about problems and problem solving. With any problem that you are given, try to figure out what learning concept is behind the problem. For example, look at the wording of a problem and then review the concept that applies to that wording. Consider the problem, in diabetic ketoacidosis, glycerol is primarily used for what? To answer this problem, you need to know something about the biochemical derangements that take place in diabetic ketoacidosis. In diabetic ketoacidosis, the patient is acidotic which implies that ketone bodies have been released and have lowered the pH of a patient’s blood. What else do you need to remember? You need to remember that while the blood sugar is high, the patient does not have adequate insulin which allows glucose to enter the cells and undergo glycolysis and be used for fuel. That leads you to thinking about why the ketone bodies are out in the blood stream in such high quantities in order to cause acidosis. This because the brain primarily, needs to have a constant fuel supply and in the face of a huge amount of glucose in the blood, none of it can be used by the brain because there is no insulin to allow the brain cells to take up the glucose. Now what do you need to know about diabetic ketoacidosis in addition to the above and that is that fat is being catabolized into acetyl Co-A that is being used to make the ketone bodies and that the fat comes from the breakdown of stored triglycerides into fatty acids and glycerol. The fatty acids can undergo beta oxidation to acetyl Co-A and then shunted into ketone bodies but the glycerol goes to the liver as a substrate for gluconeogenesis or the making of glucose. In the face of large amounts of glucose in the blood, the diabetic can’t use that glucose to feed their brain and thus they are making more glucose in addition to ketone bodies which are acidic. This is the concept behind this problem and why you need to approach problems like this or questions like this from many different angles rather than just memorize the answer. You have to be able to master the concepts so that in any manner you are questioned, you can figure out the correct answer not attempt to rely on you memory.
The next thing that you must think about is that you have all of the tools that you need to master your coursework under the conditions that work best for you. Don’t compare yourself to anyone in your class. Some people are visual learners (tend to sit in the front of the class) and some folks are aural learners (tend to sit in the back to avoid aural distractions). Most folks use a combination of both visual and aural and thus learn best when they utilize both methods. If you are a visual learner, then make a brief outline of the material to be covered in lecture and take a note here and there. Don’t try to write down every word that the professor says but watch how the material is presented and fill in your notes later. If you are an aural learner, listen to the lecture and take a note here and there. Listen for inflections in the professor’s voice. Listen for key phrases such as “in summary” or lists of important topics. If you worry that you will miss something, take a small digital recorder with you and record the lecture. You can then upload it to your lap top and it’s there if you need to review concepts.
In short, if you have managed to get through first semester, you have every tool that you need to excel second semester. You may need to adjust some of your study habits or you may need to fine tune others. The important thing is not to dwell on what anyone else in your class does but to do what you need to get the results that you want. There is no class invented that could not be mastered because after all, someone had to come up with the facts and concepts for the professor to present. Don’t go into any of your courses with preconceived notions that the course is too “touch” or is a “weed-out” course. The coursework is there for you to master and you have to figure out how you will master it.
Another common mistake that many students make is relying on their perceptions of the professor’s like or dislike of them personally. No one who is lecturing actually cares about you as a person. They don’t have a personal relationship with you, and if they do, it doesn’t matter in terms of the presentation of the material to be mastered. The material is there and it doesn’t care about you or the professor or whether or not you “like” or ”dislike” the subject matter. If you spend the dollars in tuition, then that alone should be enough for you to have a vested interest in mastery of the material that is presented. In short, you need to get your tuition dollar’s worth out of this class for whatever reason. Whether you ”like” or “don’t like” the way the professor talks, looks, or anything else has no relationship to how you deal with the material that is presented. The professor is not your main source of knowledge but someone to help you navigate (by their experience) though mastery of this class.
Finally, you can decide in this very instant, that you will change your “thinking” in terms of how you approach your coursework. You can approach your coursework from a point of fear and trepidation or you can approach your coursework from the standpoint of “hit me with your best shot because I can hit it back and score”. You can decide to toss old habits of trying to “cram” at the last minute and replace them with solid organization and daily study. You can decide that you will either adapt a lifestyle and study style that will allow you to become an excellent scholar or you will continue to do what you have been doing that doesn’t get the academic achievement that you want. The key point is that you are the complete master of your thoughts, actions and reactions.
On the first day of your class, you will be issued a syllabus that outlines the professor’s grading policy, what will be expected of your in the class and a lecture/test schedule. Once you have that document in your hands, you can begin to set up your schedule for the rest of the semester. Ideally, you may want to purchase a very large desk blotter but the calender in MS Outlook (or something like it) will do just fine. On that calender, you want to place the date and time of every lecture, the topic, and the required reading. You also want to place the dates of your exams and note the dates of 3 weeks to exam, 2 weeks to exam and 1 week to exam. Any papers that are required should be treated like exams with 3 weeks to paper due, 2 weeks to paper due, 1 week to paper due.
If you are taking a lab course, you need to add the dates and times of your various lab sessions to your calender along with the topics of each lab. If you list your labs by subject matter of each experiment, you can relate these to your lecture material for better integration of the course subject matter. If your course has a recitation section, be sure to list this too as you do not want to skip any recitation sections. These sections can be invaluable when it comes to test preparation time.
Once you have set your master schedule for the semester, fill in your schedule for the week. This means filling in how much time it takes for you to get to school, the times of your classes and labs, your study time – remember one hour of study for each hour of lecture and 45 minutes of study for each hour of lab-your meal times, your work out times and your bedtime. If you are using a computer-based program for your daily schedule, print out your next day’s schedule when you are studying the night before. Look at it and be sure that you have organized and prepared for the classes that are on this schedule.
Class preparation means look at the subject matter of the upcoming lecture. Review the assigned readings – pay close attention to any bold words, headings and topics-review the syllabus and do any assigned problems. If you have difficulty with any of the problems, put notes or checks where you had difficulty so that you can walk into your professor’s office during office hours and get your questions answered. Don’t wait until after the lecture to work pre-assigned problems. Most of the time, anything that you had difficulty with, can be answered in class. If you wait until after class, you will be behind. Attempt assigned problems before your lecture.
Listen to your lecture and take notes only on the things that you know are not in the syllabus or text book. (See my previous study skills posts for how I would cut my textbooks). Take notes on things that help you to understand the important points of the lecture or clarify concepts that you previously did not understand. As I have outlined in other study skills posts, I would take notes on the left side of my notebook only using the right 2/3rds of the page. The left 1/3 of the page would be left blank so that I could write in summaries of the notes or definitions of terms that were important. On the right pages of my notebook, I would recopy notes that were taken in a hurry so that they were legible. I would also place notes and information from my text book.
Most of the time, I took lecture notes on my laptop computer or on looseleaf notebook paper. I discovered the utility of using notebooks that were designed for law students (summary paper) and then resorted to making my own version of these summary pages. I would print out my notes and clip them into a looseleaf notebook so that I could highlight them or make notes to myself as I studied. I would review the previous lecture, study the current lecture and preview the upcoming lecture doing the text readings.
As I stated under Organic Chemistry, I never walked into any lab unprepared. My lab prep consisted of knowing the purpose of the experiment; how long each step would take; what data needed to be obtained and what conclusions/observations I would be expected to make. I kept a sticky note in my lab manual or notebook with the steps of the experiment briefly outlined so that I could refer to my note. This make any lab write-ups pretty easy to finish. If there were pre-lab exercises, these were done before I attended lab. I would also consult my textbook if the material covered in lab didn’t correspond with the lecture (most of the time the lab material was a bit ahead of the lecture).
For courses like English and Math, I made sure that I had a solid reading schedule that kept me ahead of the class. Again, I would have problems worked before coming to class. In English, I would make sure that I had thoroughly covered the readings taking notes as to tone, argument and subject matter as I moved along. Again, sticky notes were good for making extra notes in my reading books. I could past them in and add them to my professor’s notes after the lecture.
Soon after each lecture, I would quickly review the lectured material filling in any words that I had left out or drawing arrows to link materials. I would make any quick notes of things that needed to be clarified during office hours. In terms of Math and English, I would have circles around any problems that I had attempted but was not able to complete before class so that I could get my questions/problems taken care of. If these were not taken care of in the lecture, they would be taken care of during office hours.
My professors got to know me pretty well because I would attend office hours even if I was sure that I had mastered the material. It doesn’t hurt to have a “tune-up” and a “knowledge-check” even if you are sure that you are understanding everything. Sometimes these “tune-up” sessions would give me valuable insight as to what to emphasize for the exams and what to place less emphasis on. I figured that if I was paying thousands in tuition for each course, I was going to get every bit of instruction out of the course that was available. It also gave the professor a chance to get to know me which was good when I requested a letter of recommendation for graduate/medical school. I always received high praise for my business-like attitude and organization of my coursework.
Spending so much time preparing and previewing for each class made studying and review for each exam practically effortless. By the time the exam rolled around, I had been over each lecture a minimum of three times. I reviewed the previous weeks lectures on the weekend. By staying ahead of the professor and the class, I always had plenty of time to integrate the materials for every class. My attitude toward university coursework (honed by loads of experience in secondary school) was that my “job” was to master this material. I needed to thoroughly master my coursework because it was background for my graduate studies and I wanted the best undergraduate education that my university offered.
Don’t get the idea that I spent every waking hour in front of a book. I used my university time to attend lectures and seminars on any subject matter that was of interest to me. I went to lectures on the Holocaust, aerospace engineering, mathematical theories, social theories, political science in addition to departmental seminars in biology, chemistry and physics. I obtained a departmental seminar listing during the first week of class and added these to my schedule. Even if you do not completely understand everything in a seminar, you can pick up valuable experience and broaden your knowledge base for free. These seminars are also a great opportunity to get to meet the faculty and learn their research interests.
As a medical student, I tried to attend grand rounds in Surgery, Medicine and Pathology as much as my schedule would permit. These grand rounds became invaluable for USMLE (all steps) as the speakers always presented both the basic and clinical science of their discipline. It was my interest in every aspect of medicine that lead me into academics and today, continues to allow me to keep up with basic science as well as clinical science.
As a student of science and medicine, you have to be quite proactive and a bit of a self-learner when it comes to the mastery of your craft. If you take the time to start keeping up with the literature and attending seminars/grand rounds while you are an undergraduate, you can carry those skills into graduate/medical school. You cannot afford to be a passive learner relying on the professor’s lectures for your entire education. I totally attribute my performance on the Medical College Admissions Test (MCAT), United States Medical Licensing Exam (USMLE) and my specialty board/in-training exams to my attendance at all of those seminars and grand rounds. By listening to the “cutting-edge” leaders in various subjects, you learn to analyze information and you learn to present information logically. These skills are free and the seminars are often free and easy to take advantage of.
Finally, approach your studies as you job. If you are working and attending class, you need to be organized but you need to do both well. I always recommend that students who work, need to take less hours. It is not useful to load up on semester hours only to do poorly or mediocre in the coursework. Take less hours in the first place, do well, and if you find that you have free time, use that time to attend seminars/grand rounds. If you are a full-time student with no employment, use some of your free time for seminars and experiences that widen your educational experience. You only get once chance at your university experience and you need to be sure that you are getting the most out of every class for you money. Make your studies of prime importance and be proactive about getting your needs met.
As many folks are heading for summer school, medical school or just taking a much-needed break, I thought it would be a good time for me to review some study skills that helped me excel in undergraduate, graduate and medical school. I am planning to present my “Study Skills” in more than one part and as an ongoing series. One of the first things that needs to be done is an assessment of the skills that every student needs in today’s world. Along those lines are :
- Excellent reading and reading comprehension skills
- Computer skills
- Excellent writing skills
- Good math skills
The above components are the essence of doing well in your coursework and laying a strong foundation that will enable you to do well on the Medical College Admissions Test (MCAT). If you find that you are weak in one of these areas, use the summer to work on your weakness and convert it into a strength. All of the above skills can be mastered with practice.
Reading and Reading Comprehension
One of the best ways to increase your reading skills is to just read. Start with materials that you enjoy and move into your course materials. If you have the time, read some short fiction authors like Hemingway, Baldwin and Oates. As you are reading their stories, note carefully how their works are organized, how they set the tone of the work and how they use language to convey their thoughts to you, the reader.
Other short materials that you can look into are the editorials in your newspaper. These editorials are generally about the length of the writing sample that you will create on the MCAT. They usually follow the outline of Introduction and thesis, evidence, evidence and conclusion. Look at the paragraph structure; underline the thesis statement and circle their evidence. Are their conclusions logical? Did they have a strong argument? Did they include a counter-argument? If you do not subscribe to a local newspaper, most large-city newspapers now publish on-line. Some of the best writing and editorials can be found in The Washington Post, The New York Times and The Richmond Times-Dispatch.
Another benefit of becoming a good reader is that good readers are almost inevitably good writers. As you read and become adept at critical analysis of your readings, you will likely become more skilled as a writer. Try reading an editorial and writing your version of a counter-argument to the editorial. It doesn’t matter if you agree or disagree with the editorial, just learn how to formulate a counter-argument. This task will also helps with getting used to using good grammar, sentence construction and word usage. By taking some time during the summer months (or a hour on the weekend) and practicing your reading and writing skills, you can greatly help yourself when it comes to writing your personal statement for you medical school education.
Another useful reading comprehension skill is learning to read and utilize your textbooks. Many courses such as General Biology, General Chemistry, Organic Chemistry and General Physics have excellent texts that are good adjuncts to your class lectures if you utilize them properly. At the beginning of every semester, you should be handed a course syllabus that contains your assigned readings, a lecture schedule and how you will be evaluated. Making sure that all assigned text readings are done BEFORE lecture can greatly increase your understanding of concepts.
The first task in evaluating a text book is to look at the overall organization of the book. Who is the author(s)? Where are they located? There is usually an “About the author” essay at the beginning (or end) of the book. Look at the table of contents and see how the material will be presented. Finally, look at each chapter and see if there are chapter summaries, key word summaries, concept summaries, questions and problems. Is there a glossary? Look at any appendices (often problem answers can be found here). Compare the table of contents with your course syllabus. This usually gives an excellent indication of how closely your professor will follow the assigned text. Finally, if there is a “study guide” for your textbook, purchase it. Study guides can help keep your mastery of the material on track. Also be aware that many textbooks have on-line study materials and extras. Be sure to take advantage of these materials whether they are assigned or not.
In 2007, no college student can afford to say, “I don’t know anything about computers!” because the computer is as necessary to your college career as pen and notebook. If your computer skills are rusty, rudimentary or weak, go to your schools computer lab and take any free courses or just ask one of the assistants to get you started. Learn to use word processing software and presentation software. Add the use of data entry software after you have mastered word processing and presentation. Most colleges have courses and companies like Microsoft have free on-line tutorials.
If you don’t own a personal computer, head for the public library or your school’s computer lab. Purchase a portable “thumb” or “jump” drive to keep your documents handy. These drives can be purchased for less than $10 (512 MB) and can be worn around your neck or attached to your school ID card. You can use your jump drive to work on documents at home and at school. Just be sure to save your work on both drives.
Excellent Writing Skills
You should be sure that you have taken both English Composition and a literature course. You need to be very facile with both composition and critical reading. I have outlined some practice skills but your English coursework has to be in place in addition to practice. If your college English department offers a Critical Reading course, take it and do well. Often History and Philosophy Departments will have excellent critical thinking courses. These courses generally have research and writing assignments which should be taken into consideration as you are preparing your course schedules. Beware of taking a semester of heavy lab sciences coupled with heavy writing coursework.
Excellent Math Skills
If you didn’t study math in secondary school, most colleges will have remedial math courses for entering students. Take these courses and master mathematics. If you test beyond the remedial courses, the start with the math course that you testing indicates. Be sure to master mathematics as it is your main tool for mastery of General Chemistry and General Physics. Don’t “talk” yourself out of doing well in these courses by saying, “I am no good at math” because pre-medical studies will not allow you the luxury of being “no good” at anything. Just as I have to master the skills necessary to do surgery, you have to master the skills necessary to learn math and use it as a tool. Just because you are not working calculus problems in medical school, does not mean that you can afford not to learn calculus. It’s a great discipline and tool that enables you to master General Physics.
This is the end of the first edition of Study Skills. No matter where you are in your college or medical school career, you can utilize some of the things that I have outlined. You can decide today, that you are going to acquire the skills that you need to excel in your coursework.