As we move further into the 21st century, the presence of  mid-level practitioners will become more and more prevalent in medical centers and in general health-care. Long gone are the days of one’s total health care being managed by a physician only in the ranks of primary care. For some patients (and practitioners), the presence of a mid-level practitioner is both confusing and unwelcome. Physician assistants make up a portion of the mid-level practitioners that will be found in many modern health care centers (along with nurse practitioners) but patients will often be unaware of their training and purpose in adding(extending) what a physician can do for them.  Many of my physician colleagues will feel that physician assistants will somehow encroach on their areas of practice which is far from the truth. In essence, my physician assistants extend and reinforce what I am able to do in medicine. They function as my eyes, ears and hands in places that I physically cannot be present and  my PA colleagues provide a very high level of care for my patients. In my practice it isn’t you see the physician or the physician assistant but in most cases, you will be seen by both.

Myth No. 1 -Most people who become physician assistants couldn’t get into medical school so they are physician “wannabes”.

In 2012, the entry-level for most physician assistant programs is at the level of master’s degree.  Not only is a minimum 3.0 GPA required to apply to these programs, the competition to enter these programs is much stricter and more stringent than ever. Most of the folks who applied the Physician Assistant (PA) program at my university had over a 3.5 GPA and most who were accepted into the program had over a 3.7 GPA. This would indicate that the folks who were able to enter our PA program were definitely capable and would have been competitive for many medical schools in this country. Many of the people who entered our program sought to become a PA rather than an MD because they didn’t feel that they wanted to spend a minimum of 7 years before they could practice. Our program is 27 months from start to finish with our graduates being able to enter any area of medicine one would find physicians. In addition, they can seek additional training in anesthesia and critical care if they choose to work in these areas. The vast majority of our PA grads go into surgery, pediatrics , emergency medicine and internal medicine much the same as our MD graduates.

Myth # 2- PA school is easier than medical school so these folks give inferior care

In truth, PA school is a bit more difficult than medical school. In essence, I had two years of pre-clinical didactics before I entered the clinical phase of my medical school. PA students have about one year of pre-clinical didactics before entering their clinical phase and they are taught on clinical rotations alongside 3rd and 4th year medical students. PA students attend the same clinical lectures and are expected to carry the same clinical loads as the 3rd and 4th year medical students. We often don’t know whether a student is a PA student or a medical student unless we are able to read the name badges. I ask rotating students the same questions and expect the same level of functioning regardless of which degree they will complete. In the end, the PA student will leave at the level of a  PGY-1-2 resident and function at they level  for most of their career while the medical student will leave at the level of a PGY-1 resident and move through residency to become an attending physician. Most of the patients that are treated in clinics at medical centers are seen by a combination of PAs and residents on teams that are run by a chief resident or attending physician with no compromise of care.

Myth 3- PA don’t know things at the level of a physician so they might miss something in my care

Most PAs are very adept at self-directed learning in the same manner as a physician. Whether one attends medical school or PA school, one cannot expect that what is learned in school is all that is needed to be a competent practitioner. My state requires that I complete many hours of continuing education in order for me to maintain a license to practice with PA having the same licensure requirements. In addition to seeing patients, PAs are constantly upgrading and honing their knowledge often at the same conferences and meeting as physicians.  Physicians often consult each other in terms of taking care of complicated patients and good PAs will consult with more experienced PAs or physicians in the care of their patients. The PA that work on my service know the scope of their practice and do not exceed this. While the PA may be able to do 90% of what I do as a physician, they are very aware of when a patient is beyond their scope of care the same as any physician is aware of when a patient is beyond their scope of care.

Myth #4- If I see the PA, I have to see the doctor too so why the extra step?

Many of my patients may not be seen by me on some office visits where they see the PA only. If the PA feels that the patient does not need to be seen by me, they will take care of the problem and the patient gets out sooner. On the other hand, most of the PA who work in my practice will state that, I know the doctor wants to see you so wait a couple of minutes until she is available” while in the meantime, I will consult with the PA on how the care of that patient is going along. PAs in our practice will perform treatments, manage wound care and work patients up for surgery. In most cases, just as with the residents who are on our team, the PA will assist in the surgery of the patient that they worked up unless the case is of vital learning for a resident.

Myth #5- PA education is inferior to physician education

PAs are educated under the same model as physicians. They take the same coursework in some cases but they don’t spend the same amount of time in school as a medical student and they don’t spend the same amount of time in post-graduate training as a medial student would. The ability to practice medicine with less training is something that is very appealing for most of the people who enter PA school. At the end of training and upon passage of their certification examination, most PAs start out at around $78,000 and max out around $110,000 after a few years in practice. For many people, spending a minimum of 3 years in residency above 4 years of medical school (expensive) only to earn about $47,000 as a resident is not something that they can afford financially. Most PA programs will cost far less than medical school and will enable their graduates to get into the health care work force much sooner at higher salary. Additionally, physician assistants can apply for and qualify for public health care scholarships that will pay back their student loans which are far less than the average $158,000 that a medical student will owe after medical school.

Finally…

I wrote this post because many students have negative ideas of what the training and work of a physician assistant will involve. For many students who have a strong desire to work in the medical field but family and financial obligations that will not allow them to spend a minimum of 7 years in training above  the baccalaureate level, becoming a physician assistant is something that they might find appealing. In today’s world of medical practice, PAs diagnose, treat and prescribe right alongside physicians. Often it’s the PA who gets to spend more time with the patient and who will develop a more personal relationship with their patient because the PA is not subject to the time constraints that a physician is often subject to. Good PAs build upon their clinical skills learned in school and spend as much time upgrading those skills through continuing education and journal reading as any physician would. It’s no accident that physician assistants enjoy the highest job satisfaction of any profession in health care with other professions not even coming close to their level of satisfaction.

I would encourage any premedical student to take a long and objective look at the physician assistant profession in addition to medicine. You may find that it’s a good fit for your professional ideals especially if you enjoy one-on-one interaction with your patients. One of our frequent questions for entry into PA or medical school is ,”What other health care professions have you looked at and what did you find out about them?”.  I am always surprised at the number of students who have applied to PA or medical school that didn’t do a thorough investigation of health care careers besides physician or physician assistant. Certainly if one anticipates preparing for a career as a physician, one should definitely make sure that they have done a thorough investigation of everything that is available, including alternatives and make the most informed decision before they embark on a career that takes a minimum of 7 years beyond university. Additionally,every PA that works in my practice is far from envious of my practice and love the scope of their profession. As you look at becoming a PA, make no mistake in believing that compared to medicine, it’s inferior or easier because this simply isn’t accurate and you may find that this very modern career is a great one for you.

I have been teaching (involved in academia) in some form since 1994 which means that I have “been around the block a few times”. Teaching has been my way of “paying it forward” since I was in graduate school in the 1990s. I use the term “paying it forward” because I was fortunate enough to have outstanding professors at every juncture of my education. Medical school just added patients to the list of persons that I teach which continues to make my practice interesting and fun. I use the word “fun” to describe teaching but it’s not lost on me that my teaching is a way to show how my teachers affected the way that I learned science and medicine which I attempt to pass along to my students and patients.

The first  influential professor

The first professor who had a profound influence on me was my undergraduate physics professor. A ”renaissance”  man in every sense of that word, my physics professor would start the class off by playing a few minutes of a Beethoven symphony whereupon he would ask us to identify the work. I was usually the only person to do this as I had spent more than some quality time study the compositions of Beethoven, Chopin and Mozart in my harmony and ear training courses that I had taken when I studied music. My professor marveled at how I could “guess” the identity of the piece with little more than three or four bars. For me, Beethoven, Chopin and Mozart were so distinctive in their styles that my task was simple. If he wanted to “stump” me, J.S. Bach would do the job.

In addition to music, this professor was a prolific writer, photographer and collector of thousands of ideas. My favorite idea was when he spoke of walking though Einstein’s office at Princeton and breathing much of the same air as the famous physicist. My professor also had the gift of being able to explain extremely complex ideas and theorems in a language that added this knowledge to our fledgling knowledge bases. As he filled multiple chalk boards with derivations of quantum theory and mechanics, I learned how to approach a body of knowledge, immerse myself and convey my thoughts and findings within the language of those complex theorems. In short, my professor showed me how to look at the world from the standpoint of mathematics and precision. After one semester of university physics for scientists and engineers, I was transformed.

My mentor in analytical chemistry

My next influential professor was an analytical chemist from Hungary. His influence on me was teaching me to love electrochemistry from the standpoint of chemical analysis. Like my physics professor, my chemistry professor was able to teach the utilization of any and all “tools” in the craft of studying a body of work. My chemistry mentor taught me how to prepare a PowerPoint lecture of a complex subject for different audiences.  He always said that one needed to be able to explain their research, no matter how complex, to other scientists, to scientists in other disciplines, to potential investors and to the lay public. His great lessons have proven invaluable to me over the year of graduate school, medical school and practice. He has a thriving research group that is putting out some amazing experiments because of his ability to bring out the strengths of each member of his team and his ability to get everyone to work toward a common goal. His lessons were great. Like my physics professor, my chemistry mentor was a man of ideas.

My biochemistry/physiology mentor

My mentor in biochemistry was actually a physiologist and a woman. She had a fine analytical mind but was very vulnerable in many areas. My greatest lesson from her was to be able to see collaborative possibilities in a multitude of situations. She had thousands of ideas every day which was refreshing to be around. When she needed to focus on one path, she was unshakable but she always saw the larger implications of everyone’s work and contributions which never went unrecognized.  She admired my quest for knowledge and I admired her ability to cut to the “bottom-line” of any situation, scientific or political. Under her tutelage, I became exposed to the politics of academia and came to understand how to get what I needed to present my best to my students. From my studies with her and under her, I learned how to integrate basic science with clinical medicine. One cannot separate science from medicine as science drives medicine which is its practical application. I also came to realize that since she had been one of Sir Hans Krebs’ graduate students, I was by association, a student of Sir Hans Krebs. Yes, I know the citric acid cycle inside, outside and backwards. One of my favorite tasks in graduate school was to substitute nitrogen for carbon and rework the “Krebs” cycle. (Hint: follow the electrons because it’s oxidation and reduction that “fuels” life on earth).

My first clinical mentor

My first clinical mentor was another renaissance man whose broad interests and talents make him a character. He was a specialist in Internal Medicine who was fond of referring to surgeons as “Philistines” (Orthophilistines, Neurophilistines and others) in the sense that Philistines are ill-mannered and generally crude. Some of his favorite statements were, “Internists practice classical medicine while the Philistines practice common medicine”. To his delight and astonishment, I ended up choosing to enter the practice of “common” medicine and become one of the “Philistines”  for which he always teased me when I encountered him.

The greatest thing about my clinical mentor was that he always gave his patients 100% of his attention and ability. He was a voracious reader and writer who encouraged me to begin reading the New England Journal of Medicine from the day I received my acceptance letter for medical school. He said that I probably wouldn’t understand much of the journal but have a daily habit of spending at least 30 minutes reading a journal would be of great utility to sound practice and education. He suggested that I read the Case Reports from Mass General first thing in every issue and then turn my attention to the Original Articles. To this day, this is the manner in which I approach the New England Journal of Medicine ( I have added about 30 additional journals each week). Again, I see the utility of putting the basic science with the clinical science which cannot be separated.  I am a profound believer that medical students should make it a habit of reading Mayo Clinic Proceedings, Nature Medicine and The New England Journal of Medicine from day one.

My surgical mentor

My surgical mentor is a laparoscopic surgeon who was trained a Duke University. When I met him, I realized that he had the same approach as the rest of my mentors which meant that he is a man of broad interests and abilities. He is an avid distance runner for whom I suspect his running keeps his agile and always active mind on course. He is another mentor who is able to put a strong team together where everyone’s strengths are highlighted. From my surgical mentor, I learned to never give up on any patient for any reason. When that 30th hours is creeping up and one is fighting sleep and a wandering mind, my mentor taught me to find a “kernel of focus” and build upon it. He also taught me the utility of rounding alone late at night when one can see the patient with renewed perspective. His late night teachings were some of the best (yes, he was up at 4am too). He taught me to rely on my training and thinking rather than emotion though I suspect that his emotions are far deeper than he shows on the outside. Under his direction, I became fearless to a certain degree and confident in my skills as a surgeon. The most outstanding characteristic of my surgical mentor is that he loves to teach and thrives on the excellent training of those who are under his direction.

Common thread

The common characteristics of my mentors over the years is that they are people of diverse ideas and interests. Every year at the start of a new year, I strive to get back to the characteristic that I most admire in my mentors. At each year’s end, I take stock of what I have learned and appreciate in this journey of medical practice. I know that I am fortunate to have had an opportunity to have been taught by many outstanding professors who have left their profound influence. I also know that there are those who I hear “whispering” in my ear on a daily basis. No matter where you are in your training in medicine, you should stop and take a minute to thank the people who have taken the time to teach you something. It’s good to remember that not all lessons are learned in the classroom and that it’s a privilege to have a mind that allows one to learn from a good professor.

There are some things that I have been telling my patients to institute for the last two weeks of 2011. I don’t call these “New Year’s Resolutions” because they can become habits for the new year rather that something that will be forgotten by the second week of January. These are:

• Perform at least 10-minutes of exercise of some type per day.
• Give up meat for three dinner meals each week
• Don’t patronize any restaurant with a “drive thru” window (Sorry Dunkin Donuts!).
• Don’t add salt (NaCl) to any food before tasting it
• Try a new vegetable each week (most stores have a great selection).

Taking each one of my goals

I know that every study out in the news media states that one needs at least 30-minutes of exercise 5 to 6 times each week but I know that if one strives for 10-minutes, they will increase to 20 minutes and get to 30 pretty quickly. I am a person of small increments of change working better than one large increment that does not work. Like your studies, exercise can be divided into small manageable bits that can be checked off and mastered. A 40-page paper is written one letter and one page at a time. Daily systemic practice of one small change can lead to larger and better results as that practice becomes a welcome habit.

I also encourage my patients to allow their 10-minute exercise break to be a time when they don’t multi-task. This means that this break should be a true break from cell phones, tablet computers (well maybe the I-pod/MP-3 player) were the mind can be refreshed and renewed. Couple that with getting one’s heart rate up and you have a true “mini-vacation” that decreases stress and makes the rest of your day more efficient. If you want more of a challenge, go up flights of stairs on your 10-minute break. Your brain and joints will be grateful for the movement.

In getting to know vegetables/fruits again, one can develop a relationship with color, texture and anti-oxidants. While I know that fast-foods are wonderful time savers, those heavy fat meals are terrible for keeping alert later in the day. If one does the burger/fries routine for lunch, the rest of the afternoon is spent trying to overcome “food-coma” so that you can get through the day. If you do the burger/fries routine for dinner, one finds that “food coma” can make your studying particularly inefficient. Try making a nice light dinner/lunch of rice noodles and grape tomatoes which can be appealing for the eye and add some “zip” to your taste sensations. One can also have a bag of cut and uncut vegetables, carrots, bell peppers (red and green), carrots and those lovely grape tomatoes in your backpack so that you can snack on something that won’t put you into nap time during your study time. One can also invest in great spice mixtures, curry powders and chilis for waking up taste buds and mental clarity.

If I have one vice, it’s a hot, fresh cup of Dunkin Donuts  (DD )coffee. I just have to stop by the shop, get out of the car and walk in to get my steaming cup. I can drink this coffee black and enjoy its rich aroma and flavor. For me, DD coffee is less harsh than Starbucks (though I will drink Starbucks when I can’t get DD) and is a nice break during my day. In the late afternoon, I often reward myself with a nice hot cup of coffee or tea (Twinings Earl Grey) rather than something fatty or sweet. I try not to drink anything with caffeine after 5pm if I anticipate getting into bed at my usual time. Since I get up around 3AM most days, I find that I need to be in bed before 11PM most night for sleeping. If I am on call, all bets are off and I enjoy my coffee/tea at any hour. When my favorite Dunkin Donuts shop put in a drive thru window, I had to change shops because I don’t want to break the drive-thru habit.

Finally, the NaCl habit is one that most of my patients need to skip. The American diet has increased the love of that salt taste in most people in this country. Since most of my patients have more than a passing experience with hypertension and diabetes, I do encourage them (and my students) to tread lightly where sodium is concerned. This is why most ”fast foods” are not good diet choices. Couple the high sodium content with the high fat content and one has a potentially troublesome combination. Do keep in mind that it takes some time to get used to eating foods without salt and to lose that love of salt. For me, it was difficult to get used to eating baked potatoes with no added salt but now I use pepper and happily enjoy munching on the potato (with skin) with nothing other than pepper added to this vegetable.

Taking Stock

Be willing to forgive yourself for doing things that were counterproductive to a strong performance in your academics or in any area of your life. Everyone, even the person who has the highest grades in class, would like to perform better and more efficiently. Efficiency comes with experience and with adaptability. If you can make some shifts and learn from things that didn’t work well for you, then your efficiency and performance will increase. Remember that every day is another chance to do better than the day before. One test, one semester or even one year do not define a lifetime. One can just decide to change your thinking about any subject or taking one step ahead rather than remaining stagnant. No one’s past defines them but the past does allow one to have thousands of experiences to draw from and to learn from.  As you move into the new year, look at one or two small things that you might like to try to do differently and try a to change them one day and one small experience at a time.

If you are asking the question,”What do I have to know in medical school?” then you have already started at a disadvantage. Medical school is not about “what” you “have” to know as much as it is about application of a body of knowledge to problem-solving. Sure, you can sit down and attempt to memorize a bunch of lecture notes so that you can repeat them verbatim but that isn’t going to get you past USMLE (any of the steps) or through residency. Medical school provides a foundation of knowledge that you can build upon. The more solid your undergraduate preparation, the easier you can add to your knowledge foundation that will enable you to treat patients.

Many medical students get into the “whine” about why they have to know so much detailed information when vast information resources are available at the “whisk” of a finger. In truth, the internet is as much of a blessing as it is a curse. No amount of information at your fingertips is going to be very useful unless you know how to evaluate that information and how to apply that information to clinical problems. While many undergraduate institutions are adept at getting students into a mode of being able to “memorize and regurgitate”, they fall far short in terms of providing a solid foundation in research and problem-solving. While there is no lack of information, learning what information to utilize and how to utilize the information that you learn is the biggest hurdle for most pre-clinical medical students. In short, all of the things that are on the internet are not useful or helpful when it comes to patient care.

Becoming an efficient learner in preclinical medicine

Many students start out with the idea that they are going to go home every night and re-copy their notes in order to memorize them for the upcoming exams. They quickly find that this strategy is neither useful nor efficient. The notes are generally an outline of what needs to be mastered in detail with the details largely coming in the form of the information that is stated in class between the bullet points on a lecture outline. Simply recopying notes will largely get one to the point of being a good “clerk” but generally doesn’t provide much of a basis for the depth of understanding that is needed for knowledge base mastery. In short, the Powerpoint lecture notes and the review books are just not enough by themselves for a thorough understanding. One just cannot “memorize the bold heading” and expect to be ready for board exams or course exams for that matter.

What is “efficiency” in learning pre-clinical medicine?

Efficiency is largely making the most of your attention span plus making sure that you synthesize and incorporate new knowledge within the context of the knowledge that you came into to school with. Many students who didn’t major in the sciences will lament that they just don’t have the background that their fellow students would have in subject A or subject B but an efficient learner will not only have the background regardless of major but will be able to add to that base with ease. In short, everyone who takes the pre-med coursework, has the background knowledge base to do well and be efficient in medical school.

If a person majored in biology as pre-med, the upper division biology courses required General Biology as a pre-requisite the same as Gross Anatomy and Biochemistry only require General Biology and General Chemistry as pre-requisites -note that I didn’t mention anything about Organic Chemistry as Biochemistry is far more related to General Chemistry than Organic Chemistry. If a first-year medical student didn’t major in science, they are at no more of a disadvantage as long as they know how to add to their pre-med base and build upon that base. In short, it’s a good idea to stop “talking” or “thinking” ones self out of a strong performance because of perceived perception that upper division science courses give an advantage. In short, the upper division science courses are only advantageous to folks who anticipate graduate school in that  subject matter.

In one wants to become an efficient learner, the subject matter is fairly irrelevant but the study techniques are quite relevant. One has to have an approach to new information that is devoid of emotional reaction, self-deprecation and a willingness to adapt to whatever comes next. Adaptability is a very useful characteristic for learning new material and thankfully, your brain is “wired” to adapt to new situations if you allow it to do the job without emotional checking. One has to have the confidence to dive into what needs to be learned, master what needs to be learned and to readjust if their first attempt at mastery falls short.

Confidence, the best learning tool

When I speak of confidence, I don’t mean that one boasts or constantly “pats their own back” but I mean that one has to have the ability to move past and learn from those myriad of small mistakes that will come with adjusting to any type of professional school. Some folks mistakenly believe that once they achieve a “high” board score or a good grade on a course exam, that they are in the upper echelons of medicine and can’t make any mistakes. Being able to bounce back and learn how NOT to do something is a valuable as knowing HOW to do something.  In every aspect of medicine, it’s the experience that will trump anything read in a book or in lecture notes but with experience should come making mistakes and making adjustments from those mistakes. In surgery, for example, skills are honed from practice and more practice but experience with practice is the best teacher and the best method of learning.

Learning in isolation

I hear over and over from medical students that they are just “not group studiers”. In medicine, one has to learn to interact, learn from and teach other members of the healthcare team. Nothing in medicine is done in isolation which means that the sooner one gets used to working with a variety of others both friends and colleagues, the better they become as physicians. I always remind the residents who are rotating with me on my service that it was a physician assistant who taught me the skill of closing the chest. This PA had spent years doing chest closures and knew how to teach in a manner that was great for a resident who was in the learning stages. My thoracic surgery attending was brilliant and guided me in many ways but that cardiothoracic PA taught me how to handle sternal wire efficiently and safely in the step-by-step manner that a junior resident needs to be taught. In short, the best physicians learn to appreciate knowledge from any good resource and learn to appreciate anyone on the team who is dedicated to the perfection of their craft. This holds most importantly for pre-clinical medical students as well as residents who are further along in their learning. Work with anyone at anytime who is willing to share their knowledge with you or who needs the benefit of your counsel. The ability to work with others and learn from them  will pay back in the years to come.  One cannot afford isolation in any part of medicine.

Getting along with others

While most of your learning is your responsibility, you have to be able to work with potentially any number of diverse people on a health care team. I vividly remember overhearing one of my fellow medical students  who was from India talk about a resident who was from Kenya. This medical student joked about how he “had it made” because the attending on the service was from India and the resident’s opinion wouldn’t really “count” in his grade for the rotation. Well, that medical student was pretty surprised to find out that his “honors” didn’t materialize because he just wasn’t receptive to learning from a resident whose ethnicity was different. He appealed his grade to the attending and to the dean of education but it stood because he wasn’t ready to work professionally with another person who had earned the right to be a resident and who attempted to teach. In short, professionalism means that one has to be able to work with a broad range of people and treat a broad range of people with respect.  The first mistake that many medical students will make on a rotation of any sort, is believing that they can’t learn from anyone except the attending physician who is in charge of the service or that they can treat anyone associated with patient care in a manner that is disrespectful.  I will often question nursing assistants, environmental service workers and nursing staff about the manner that students and residents treat them on a day-to-day basis. In short, everything on a clinical or in pre-clinical coursework always “counts”.  It’s just as easy to treat everyone  with respect (becomes a habit after a while) and not have to worry about offending  (or impressing) anyone.

So what DO you have to know in medical school?

You have to KNOW:

• How to be an efficient and self-directed master of course materials.
• How to work within a very diverse population of patients and healthcare workers.
• How to make adjustments after trying something that didn’t work as well as you thought.
• How to recognize that every experience is a learning opportunity and be open to the learning.

Once you have started your coursework in medical school you quickly realize that there are many things to read and master in a very short period of time. If your reading skills are not excellent, your reading efficiency goes down markedly. Fortunately, reading skills can be upgraded with regular practice and fortunately, your efficiency can upgrade along with your reading skills. Your first strategy is to have an open mind and a willingness to do something different and practice that “something different” on a regular basis. In changing any study technique or tactic, go slowly and practice your changes regularly. After all, it took years of practice for you to have the skills you are presently using, thus change doesn’t need to completely revamp in a weekend. Make any changes slowly and sparingly unless you have a large amount of free time (not likely in medical school).

Adding textbook reading to your learning strategy

If you have been using your textbooks for exercise weights only, open one of them and take a look at how the book is organized. Most textbooks have a Table of Contents in the front and an Index in the back. These are always the first things to look at when you purchase a new text (or review book for that matter) so that you may become familiar with the book’s content and organization. The index gives an idea of the detail and the table of contents gives an idea of the breadth and scope of the text. As a surgeon, I always evaluate a surgical text by their treatment of rectal prolapse. If a surgical textbook has a complete and well-organized treatment of this topic, generally other topics in the text are well-written and organized.

When you move into a specialty and have acquired mastery of medical concepts, pick one, relatively obscure topic and do a quick perusal of a text’s treatment of that topic. This practice can be a quick means of evaluation of a text (or review book) while you are standing in the bookstore. If you are an online purchaser, I would not invest more than $40 in any textbook/review book that doesn’t provide a sample chapter/table of contents and index for preview. Wait until the book arrives in the bookstore so that you can scan it before making a sizable investment.

If you have a required textbook for your course, be sure to read the material assigned. Most medical school professors do not assign reading to “occupy your mind with busy work”. If the reading is assigned, get it done before you go to the lecture. Not only will you get a better grasp of the lecture material but you will have completed at least 1/3rd of you study of that material before you have actually heard the lecture as attending a lecture “cold” is worse than not attending the lecture at all.

You will hear your classmates brag and boast about “never cracking” a textbook but look past that strategy. You have one shot at not ”screwing up” your coursework thus you need to get every dollar’s worth of tuition out of your classroom/course experience. Not only will you do better on your board exams, but you will do better in your coursework. Applying for residency with a string of just passing or nothing distinguished on your transcript is not going to help you get into a good residency program. Without having a good knowledge base that has some depth, you won’t interview very well either. Resist the temptation to just study a review book and Powerpoint lectures as they are not enough for boards or your course exams. In the medical education process, just passing or short-cutting is not a sound method for future practice.

Another strategy for getting your textbook reading into your study schedule is to read your text assigned readings the week before the lectures. This doesn’t mean that you waste time outlining a chapter and memorizing every word, but becomes more meaningful if you have an idea of where the details of a process are located in the text and if you have an idea of how important a particular topic might be to a body of knowledge. For example, it’s very difficult to master cardiovascular physiology if you do not throughly understand the Frank-Starling Principle. Most medical physiology texts will have plenty to explain concerning this principle but you need to know how this principle affects cardiac function in a very detailed manner. How does this principle translate in terms of myocyte function? How do pharmacological agents affect heart function within the context of this principle? How does cardiac innervation affect this principle of heart function? In short, you have to put new concepts within the scope of all of your didactic coursework and not just memorize the physiology for the sake of memorization so that you can “spit it back” on a class test. In short, you have to know that principle well enough to apply it across disciplines in medicine. This is where having the knowledge base of your textbook reading before you attend the lecture is crucial. If you don’t have a good base, you can’t listen with a discriminating and informed ear.

Getting overwhelmed

If you find yourself procrastinating because you have not been studying and reading on a regular basis, you can quickly find that you are behind your class and overwhelmed. Immediately sit down and write a schedule to get back on track immediately. Go to where the class is and catch up on the weekend. This means that you sit down on a Saturday and Sunday morning and check off materials on your schedule that you were not able to get around to during the previous week and get them mastered. Never, ever let yourself get more than one week behind in any of your courses. In medical school, playing “catch-up” is the beginning of the end and your grades will quickly fall. Students who are ashamed to ask for assistance are often the ones who will ”put off” studying because they don’t understand one principle. If this happens, move to something else in the course material and keep moving forward. Get the help you need as soon as you can and fill in the details that you need but don’t just “quit”.

Reading a textbook chapter

First look at the subject headings to get an idea of what the chapter will cover and how it will be organized. Then look at how much space is alloted to each of the subject headings. This will give you and idea of the importance of each subject in terms of mastery of the entire chapter. Next, look at any chapter questions or objectives that are in your textbook. These are for you to check your understanding of the chapter materials. Many textbooks will have chapter objects at the front each chapter which are great in terms of allowing you to know what’s most important in the reading to come. The last thing that you do is read the material making pencil notes of the important explanations or of any questions that you want to answer in your reading.

One of my strategies is to pose each subject heading in the form of a question and see if I can answer that questions when I have completed reading that section. If you can’t answer the question, then figure out what you missed in your reading. Are you having a problem with the author’s style? Do you need to have a medical dictionary nearby so that you can look up any terms that you don’t understand?  Are you having difficulty concentrating because there are too many distractions in your study location? Are you finding it difficult to concentrate because you are tired, thirsty and hungry? If you are having any of these problems take no more than 10 minutes and get them solved immediately.

If you can’t understand or figure out an author’s style, then you need to check with your professor in order to get some help with your text reading. In short, don’t just sit and “throw up your hands” in frustration but take some immediate action. Consult with your professor in getting a grasp of the basics of your text so that you can utilize this resource regularly This is why getting down to your reading before you attend a lecture is a better strategy than waiting until a couple of days before an exam when you are far behind in your reading.

Use your study time wisely and regularly

Practice reading your textbooks and other materials on a regular basis. Having a large white dry-erase board is good for making concept maps from your reading or listing vocabulary words to look up (so that you can incorporate them into your knowledge base). The action of getting out of your chair at least every 50 minutes and writing something on that board will help to keep you focused. Reading and re-reading the same section or paragraph three or four times with poor understanding generally indicates that you are not concentrating on the task at hand. Don’t let lack of concentration derail your efforts as you just don’t have too much time to waste on being distracted. If something is bothering you, write it down on an index card (or “sticky note”) and think about it in the car, on the treadmill when you work out or when you take a walk.

Don’t sit in the same spot in the library for hours on end without standing up and getting your blood circulating. Just sitting in one spot is a good way to find yourself fatigued very quickly. Get some fluids to stay hydrated and walk around for 5 minutes or so to just let your eyes focus on other things besides your books and notes. If you are in a study room, read a passage or two out loud and take some deep breaths as you recite the material back to yourself. Stretch regularly and watch your posture as sitting “hunched” in an awkward position can cause muscle strain too. This is why getting some regular aerobic exercise plus strength training can actually make you a more efficient student and is well-worth taking an hour from your study to perform. Regular exercise will greatly decreased your natural stress level which will make your study more efficient in the long run.

Finally, practice reading your textbooks early and often. Anything that you practice regularly becomes a good habit. As you become more efficient and less stressed, your concentration will improve too. I am always amazed at how much many medical students will “talk themselves out” of high achievement and scholarship because they haven’t been used to studying at the level demanded of them in medical school. Don’t be one of those students. It’s easy to allow other things to interfere with your studies but planning and efficiency can give you more time in the long run. Learn to say “no” to demands on your time and remember that you have one shot to get the most out of every class. Retaking exams and repeating years is problematic if the reason for your retakes and remediation is poor study habits. Make good study habits a good habit.

Yes, I was bone tired when I arrived home each day. I usually arrived at the hospital at 4:30AM and didn’t leave until after 7pm each day. By the time I arrived home, I took a shower and hit the bed so that I could get some rest to start the day over again the next day. If I was on call, the other interns would sign out to me around 6pm and I would generally make quick rounds on the sign-out patients so that I could see if there would be any issues. I was also a compulsive list-maker so that I could check off things that just needed to be done. I would try not to eat a heavy dinner because I found that the night would drag on. I kept myself well hydrated with iced tea (avoided coffee in the evenings) and generally used my call time (if I wasn’t busy) to dictate discharge summaries and get things ready for my patients who would be going home the next day. During the night, I would read and then nap (couldn’t really sleep soundly in the noisy call room) and rest as much as possible. At 4:45 AM, I started my post call day, did my morning notes and usually left the hospital around 12 noon after all notes were done. If there were many things to be done in the morning, I would help the on call intern and then leave when things started to slow down for him.  I learned quickly that teamwork was the best thing that we could do for each other to get the work completed as efficiently as possible.

On my very first rotation, my fellow intern on service was not much of a colleague. He left many things undone and generally refused to do work that needed to be done such as discharge summaries. I simply took over his paperwork and mine too. I knew that work had to be done for the service and I picked up the slack rather than complain. Again, it was good that I just pitched in and worked for the team and the patients. I wasn’t doing the other intern’s work for him, I was doing the work that was needed for excellent patient care. All of the patients on the service were mine as much as his. Again, the more work I did, the better I became at getting things done. I wasn’t long before my residency director figured out that I was keeping the service humming along and that I was always one for taking up the slack. I also earned the respect of every one of the chief residents who always wanted me on their services and were ready to teach me things that I was eager to learn.

The thing about being a good intern is that you learn to prioritize your life. You learn to appreciate how important your home life is to your work life. You appreciate just spending time with the people who you love. You also start to be come thankful for all of those hundreds of little victories that you get during the day. You learn to forgive yourself for missing things and you learn to not forget those same things the next day. The fortunate thing about medicine is that every day is a new opportunity to learn and grow as a physician if you take the time to do so. Medicine is a joy to practice and a daily reminder of those who are less fortunate than myself. In only a second, I can be the patient lying in that bed who is worried about recovery and how their life has changed by illness. One has to take good care of one’s life at home, one’s spiritual life and one’s health in order to be able to give our patients that best that we can.

I have written other posts about staying awake and keeping myself committed to the thousands of patient care tasks that residency will demand. Most of the things that I learned about patient care and keeping up with things, I learned as an intern. It took about two weeks into my first rotation as a new intern, to not be panicked with those “calls” from the nurses in the middle of the night. I learned that I actually know how to take care of patients and that I was confident in getting the best for the patients that were under my care. I learned to have a good relationship with the folks in the allied health care professions because they helped me take care of my patients. Medicine today is a team and not just one person doing everything.  Yes, the physician is at the head of the team but having good people around me who can do their jobs professionally, is worth gold. I am thankful that I am generally an easy-going person but can be pretty decisive when I need to make decisions.

If medicine becomes drudgery, then you have chosen the wrong profession. If you can’t keep your mind interested in the care of your patients, then you are likely not going to be a very good or very competent physician. Your patients teach you and your colleagues help you every day. Medicine is truly magical when every one and everything is in that zone where you start to appreciate the magic. Medicine is and never was a “job” for me but something that I feel blessed in order to do. When I read my friend’s blog about going through internship and all of the great learning that he has in front of him, I see myself and I see how far I have come.

• Make a daily schedule that is not so tight that you don’t have room for those “little things” that creep up and eat into your study time.
• Be sure to take 30 minutes out for some physical activity. If nothing else, walk up a couple of flights of stairs on your study breaks but don’t sit for hours without moving. Do three 10-minute sessions if you can’t do 30 in one session.
• Don’t use your meal times to study. At least for the time that you are eating, relax and take in your atmosphere (even if it’s the hospital cafeteria) so that your digestion will thank you.
• Snack on cut vegetables and fresh fruit while you study. Drink water for hydration. Junk food slows down your brain and leads to weight gain that you don’t want. Trust me on this one, snack on the vegetables instead of chips and soda.
• Try to limit your coffee (cut back if needed) to one cup with caffeine per day as coffee/tea and other caffeinated drinks are very dehydrating. Dehydrating leads to being tired and less efficient.
• Divide your study periods into 50 minutes of study with 10 minutes of break time (good time to get up and move). When you return to your studies, your brain will be ready to work again. You can also surf the net, do Facebook and other things on your 10-minute break so that you are not wasting study time with the social media.
• Limit your study group to 4 people or less who have the same study habits as yourself. More than 4 people is too social and less efficient.
• Change your study location often. If you love the library, move to a classroom once a week. If you are on campus, go to a Starbucks or something just for a different background.
• Remember that the school administration is there for your success. At the first sign of trouble, illness or anything that takes your from your studies, meet with your faculty adviser (or dean of students) so that you can get the problems taken care of immediately. Waiting around to attempt to “gut it out” is a poor decision because your classwork is going to move very rapidly and you don’t want to get behind under any circumstances.
• If you find yourself behind, go to where the class is currently and do your “catch-up” on the weekend. I can’t emphasize more that medical school goes so rapidly that even slacking one day during the week can put you behind quickly.

Try NOT to listen to what others in your class are doing or not doing since  you have to take care of your needs and you have to be very selfish with your time.What others do or do not “do” is meaningless unless you are directly affected by their actions.  If there are troubles at home, you are going to have a minimum of time to get personally involved with things that may be largely beyond your control. You can lend your support verbally but essentially, you have one shot not to “screw-up” your medical school coursework. In today’s world of high tuition and heavy investment, you have to be selfish with your time and energy. Putting your time and energy into your coursework will pay off later on when you are trying to get into residency. Again, there is very little room to make mistakes at this point in your career.

If you have home demands, again, seek help early rather than later. If you have a spouse (or significant other) that appears to be demanding more and more of your time, you must have a long conversation with that person. You just don’t have the luxury of being able to make every child’s soccer game or even “date-night” if the exams are coming fast and furious. This means that on your vacations, you will have the time to play and enjoy the relaxation but when classes are in session, your time is largely going to be involved in mastering a curriculum that can seem endless. If you haven’t started school, make sure that your spouse/SO/children know that you will need some time to adjust to the pace of your studies which means that you may not be around very much. This doesn’t mean that you don’t love them but it means that your studies are more demanding than ever before.

The faculty coordinator for any of your courses is the first person that you should see if you are having problems. The faculties are experts in terms of the mastery of the curriculum thus, you should “tap” that expertise as needed. Don’t make the mistake of “killing” your career because you are “too proud” to ask for help. I always went to office hours just to do a periodic “check” of my understanding of the material as presented. This is a very good practice to get into long before the exams come up. If you have taken an exam, and scored lower than you expected, then you NEED to spend more than a small amount of “quality time” with the course instructor. Again, you essentially have one shot at learning everything that you can master as quickly and efficiently as you can get the job done.

Do not ever attend any class/lab unprepared. You have a course schedule and you have a course syllabus. You should be ”pre-viewing” every lecture before you attend it without question. The more you are exposed to the material that you must master, the more efficient you will become with the mastery. I always previewed for the upcoming lecture right after I completed my study and mastery of the current lecture. On the weekend, I reviewed the previous week’s materials as if the test would be on the following Monday. In short, the weekends were my best friends because there would be no lectures on Saturdays and Sundays.

Keeping a well-balanced and well-rounded schedule is vitally important in medical school. If you have shorter lecture days, this means that you have longer study periods. Just because you are not sitting in lecture, does not indicate that you have “nothing” to do for the rest of the day. Again, shorter lectures and labs mean that the mastery of the curriculum materials is more dependent on your ability to “teach yourself” the materials. A shorter lecture day does allow you to get those 30 minutes of physical activity done during the daylight hours which is wonderful but get to your studies as soon as you can and check off tasks on your daily schedule as you complete them.

I would make a weekly schedule on the weekend before the “work week” began. I would make a daily schedule from my weekly schedule making sure that I put things in like ” 2 weeks until exam week” or 2 days to cardio drug quiz”. I made sure that I kept up with my reading before the lecture and not after the lecture. For me, the textbook was my key to recognizing the key components of the upcoming lecture. I would put my textbook pages on my daily schedule along with a check box so that I could check off as I completed my readings .

My other system was to take notes on the left side of a loose-leaf binder. I would divide the page into 1/3rd for a margin and 2/3rd to take notes from the actual lecture. The margin was to list the key terms/concepts/things from the text that were related to the notes. When I studied, I filled in the right side of the loose-leaf page with summaries of what was on the left sheet. When I did my weekly review, I essentially studied from the right summary sheets only with annotations from the textbook as needed. Since I had already completed my readings in the text, I knew what I needed to have in my notes versus what was already in the book. I was also able to write my own test questions and insert them in my small loose-leaf binder right near my lectures/handouts/notes. If there were other important hints that I garnered from my meetings with the instructor, I would put these on “Post-It” notes and stick them on my study pages.

My other system was to head to Kinkos and allow them to cut the bindings from my textbooks which allowed me to punch holes in the pages and insert them into my binder I had my textbook pages, my notes from reading and my notes from lecture all in one place. I also kept three colors of pen (blue, black and red) for hand-written notes plus my four colors of highlighters that I used to circle things and make arrows in the margins for key concepts. The highlighters were a study tactic learned from a friend who had a type of dyslexia that made visual cues vitally important for her. I utilized the highlighters in much the same manner and found that on test days, I could recall the materials that I had circles and highlighter with the varying colors more easily. If you type your notes using word processing software, you can use the same system but you must format your pages. See Photo below.

These are just some suggestions to help get you off to a good start. Consider them or use them but make sure that you get moving fast.

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.

Every day I read  many letters and posts from undergraduate students who view a career in medicine as the ultimate prize for academic achievement. While this view may keep many pre-med students on the road to high academic achievement, a more realistic view of this profession and it’s practice is a better choice for keeping a strong perspective. It’s very admirable to wish to enter medicine to “help people”. In truth it is also admirable to enter medicine because you want to be well-compensated for the work that you perform but monetary compensation will not keep you bounding out of your front door every morning as you begin a 16-hour day with many challenges. Medicine is very much like the publishing of a daily newspaper in that you have to work through the hundreds of daily challenges and get them right while loving what you do. When I say loving, I can also add that along with that love there needs to be a bit of compulsion albeit healthy that has to be in your personality. In short to be an excellent physician, it’s about always being, to quote Larry King, “100 per cent when the light goes on” with the  light on practically every minute of the day.

Why good medicine may be difficult for even the most dedicated

It’s not just the surgical specialties where one has to “get it right” or life-changing consequences can happen for both the surgeon and the patient. Non-surgical specialties are far more difficult to practice at the highest level than most surgical specialties with the greatest hurdle for  the primary care physician, being the time constraints, though operating room time has always been expensive too and the knowledge acquisition challenges that would frighten many other professionals. A physician simply has to be adept at the mastery of many hundreds of pages of information that will prove crucial to practice on a daily basis, like no other profession. It’s the time between seeing patients that becomes a snippet of both “down time” and “breathing” time which keeps everything moving. Additionally, a good physician has to become adept in communicating with patients and staff in order to achieve the best outcome for their patients. It’s a narrow fence to walk on a daily basis with the unknown which eventually becomes a constant companion.

If the pursuit of a career in medicine is causing an applicant to attempt to significantly change their personality or ethical system, then medicine becomes a symptom of a problem that will make the practice of medicine very difficult. Medicine is not for every person either from an academic/scholarship standpoint or from a personality standpoint. With the length of the day and the complexity of excellent job performance, a candidate doesn’t have the time or the energy to keep up and “act” in order to fulfill some perceived “fitness” for medicine. My medical practice is as much an extension of who I am as a person rather than the product of any training that I received in medical school or residency. It didn’t make a difference that I entered surgery as my personality doesn’t allow me to act like an “entitled jerk”. There are too many moments when I find myself thanking my maker for getting through the day and not losing my perspective or awe of the majesty of every human being from that elderly veteran to a newborn with multiple congenital anomalies. In short, your patient’s and your community will demand that you keep a solid balance between humility and hubris.

When one starts to complain about “lack of a life” or having other “passions” outside of medicine before one enters the field, one should probably question whether medicine is the sound or compatible career path. If you find that you just love doing procedures and duties of the physician but you are constantly worried about your life outside of the practice (“I want to be home at 5pm every night”), you may want to consider pursuing the profession of physician assistant (less training time and less responsibility) rather than making a minimum 7-year commitment to medical training in addition to the life-long learning at a high level. If you can’t learn to find balance between medicine and your outside life within the boundaries of training, you won’t find that balance once your training is completed. By selecting the profession of physician assistant, the shorter training period coupled with a bit less responsibility might be an ideal fit for someone who has multiple interests outside of medicine.

I found quite rapidly that I needed to set more of a standard for study and scholarship outside of residency than inside. For me, combining teaching with practice was an ideal situation as my teaching forces me to keep up with my literature reading and the latest clinical practices for my specialty. For some of my colleagues, the work of practicing evidence-based medicine is a chore that they seem to avoid at all costs which can be to their detriment. There is a compulsion that tends to keep me focused on getting my work and reading accomplished each week. I generally find that I have plenty of time to pursue other interests outside of medicine within reason. As the daughter of a physician and coming from a family that boasts 10 physicians between aunts and cousins in every specialty, I can say that none of us suffered because our parents didn’t make every recital, soccer game or play. We learned to be self-sufficient, almost to an extreme point and we learned that the love and support of our parents was always present even if they couldn’t be at an event physically.

The “sacrifice”

Well, medical practice and medicine isn’t a sacrifice for me. It’s always a wonderful opportunity to test myself both mentally and physically. I have found that I have some innate qualities that allow me more ease with practice, such as not needing more than 4 hours of sleep, sleeping lightly – never missed a page, and having a generally upbeat disposition with an ease of communication. I simply adapt as best as possible to the situation at hand without much angst and worry. If I don’t believe I will enjoy working on a project, I don’t agree to do the project in the first place. I also have adapted to the thousands of changes that have become a part medical practice since I entered the profession nearly 10 years ago. For folks who have a difficult time adapting to change, medicine will be an extreme challenge. One cannot expect that medical school will teach everything needed for a modern practice nor does the medical school attended (as long as it is accredited and in the USA for practice in this country) matter much once you are done with that portion of your training. The habits learned long before medical school, such as, consistent and strong scholarship/study skills will make more of a difference in your practice as opposed to the school that you attended.

Many orientation sessions will have loads of information for you. Just like your coursework, get this stuff mastered! The check in and schedule is most important so that you know where you want to be and when you need to be there. This is also a time when you realize that you need to spring for a 140 db alarm clock without a snooze button for those days that you just can’t hear the one with the buzzer. My “super alarm” was my best friend on many a Monday morning when I was in medical school. By general surgery residency time, I found that I didn’t need it as I woke up when the curtains rustled; surgery makes one a light sleeper by necessity. You also do not want to get into the habit of hitting the snooze because you can’t hit that beeper once you get into practice. In short, you have to get up and get rolling on the first alarm. You will also need comfortable walking shoes and a car with a trunk so that you can carry home all of those books that you will buy, or in my case inherit, from your upper-class advisers. I watched in amazement as a few of my classmates carried what looked like a “house” on their backs as they marched to the underground or bus stop to go home. I drove during orientation week so that I could get my “loot” home comfortably.

If you haven’t done so, get all of the stuff that you need for your apartment (crib/loft) arranged and unboxed. I can’t emphasize more, how little time you are going to be spending there during first year but you don’t want to waste any time trying to arrange things when you need to be studying. Orientation week for medical school is also orientation week for getting your housing together too. Make your place as efficient as possible. Stock up on “the noble necessity – bathroom tissue” , soap, deodorant, ramen noodles- can be enjoyed in 2 minutes 1,000 ways, laundry detergent and most important for me, coffee. If you don’t purchase at least a semester’s supply of the necessities, it will be during exam week when you have no time that you discover you have no TP! Don’t let this happen. (If you have a roommate, put a couple of extra rolls under the foot of your bed so that you always have a stash in emergencies).

I will also recommend finding a 24-hour gym that is close-by because you never know when you are going to get an hour for a workout. My biggest mistake in medical school was not keeping in good physical condition.  Regular aerobic exercise diminishes stress and just makes you a more efficient student.  It also helps to keep your immune system polished (drinking tap water helps too) and ready to fend off your classmates’ viruses and bacteria that they will try to share with you. In short, driving yourself to burnout is less likely if you have a means of working out. You don’t have to have an elaborate routine just 30 minutes or so of walking on the treadmill plus 30 or so minutes of weights. I can’t tell you how much weight work helps to keep you focused on your studies. I have learned that fact after many years of teaching and practice. Take the time to pump some iron for your sanity and your health!

Go to all of those social events during orientation. They may seem stupid but you want to get to know as many of your fellow students as possible. No, you are not running for office (don’t run for office unless you know you can get your class work mastered well- our class president didn’t do so well first year and being a class officer is pretty meaningless for residency so don’t take a chance on this) but you want to have a cordial/professional  relationship with everyone in your class. Resist the urge to form cliques (many students do this by ethnicity) because your future colleagues are going to be every ethnicity and color and you have to work with them. Get along with everyone and have a sunny relationship with everyone even if you have a family at home. You need to be able to work with your classmates on projects and in the future on the wards. It’s also your classmates that will cover for you when you need to take that sick kid to the doctor or leave early because there’s an emergency. Go to those social events and get to know everyone. I met my best friend from medical school while we were in a line to shake hands with the deans at the Deans Reception. We studied together, cried together and graduated together. Even today, I miss those great times that we had even though we thought we were suffering.  The greatest thing about my best friend is that she spoke to everyone in the class and worked easily with everyone. She is truly a gifted person.

Make sure that your study area at home and at school is well equipped (plenty of note paper, pens and highlighters) and easily accessible. Don’t seek out the darkest and most remote area of the library (too dangerous) and don’t seek out the most popular area ( you won’t get much accomplished). Find a place where you and a couple of like-minded individuals can study (watch each others stuff when you need to use the facilities) and get something accomplished. I found that I studied best at home (not an option if you have a family that will compete for your attention) with a couple of beagles at my feet. My “facilities” were next to my office and any telly, video games and other distractions were far away. Once a week or so, I would do a group study with my study partners but not until I had mastered my work (see my post about my study habits).

As I have said in other posts, the two times that you can truly enjoy medical school are during orientation week and during fourth year after you match, unless you haven’t taken Step II. Orientation week is a time to get to know as much as possible about your school, your classmates and how you can set a strategy to navigate the next year or two. I can’t encourage you more strongly to read all of the information in those handouts and student handbooks so that you know where things are  and know who to contact if you have trouble. If you are given course syllabi (we were), look though them and get an idea of how much work you are going to need to set aside for your courses. Planning and organization are two of the most important tasks for medical (or any other professional school) success. Have fun for this week because the classes are going live too soon!