Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Academic Excellence

For many people in both medical school, graduate school and undergraduate school, this is the beginning of the second semester (or quarter). If you are new to your academics, then you finished the first semester/fall quarter with some academic achievements (good or bad) and learned some things about yourself. Since this blog is about strategies for success in medicine (getting into medical school, staying in medical school and other things associated with medical school), I though I would post a note or two about making changes that can enhance your Academic excellence.

Doing well in academics is something that can be mastered with practice. It comes out of having a strong and solid approach to what you have to master in terms of knowledge and it comes out of having a high comfort level with the learning process. If you always feel that you are somehow “not going to be able to get everything learned” or that ” the course is too hard”, then your beliefs can become a self-fulfilling prophecy. There is no task, no matter how great or how formidable, that cannot be approached by taking small steps every day until it is conquered. You have to be willing to “chip away” on a daily basis and note your progress on a daily basis in order to see that you are handling the larger task in smaller steps.

 Let’s take Organic Chemistry for as an example. At the beginning of the year, your professor hands you a syllabus that outlines the lecture schedule, laboratory schedule and exam dates in addition to what is expected in terms of how you will be graded in the course. Usually your grade is the result of your grades on some combination of exams and projects. Armed with this information, the first thing that you need to do is make a master subject calendar of lecture topics and test dates. Also include things like “one week to Exam 1 ” and “2 weeks to Exam 1” along with “3, 2 and 1 week to project due”  so that when you look at your calendar daily, you know exactly how much time you have to master the knowledge for the material on your exams/projects.

The next thing to do is look at your reading and problem assignments each week for your lectures/topics. Some topics have many problems and some don’t have so many problems. Divide and conquer here by looking at the amount of time alloted for each topic. This should give you a good idea of the importance of each topic. Your textbook is a good resource in terms of looking at how much time and space it devotes to a particular topic. For example, look at functional groups of organic compounds. This is a topic that can be divided into families with the simpler families being presented first and the more complicated families being presented later. You can use your text to add upon your knowledge base.

The other thing that you want to do is be sure that you are prepared for each lecture. Don’t go to class with the idea that you can sit there, listen to the lecture and learn what you need for mastery. You need to know something about the topic before you hear the lecture. The best way to do this is to read about the topic before you hear the lecture so that you know something about the items that will be presented. Don’t every walk into a lecture “cold” as 50% of your actual studying can be done in your preparation for you upcoming lecture. The other 50% comes in your digestion of both the reading and lecture in addition to any problems that were assigned.

A point about problems and problem solving. With any problem that you are given, try to figure out what learning concept is behind the problem. For example, look at the wording of a problem and then review the concept that applies to that wording.  Consider the problem, in diabetic ketoacidosis, glycerol is primarily used for what? To answer this problem, you need to know something about the biochemical derangements that take place in diabetic ketoacidosis. In diabetic ketoacidosis, the patient is acidotic which implies that ketone bodies have been released and have lowered the pH of a patient’s blood. What else do you need to remember? You need to remember that while the blood sugar is high, the patient does not have adequate insulin which allows glucose to enter the cells and undergo glycolysis and be used for fuel. That leads you to thinking about why the ketone bodies are out in the blood stream in such high quantities in order to cause acidosis. This because the brain primarily, needs to have a constant fuel supply and in the face of a huge amount of glucose in the blood, none of it can be used by the brain because there is no insulin to allow the brain cells to take up the glucose. Now what do you need to know about diabetic ketoacidosis in addition to the above and that is that fat is being catabolized into acetyl Co-A that is being used to make the ketone bodies and that the fat comes from the breakdown of stored triglycerides into fatty acids and glycerol. The fatty acids can undergo beta oxidation to acetyl Co-A and then shunted into ketone bodies but the glycerol goes to the liver as a substrate for gluconeogenesis or the making of glucose. In the face of large amounts of glucose in the blood, the diabetic can’t use that glucose to feed their brain and thus they are making more glucose in addition to ketone bodies which are acidic. This is the concept behind this problem and why you need to approach problems like this or questions like this from many different angles rather than just memorize the answer.  You have to be able to master the concepts so that in any manner you are questioned, you can figure out the correct answer not attempt to rely on you memory.

The next thing that you must think about is that you have all of the tools that you need to master your coursework under the conditions that work best for you. Don’t compare yourself to anyone in your class. Some people are visual learners (tend to sit in the front of the class) and some folks are aural learners (tend to sit in the back to avoid aural distractions). Most folks use a combination of both visual and aural and thus learn best when they utilize both methods. If you are a visual learner, then make a brief outline of the material to be covered in lecture and take a note here and there. Don’t try to write down every word that the professor says but watch how the material is presented and fill in your notes later. If you are an aural learner, listen to the lecture and take a note here and there. Listen for inflections in the professor’s voice. Listen for key phrases such as “in summary” or lists of important topics. If you worry that you will miss something, take a small digital recorder with you and record the lecture. You can then upload it to your lap top and it’s there if you need to review concepts.

In short, if you have managed to get through first semester, you have every tool that you need to excel second semester. You may need to adjust some of your study habits or you may need to fine tune others. The important thing is not to dwell on what anyone else in your class does but to do what you need to get the results that you want. There is no class invented that could not be mastered because after all, someone had to come up with the facts and concepts for the professor to present. Don’t go into any of your courses with preconceived notions that the course is too “touch” or is a “weed-out” course. The coursework is there for you to master and you have to figure out how you will master it.

Another common mistake that many students make is relying on their perceptions of the professor’s like or dislike of them personally. No one who is lecturing actually cares about you as a person. They don’t have a personal relationship with you, and if they do, it doesn’t matter in terms of the presentation of the material to be mastered. The material is there and it doesn’t care about you or the professor or whether or not you “like” or “dislike” the subject matter. If you spend the dollars in tuition, then that alone should be enough for you to have a vested interest in mastery of the material that is presented. In short, you need to get your tuition dollar’s worth out of this class for whatever reason. Whether you “like” or “don’t like” the way the professor talks, looks, or anything else has no relationship to how you deal with the material that is presented. The professor is not your main source of knowledge but someone to help you navigate (by their experience) though mastery of this class.  

Finally, you can decide in this very instant, that you will change your “thinking” in terms of how you approach your coursework. You can approach your coursework from a point of fear and trepidation or you can approach your coursework from the standpoint of “hit me with your best shot because I can hit it back and score”. You can decide to toss old habits of trying to “cram” at the last minute and replace them with solid organization and daily study. You can decide that you will either adapt a lifestyle and study style that will allow you to become an excellent scholar or you will continue to do what you have been doing that doesn’t get the academic achievement that you want. The key point is that you are the complete master of your thoughts, actions and reactions.


5 January, 2008 - Posted by | academics, difficulty in medical school, medical school coursework, medical school preparation


  1. Dr. B, I agree with most of your ideas behind academic excellence, but based on my own experiences, I would expand it for some people to being a product of hard work/good preparation, talent, and luck/fate. All of these may work to varying degrees and in varying combinations for people, often varying from one learning situation or class to another.

    For example, your OChem: Some students are “naturally” good at the concepts that underly organic chemistry (and chemistry, for that matter); when material is presented to them, they seem to “get it” right away. Perhaps this is due to both previous preparation and/or a “natural talent” for organic chemistry or chemistry. Other people struggle through organic, memorizing pathways and reactions without seeing or understanding the underlying fundamental principles. Even those students who do understand may still complete the course with less than top grades.

    Lastly, there is the luck/fate factor. While educators may dispute its existence, to some degree how one does in a course may also be affected by luck. I can use my experience in Advanced Physics for Scientists and Engineers as an example: The professor handed out a take-home test meant to be done by oneself without discussing or using another person’s help. It was fiendishly difficult, as most take-home exams are, and I did my best based on what was presented in class and in our textbooks, but I did not get any help from another person as required. I got a D on the exam. Later, the professor confided in me that he believed that I was one of only 2 students who did not cheat on the exam. In looking over the other students’ responses, he believed there was widespread cheating but could not prove it. In turns out, he was right: After handing back the test, other students admitted among themselves (after the professor left the room), that they had indeed cheated and copied each other. Later, I complained to the teacher about the cheating, but he refused to do anything. So, while I did get A’s on the next two exams, my final grade in the course was a B.

    This luck/fate factor also relates to non-academic situations as well. I will post more about this a bit later.

    Comment by Xoco | 23 August, 2012 | Reply

    • To Xoco:
      At the university that I attended, our honor code would not allow us to NOT report cheating if we knew that it existed. If your professor did not investigate your information, you need to take your information to the next person in the chain of command. You should always put your information in writing and CC the chairman, dean etc along with the professor about the situation. I know that if I had observed or even heard claims of cheating, I would have been honor bound to report these things in detail.

      As for “natural” ability to memorize or do anything else, some people will be more efficient and some people will have to take more time but there is no academic course that may not be mastered with the proper approach. If a human being designed the course, another human being can take the course and master the material. At the first sign of trouble with coursework, the instructor is always your first contact. Even if you are doing well, meeting with the instructor on a regular basis to test your understanding of the material is not a bad idea. My instructors knew me quite well, not because I struggled but because I wanted to make sure that I was on track and stayed on track.

      What one student does (or does not do) has no effect on your performance. You have to do what works best for you without exception. I always had the ability to “tune out” others and do what I knew was best for me. This wasn’t “luck” but careful and very deliberate planning for my studies. Believe me, my first math course in university was Multivariate Calculus (Calculus III) followed by Differential Equations and Applied Differential Equations (I had a math minor). Most of the folks in my classes were Math/Engineering folk who were as determined as myself to make sure that our math was a useful tool for our understanding of Engineering and Science. To that end, we went for mastery and practical use rather than a particular grade which made the class interesting and fun. Good luck.

      Comment by drnjbmd | 23 August, 2012 | Reply

  2. Thank you for the excellent response. Would it be possible for you to include some snapshots of how you organize your notes and create concept maps. I am in the process of implementing this into my learning and would appreciate the launch pad. Again, thank you for this wonderful resource!

    Comment by Dan | 19 January, 2008 | Reply

  3. To Dan:
    You always retain more than you thing you are retaining. Use a check sheet (make study goals for each session) and check as you review something.

    I am a huge advocate of organization of any material to be studied. I break everything into 50-minute chunks (my attention span is 50 minutes). I used to set a kitchen timer but now I know how much I can cover in that time. After each 50-minutes, I would check of what I had reviewed and then take a 10-minute break (walk outside; get a drink of water etc). I would then come back and go to the next block to be done.

    There is something about seeing those checks that helps you to see some progress. I also try to be active in my learning process in terms of pacing as I review something; writing a concept map on a large white board; making a list of key terms for end of day review.

    If you are a visual learner, the concept map (enhanced with colored markers)is a great tool. I would say take an organ like the gall bladder. I would write the parts of the gallbladder in black but put the blood supply in red and blue. I would do the same for the liver; then the stomach etc. I would just draw lines connecting the arteries with the organs etc.

    In short, make your learning active and don’t just attempt to memorize lists of things. Make any list have meaning such as Right Coronary Artery gives off: anterior rt atrial branch which gives off branch to SA node; right marginal branch which runs inferior and supplies the wall of the right ventricle; posterior interventricular branch which runs inferior in the interventricular sulcus.I would look at the Netter plate and see this artery and it’s branches and where they run. Look at Plate 214 (3rd edition) and see the right coronary coming off of the aorta and look at where the branches come off. Try to make a schematic on a white board of the heart in the RAO view and picture these branches. Look at Plate 212 and add in the venous drainage etc so that if you are asked a question on either a lab practical or written test, you can visualize how these branches run. Also be sure to follow these vessels on an actual heart so that you can get a three-dimensional idea of what is going on here.

    Comment by drnjbmd | 14 January, 2008 | Reply

  4. I really appreciate your approach as I am also a very visual learner. Can you provide some detail about your actual study process. For example, I have been studying the past 2 hours on Gross Anatomy. But, when I look at how much I’ve learned based on the time spent, I feel I am not using my time to my advantage. Therefore, there must be something in how I approach the material upon memorizing the details. Thank you in advance for any tips!

    Comment by Dan | 14 January, 2008 | Reply

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