Medicine From The Trenches

Experiences from medical school, residency and beyond.

Summer School

For many pre-medical students, summer courses look like a great way to get ahead of the curve and fast-track through your introductory sciences, math or general educational requirements. For some medical students, summer coursework is an opportunity to shore up deficiencies or remediate coursework from the previous year before academic progress is granted. In both the case of the undergraduate and the medical student, there are characteristics of summer coursework that need to kept in mind.

Summer courses at any level go very fast. There simply are not enough weeks during the summer months to allow the same pace as regular-term coursework. Keeping this in mind, prepare to work faster and longer to master the same amount of material as a regular-term course. In the case of repeating a medical course -or remediation of previous course work-you are expected to be able to move through the material faster because this is the second time you will have covered this material. In the case of an undergraduate course, the summer student has to be dedicated and disciplined during a time when many of your friends are enjoying a much needed vacation.

My rules for mastery of coursework apply for summer coursework but let’s call the rules “course mastery on steroids” because you have to devote more time and cover more material at each sitting. There is little time to allow the material to “digest” before you move onto another topic or lecture. To this end, your previewing and reviewing become more focused in addition, the student has to be more adept at moving through the material at a more rapid pace. If mastery of concepts comes slowly, summer school is not a very good idea.

In the case of the remediating medical student, this being the second time through gives you an added advantage in the sense that you already have good insight into what you need to master. Each time the material is presented, you will gain new insight. This doesn’t mean that doing a summer medical school class is going to be wonderful and a “cake walk” but it does mean that you will likely know your remediated material in great depth for your board exams. This is not a bad trade-off for missing your vacation time and staying with the rest of your medical school class.

I never recommend that pre-medical students take pre-med coursework during a summer session. Summer courses move so rapidly that there often is not enough time for good integration and mastery of the concepts in sufficient depth for application on the Medical College Admissions Test (MCAT). Good summer courses are English courses, History courses, physical education coursework and math coursework. By taking these types of courses during the summer, a pre-medical student can get pre-medical course pre-recs out of the way or get degree requirements out of way allowing more time for concentration of major subjects.

Other great summer coursework for pre-medical students are “immersion” type courses such as marine biology (on a ship at sea), summer semester in Europe or South America, or summer research. Being able to devote your attention to one subject in total immersion can greatly enrich your college experience. Many undergraduate institutions offer immersion language coursework over a summer or opportunities to work with world-class researchers during a summer session.

Summer Course Study Strategies
As soon as you receive your course syllabus, reading/lecture schedule, sit down and plot your study schedule. You need to figure out how much time you will have to devote to study in order to cover the material. A good rule of thumb is two hours of study time for every hour of lecture time (same as for regular session). Since summer lecture are often longer (or take place five times a week instead of two or three), you have to block out your study time without exception.

Be sure that you have a strong and organized approach to mastery of your material. Having a buddy in the same class to study and work with becomes invaluable especially when you quiz each other and explain concepts to each other. It is also a good idea to meet with your instructor on a regular basis to be sure of your understanding of your coursework. Since summer courses go so fast, you do now want to “dig into a hole” that you are constantly attempting to pull out of. Chances are not good for pulling up, if you get into trouble on a test.

Because of the heavy concentration and course time commitment, working will be very difficult with summer courses. Unless you are taking a physical education course or a performance course with minimal prep time, working will be very hard. The effort that it will take to keep up with your course materials will generally rule out employment except for either a Saturday or Sunday on the weekend (but likely not both). If you need money, opt not to register for a summer course unless you have a job that permits long hours of down-time regularly. Even then, attempting to work and do a summer course will be very difficult.

If your family (or you) have an elaborate vacation planned, do not expect that you will be able to “miss a couple of days” of your summer course. You should have enough time for a weekend at the beach or to take a short trip but missing a day of summer work is equivalent to missing a week of regular session work. Again, opt not to take a summer course if you NEED your vacation time. Taking the time off is a better use of your summer instead of attempting to take a summer course and doing poorly because you had to go on vacation. If summer school is your plan, it IS your vacation.

29 May, 2007 Posted by | academics, study skills, summer school | 5 Comments

Study Skills – Part III

In this short essay, I am going to tell you something that I didn’t do that I should have done. It’s called “Learning by Experience”. When I started graduate school, I vowed to get myself into good physical condition. I had a few extra pounds but nothing that was morbid obesity just about ten extra pounds. I had been a middle distance runner (10K) off and on with my best mile time being 6:25 and my best 10K time being 40 minutes but working in the chemistry lab and getting ready for graduate school had eroded most of my base-line mileage. I saw the pounds creeping on and I decided to “stem the tide” right then and there.

I joined a gym where loads of guys from the U.S. Navy JAG office worked out. Soon I was grunting and sweating with the boys. Those extra ten pounds quickly melted off and I would run 4 to 5 miles daily. My flexibility increased and my brain loved the extra perfusion of oxygen from those daily runs either outside on the bike paths or inside on a treadmill. My workout partners, all JAG guys, introduced me to weight training. Soon I was benching 125lbs and leg pressing 400lbs.

I loved swaggering into the gym in my baggy gym pants and muscle shirt. I would hop on the stationary bicycle for a 6-minute warm up. After a few stretches, I would start my circuit working legs first then arms and finishing up with abs. I wore a red scarf on my head and definitely sweat as much as the guys. When I reached 80lbs on the bench press, I earned a spotter. Nothing gave me more satisfaction then when the guys and I would take turns on the chin-up bar. (No other women came near the bar). My biceps and triceps bulged. I would put 400 lbs on the leg press and just work away with some nice hamstring stretches in between.

After my weight-lifting, I would take a soak in the Jacuzzi and then a dip in the pool. I am not much of a lap swimmer but swimming a few laps would bring my body temperature down and would keep my back stretched out nicely. My entire gym routine took about 2 hours from start to finish. I would get a protein shake in the juice bar and head back to my lab feeling powerful and refreshed.

The best thing about being in such great shape was that the discipline of working out carried over into all aspects of my life. I slept better at night with no stiffness in the morning. I easily ran flights of steps and could carry heavy loads with no problem. My clothes fit great. I had a solid study plan that had gotten me a 4.0 in my graduate studies. While I ran, I thought of new experiments and analyzed my data in my mind. Though my diet was not bad (I am not much of a junk food eater), when I was working out, it was excellent. I ate plenty of fresh vegetables, fruits and little meat.

With all of my energy, I was able to awaken in the morning, run a couple of miles with the Marines from the barracks down the street, and then bike 6 miles to school in the dawn. I would check my experiments and review my lectures for the day. I would then shower (I really sweat when I bike); change into my suit and lab coat, and then do my morning lectures. During lunch, I would hit the gym. After lunch, I would study and prepare more experiments or go to meetings. This was the routine of an assistant professor.

When I decided to attempt medical school, I knew that I needed to take the Medical College Admissions Test (MCAT). I had far more coursework between a double major in biology and chemistry with double minors in physics and math. My graduate work was in Biochemistry and Molecular Biology so those subjects were well covered. I knew that I needed to brush up on my verbal reasoning skills so I bought a review book and worked some problems daily. I also worked on my Physics too since it had been five years since I had taken General Physics. I was solid on the Quantum Mechanics but Classical Mechanics and Optics needed review.

My graduate comprehensive exams were also looming that summer too. We would be examined over the course of two days with eight hours of testing on both days. I studied for my comprehensives and studied for the MCAT at the same time. This turned out to be a great strategy. I simply made a review schedule topic by topic and checked off as I reviewed each concept. As a poor graduate student, I couldn’t afford a prep course so I purchased ($35) a huge review book called Flowers and Silver. It was money well spent.

After completing my comprehensives in June and getting my AMCAS application done, I knew I had one month to prepare for the August MCAT. I had stuck to my study schedule and my workout schedule. The funny thing was that none of my graduate school colleagues, except my best friend, knew that I was even interested in medical school. My best friend in graduate school was a neurosurgery resident who was working on his Ph.D. We had been study partners for the comprehensive exams.

On the morning of the MCAT, I hopped on my bicycle and rode the 6 miles to my testing center. It was great rolling off the hills at top speed and feeling the early morning wind in my face. My legs were strong and I imagined myself “smashing” that exam as I pumped up and down the street. I stopped into my favorite coffee shop for a morning cup of fresh “joe” and a high-five from the shop’s owner (a little Korean lady who always offered me encouragement).

I stood in line, dressed in my bike shorts and muscle shirt with my helmet and gloves. I stretched some but other than that, I was pretty relaxed. I could feel the tension all around me. As I got to the test room, I hoped for a seat next to the window because outside, there was a beautiful pink blossomed tree. I knew that I would be able to look up and out the window for a little mental break if the test was too much. My prayers were answered as I took my seat next to the window.

I moved through the Verbal Reasoning. My strategy was to do the passages that I found least interesting first and the things I loved last. I paced myself reading the questions first and marking the answers as I read through the passages. I paid close attention to punctuation, tone and critiqued in the margins of the test booklet. Soon this portion of the test was behind me. About ten minutes into the test, three young men, arose from their seats and left the test center. Was I missing something? The entire test went fine for me with my being able to figure out the “hook” behind each question. It was more like a game than anything else.

At the end of the test, I rode to my lab, checked my experiments and said a “thank-you” to God for giving me a nice day to ride and a clear head. From then on, I was stayed in great shape and kept working out clear up until the last day of medical school orientation. When classes started, I started studying and eating. My study group would feast on Nacho Cheese Doritos as we quizzed each other. By the end of first year, I had gained 30 pounds. My teaching over the summer and second year packed on another 20. By the end of medical school, I had gained 65+pounds and carried that weight around until my third year of residency.

After three years of standing and huffing up stairs, I vowed to get the weight off. I didn’t have two hours to work out daily but I made time for an hour workout even if I lost sleep. On my call days, I would walk the steps. Soon I had a good aerobic base but I am still working on getting my weight lifting back up to my level before. Even today, I work out at least four to five times weekly doing something. My gym opens at 5:00AM so I can get an hour in on the elliptical trainer if necessary.

In short, in medical school, I let my fitness level drop and endangered my health. I am fortunate to be able to get back to my previous level of fitness though the weight is not coming off as fast as I would like. I know that I won’t lose as much weight until I can get my running base back and I won’t pound my knees until I have lost another 20 pounds. That day is coming though.

In short, get a good fitness plan today, if you don’t already have one. It can be as simple as a 30-minute walk after dinner. Keep yourself in good physical condition and take an hour for yourself because you deserve that time. Physical exercise drops your stress level and makes everything in your life hum. I am having some “zone days” now that my physical condition is getting better and better. Having a good physical conditioning strategy is as important to your studies as your textbooks. Get moving.

27 May, 2007 Posted by | MCAT, MCAT preparation, stress reduction, study skills | 2 Comments

Study Skills – Part II

Today is my Birthday!!

First of all, today’s my birthday and I have the day completely off. I have been basking in the warm sunshine (by the pool) and thinking about this post.

 Study Skills

Learning Style
One of the most useful things that I did was figure out my learning style. I am a very visual learner. I love to color-code information and I never go anywhere without my different colored highlighters and multi-colored pens. When I am studying, I use my highlighters to circle information, rather than highlighting words. Each color has a particular significance such as blue represents the main headings, pink represents the words that must be defined and all important concepts are circled in yellow. Green is my check-off color as I check off things as I study. This lets me know what I have accomplished.
Visual learners like to sit in the front of the classroom for less distractions. During my first and second year of medical school, I sat on the end of the third row so that I could see. I was not a front-row person (too easy to get covered in saliva) and I would only sit in the back if I was doing something else (like reviewing another subject because I wasn’t particularly interested in this lecture).

Aural learners will typically sit in the back. These folks thrive on hearing the information and are not easily distracted. They need a good seat where they can see if they need to but most of the time, they don’t look up from their notebook or computer. Aural learners are good at pacing and reciting concepts back to themselves. They are also excellent study group members because they process information as quickly as they hear it. The biggest challenge for the aural learner is making sure that information gets into their “long-term” memory.

Many folks are a combination of both of the above. This is not a bad combination for medicine and medical school. As visual as I am, I tended to make drill tapes for listening when I am doing something like jogging on a treadmill or riding the subway. Sometimes it is nice to hear information organized rather than to keep staring at a page. I would often make a large concept map (on my white board) and then make a drill tape from that concept map.

Tools

Digital Tape Recorder
One of my best purchases was a digital tape recorder. This device enables me to record lectures, notes and thoughts and then download then to my computer. My device is the Olympus WS-100 which allows me to store up to 27 hours of recording. These files are stored as .wma files but I can easily convert them to mp3 for listening on my MP3 player.

Laptop Computer
My laptop accompanied me to class daily. I could download my instructor’s power point lectures and have them ready for adding my notes. This was especially helpful for subjects like pathology and physiology. Couple the power points with digital recordings of the lecture or my own digital summaries and I had a visual and aural review. I purchased a motion detector alarm for my laptop so that it didn’t develop “legs” and walk off.

Cut Text Books
I would take my textbooks to Kinkos after I had removed the front and back covers. I would have them cut the binding and punch three holes in the sheets so that I could place the pages in a three-ringed binder. I would removed only the pages that pertained to what I was studying for a particular lecture or week and place them in a separate (small binder) that was divided by subject. I would leave the rest of my textbook at home. My small 3-ring binder would have each subject for the day, the pages of text and the appropriate syllabus pages. I would preview each lecture the night before and add what I thought I would need for the day.

Multiple Highlighters
I love nice highlighters but I used them as I outlined above. I would circle things; highlight a single word or use them for checking things off. I really didn’t do much highlighting in my textbooks. I kept a pencil box with my highlighters, colored pencils and pens ready for my use.

MP3 Player
This device is as necessary to my studying as my notes. I love to have some music playing in the background when I study. My player has video and radio so I can take a break, catch up on the news and listen to good radio when I am in the mood. I have my favorite songs for every mood and situation. My player is good for drowning out background noise such as subway noise. I generally keep the volume low so as not to damage my hearing.

Study Tactics

Sometimes I can pace and study. I take my notes and just recite to myself out loud. This is especially helpful when I don’t understand something. Sometimes just listening to myself read the concept out loud or paraphrase it, can help me to remember it.

I also question myself or imagine how my instructor will question a particular concept. Some things just lend themselves to multiple choice questions. All of the following are branches of the external carotid artery EXCEPT. Other things lend themselves to True-False or Matching.

My attention span is about 50 minutes so I would set a kitchen timer for 50 minutes. I would study my notes for that 50 minutes and take a 10-minute break. On my break, I would get a drink, move around, get a breath of fresh air but I would do anything except continue to sit and look at a page of notes. When I returned from my break, my mind would be ready to focus.

In terms of avoiding distractions, I would study in Starbucks or study in the undergraduate library. I would be less likely to be interrupted in locations outside of the medical library or in a classroom at my medical school. I tended not to study at home because I wanted my home to be a sanctuary where I could completely relax. I never, never studied in the bedroom. My bed was for sleeping (or extra curricular activities) but not a place to study.

Finally, I got rid of the telly. This device can be a huge time-waster. If you have telly programs that you must watch, tape them and watch them when you have free time. I know that folks are hooked on Gray’s Anatomy, ER and the like, but tape the show and set aside some time on a Saturday or Sunday to watch. This can be your reward for getting the week’s studying done.

25 May, 2007 Posted by | medical school, study skills | 4 Comments

Study Skills – Part I

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.

Computer Skills

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.

24 May, 2007 Posted by | MCAT preparation, medical school preparation, study skills, success in medical school | 1 Comment

It’s Saturday afternoon on call…

Well, it a S-L-O-W call day even though it’s a Saturday. Please note that I spell that word and don’t write it or (gulp) say it. As soon as I say or write that word, all he– will break loose and the trauma bay will fill up. I do love a good trauma but I am sitting here after a nice lunch of Pho (Vietnamese beef noodle soup) and there’ s a little food coma about to set in. I mused with turning on the TV to see if I could catch an Orioles’ game but I just don’t want to wrap my head around anything. It would be cool to just nap for 20 minutes and then check a couple of patients.

My junior residents are not busy so I don’t feel obligated to micromanage them. All of my senior residents have signed out to me and our services are Q-U-I-E-T (another word I don’t say write). My attending on call, has just checked in to say that he’s going to afternoon lunch with his wife and would like to let me know that he is on Mobile. I love it when they do that. It saves me the trouble of paging and waiting for a call back. I can go right to the source.

So far, I have rounded on my service and discharged just about everyone who could go. I elected to keep one gentleman over the weekend because no one is home to be with him and he is a 75-year-old recovering from a sigmoid resection. His daughter will arrive on Sunday night and he can go home Monday morning. Besides, a couple of extra days of watching especially since I am not happy with his food intake will be good for his recovery. My attending agreed with my assessment.

I am also contemplating doing a stairwell walk to get some exercise. When I start to feel the afternoon slump, I walk up the 10-stories from basement to top floor and back to my digs on the fifth floor. Then I look for a fresh cup of coffee or grab a diet Pepsi. There are fountain soft drinks on every floor at the nursing station that feature, colas, iced tea, lemonade and water. The coffee has to come from the coffee bar that is in the cafeteria. Since Saturday lunches are usually not too great, I had my fiance bring in some Pho so that I wasn’t drowning in grease this afternoon. The bad thing is that I can be pretty hungry around 5pm so I need a good protein dinner.

I am also thinking about the logistics of getting to the White Coat Ceremony that my medical school will be having for the incoming medical students. There is usually a nationally recognized speaker and then the name of each incoming student is called. A member of the physician graduates will then cloak the incoming student. We all take the Hippocratic Oath again just to remind us of what being a physician is all about. It’s a great day and loads of fun to see the newest class and catch up with some of my classmates and professors. It’s always a good time. This year, I am going to be buff so I really want to go. The bad news is that I will be making the schedule so I have to be totally fair with time off, if I leave town.

I spent an hour this morning preparing one of my pathology review lectures. I am amazed at the depth of information that I can burn out in a PowerPoint in about 60 minutes. My teaching experience has really helped me in putting together presentations. I am hoping to have all of my lectures done just in case something comes up and I am not able to teach n the days that I have been scheduled. Sometimes a case can run later or a complication will develop and thus, I have my work ready to go.

One of my junior residents just beeped me to ask about making a patient NPO (nothing by mouth). Since this patient is low-risk for surgery today, I opted for “sips and chips” meaning sips of clear liquids (no carbonation and limited to 30 ccs per hour) plus ice chips. If we do end up operating emergently, we can do so after “sips and chips”. One of my attendings allows hard candy with “sips and chips” but I leave this up to the patient. If there is any hint of nausea or vomiting, back to NPO and I will increase the IV rate.

Well, that’s a glimpse of my world at present. I have to get back to studying for my board exams. I have a strict reading schedule that I am adhering to complete with check offs. I may yet do the stairs and take a nice hot shower before the evening rush. On a Saturday night, I can expect some trauma work.

20 May, 2007 Posted by | on-call, residency | Leave a comment

It’s On to Medical School!

You have managed to go through the medical school admissions process and you have selected the school that you will attend. At this point, approximately two months out from actually starting classes at medical school, what are some of the things that you might want to place in order? Graduation from undergraduate is behind you and those wonderful celebrations are over. It is now a good time to look at some of the basic necessities that you are going to need in order to start your freshman year of medical school off on a solid foundation.

Have you found a place to live? The ideal “home” for a freshman medical student should include, a bed (mattress on the floor doesn’t work well), a desk with good lighting (preferably in front of a window), a bathroom with both tub and shower, and some manner of kitchen facilities. If you are doing the “dorm” situation, a small-refrigerator and coffee/tea pot are bare essentials if you don’t have access to a kitchen or kitchenette. Other “niceties” are a sturdy bookshelf for organizing your textbooks, a filing cabinet for papers and notes (2-drawer is fine) and a comfy chair with reading lamp for change of position. A large-sized dry erase white board (60-incher) is good for concept mapping and writing down upcoming test dates etc. You can fall asleep while looking at one of your concept maps. Leave the telly at home but an MP-3 player and radio are good to keep on hand.

You won’t be spending loads of time in your “crib” so you don’t need to load up on creature comforts. You home should be something of a sanctuary but you don’t need to spend thousands of dollars on furniture for your apartment and an interior decorator. You will be basically doing the three “Ss” in your apartment(shower, study and s–t) and rushing out of the door on most days. Even on weekends, you life is going to center around your studies for the most part. If you have a family (or significant other person in your life), then you may need to make more sophisticated provisions but in essence, medical school is going to make your life pretty simple and fairly routine.

Your home should be an easy commute to your medical school. Hours of sitting in traffic or hours of driving to and from school are a very bad idea. There will be days when you are just exhausted and traffic/commuting will be the very last things that you will want to contend with; not to mention having enough energy to hit the books and notes after you have battled traffic. When I was a freshman medical student, I had a 45-minute subway ride into the city each day. I used that time to preview lecture material or just relax and listen to the sounds of my environment. I definitely would not have put that much time into driving. Before starting third year, I moved much closer to school and my clinical rotation sites.

Most of your time will be spent in and around school. You will attend classes and you will study your notes and books in the evening on a daily basis. The more information that you have to remember, the more organized you want to be in every aspect of your life. I planned as much of my day as possible around my classes and study schedule as I became the ultimate multitasker. It was always my goal to get ahead of my professors and stay ahead of them as much as possible. This task became the goal of my organization skills.

If you have an automobile, you need to scout out parking as soon as you hit town. It may work out that you end up parking your car further away from your school and getting a short but brisk walk to school and a secure parking spot that you can count on. At my school, parking was such a premium that taking the subway daily was a better option for me until third year. It just wasn’t worth the money to park or the worry that my car might be broken into as several of my classmates discovered. If you school has safe and secure parking, again, park far and walk more. Your nerves and stress level will appreciate the extra exercise.

On weekends, I would drive into school for sessions in the Gross Anatomy lab or study groups. Since I didn’t have to deal with traffic on the weekends, driving made more sense those days. Having the car also gave me an option of finding a great restaurant for a good meal as a reward for getting my studies done.

I also made sure that I had at least three months of expense money in my savings account for any emergency. Things that might come up would be your financial aid being delayed or an extra expense that you didn’t budget for. I kept a very strict budget and could account for every penny of my expense money. Again, not having to pay for parking saved loads of change for me. I also had the option of working on holidays which added to my stash of emergency cash. I would work any holiday as keeping up with my studies gave me holiday time as extra days. In addition, holiday pay was very very lucrative for me. (I was a registered respiratory therapist with a specialty in pediatric critical care). I did not work during the regular school session no matter how thin the budget was stretched. It was difficult but my studies came first.

During the summers between my first and second year and between my second and third year, I had either a paid position (in addition to my contract work) or a paid fellowship. I would leave a couple of days to do absolutely nothing but I could not afford to do too much vacation during these summers. The summer between my first and second year, I was a peer tutor for our pre-matriculation program. The other summer, I had a pathology fellowship. In both cases, I furthered my career and honed my knowledge which proved great for boards.

Food turns out to be a fair expense for most medical students. The worst thing that you can do is rely on fast food. It has too much fat and you end up paying with your health and energy level. I would limit my eating out to once per week and explored the ethnic restaurants of my city. I would eat Vietnamese, Ethiopian, Jamaican, Thai, Japanese and Cambodian food every Saturday evening. My study group loved to go for breakfast (or Sunday dinner) at a nearby church. We would get a good home style meal and support the community which, loved having a table of hungry medical students. We learned to be very careful because “food coma” could be a major problem after one of these great meals.

If we were studying at one of our houses, we would “pot luck”. Sometimes it would be a mixture of supermarket “take out” but we tried to keep our “study meals” nutritious and non-fattening. The worst thing would be those late night sessions before an exam when the Nacho Cheese Doritos would be out on the table. There is something about crunch snacks that fits well with study time.

Collect your favorite study supplies and stock your desk as soon as you can. I had colored pencils, different colored highlighters and my favorite four-color pen. I also had a large cork board above my desk for pinning notices and sticky notes. My other favorite technique was to cut the bindings off the back of my text books, punch three holes and carry only the pages that I needed to read instead of the entire book. To this day, my pathology text (Big Robbins) is divided into two notebooks. I did the same with my Gross Anatomy text, Pharmacology text and all of my syllabi too. Kinko’s can do this little task for you.

Another essential piece for my desk was a kitchen timer. I kept one in my backpack and one on my desk. I would set the timer for 50 minutes and study for those 50 minutes. I would then take a 10-minute break and back to another 50 minutes. This kept my mind refreshed and kept me more efficient. I would also check off each subject as I studied them. This check-off was more psychological so that my mind would see that I was making some progress. During my study breaks, I would walk around, get some water or just look out the window and let my mind rest. (See the purpose of having your desk in front of a window).

Purchase a good medical dictionary such as Stedman’s Medical Dictionary so that you can look up words and terms as you come across them. I made it a point to look up any words that I did not recognize and keep a running vocabulary list. I also obtained a subscription to the New England Journal of Medicine on-line. I would print out the Case Reports and read them on the subway. The medical dictionary came in handy for these articles. I also learned how to present patients and increased my general medical knowledge. I also read the review articles and any original research that was of interest to me. I would scan JAMA in the library but NEJM was my daily reading in some manner.

Other supplies for me were ringed binders, large coated paper clips, erasers, No. 2 pencils, an electric pencil sharpener (I love sharp pencils) and narrow ruled notebook paper for written notes. I usually took class notes on my laptop computer. I used a mini cassete recorder (I have now replaced this with a digital recorder) for those days when I found myself dozing in class. I would make study drill tapes and listen to them when I walked or exercised.

15 May, 2007 Posted by | first-year, medical school, organization, stress reduction, study skills | 2 Comments

Caffeine, useful or not??

One of my simple pleasures is a fresh-brewed cup of coffee. I love the fragrance and I love the taste of this wonderful beverage. The smell of coffee brewing wafts into my bedroom as I am getting out of the shower each morning (I have an automatic pot). I love to clutch my first cup of the day in the darkness of early morning. That first cup is as consistant to my morning ritual as my toothbrush.

When I reach the hospital, I usually grab another cup (not mug) that follows me through morning rounds. You can see our small styrofoam cups lined up on the railings outside the room of the patient where we are making morning rounds. While the medical student (or intern) is presenting the patient, I am calmly sipping my “Rounding Joe”. When we enter the room to examine the patient, the cups sit on the rails outside for easy access as we move to the next room. There are unit secretaries who will time their fresh pot of coffee when we come on AM rounds. I love those people to death. This is my second cup of the morning.

After AM rounds and delivery of the days plans to the interns and medical students, I head off to the OR for my daily cases. In between cases, I usually sip water because dehydration is more of a problem in the operating room than the need for caffeine. I will usually consume a 20-oz bottle of water between each 3-hour case. The interns will update me on their morning work or any new admissions to the service between (and sometimes during) cases.

In the late afternoon, we will generally round with our attending on service. This is another opportunity for a small cup of coffee. Sometimes a small piece of chocolate will be a welcome addition to this afternoon ritual especially if we are having an afternoon conference. As you can see, I am up to three cups of coffee at this point in my day.

After 4pm, I do not consume any beverages that contain caffeine. I will dring water during my workout and will drink Crystal Light if I feel the need for a bit more than water. I keep a Brita pitcher on my counter and a Brita cooler in my refrigerator. Most of the water that I consume is room temperature but my fiance loves ice-cold beverages. Growing up with an English mother who never “iced” anything for us, has resulted in my lack of need for ice that has followed me into adulthood. If I am drinking coffee with dessert, it is decaffeinated.

When I was a medical student, I often drove into work with a travel mug of freshly brewed coffee. During class, I would continue to sip from this mug until it was empty. I might refill it during a later class or switch to Diet Coke, my other caffeinated beverage of choice. My classmates loved Mountain Dew but too much sugar for me. I never needed the sugar “buzz” to go with my caffeine “buzz”.

We had a Starbucks located across the street from our medical school. This was a great source of fresh coffee for those late evening group study sessions or for taking a beverage break. Again, I would not drink caffeinated beverages after 4pm. My Starbuck’s coffee treat had to be without caffeine. Starbucks was our gathering place for discussions because it was a change of scenery.

At our Mortality and Morbidity conferences, we have a fairly full breakfast available as this conference begins at 7:30AM. For me, this means a half cup of coffee and a bit of fruit or a small piece of quiche. There are also great breakfast breads and bagels too. If I was going to be “grilled” in M & M, at least the grilling would not be on an empty stomach. There are loads of breads, quiche, bagels, fresh fruit and eggs in addition to the Krispy Kremes too (leave those alone).

Caffeine and specifically coffee has been an intergral part of my career. I enjoy tea (Earl Grey) in the early afternoon sometimes or iced tea for lunch but that steaming cup of coffee in the darkness of early morning is my favorite. On a cold winter morning, at 4am when I have been operating all night, I sip my cup of “Joe” on the rooftop patio while I breath some fresh air to clear my head. It’s all good.

6 May, 2007 Posted by | caffeine, general surgery residency, medical school | Leave a comment

The Computerized MCAT

6 May, 2007 Posted by | Uncategorized | Leave a comment