Medicine From The Trenches

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

Textbook Reading in Medical School

Introduction

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.

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28 October, 2011 - Posted by | academics, first-year, medical school coursework, study skills, success in medical school |

8 Comments »

  1. Hello Online, M.D. I am Vasya Dimko a student of the Medical University, Russian.

    I have a few questions for your university namely students, lecturer, teacher.

    Question 1 )
    I am very concerned about the issue for a long time about the learning process at the Medical University USA. I have a great request , could you devote to these issues

    as a plot organized by the learning process at the medical university in the United States , ranging from lectures and practical classes and finishing as the students

    prepare for classes and plan your day. I’m a student who live and study in Russia . I study at the medical university in the junior year . Each lesson we have to learn

    on pages 40-50 textbook for each subject , as such items in 4-5 days . Education is a struggle , with this amount of half of all of this knowledge is forgotten .
    I have heard how our biology teacher who taught temporarily at the Research Medical Center Johns Hopkins University in the United States , said that all of its

    students come prepared for her lectures, workshops prearranged plump reading a book of 700-800 pages. In connection with this I have a question for you , how they

    manage to overpower the book of 700-800 pages per semester we dismantle ? What are the methods and techniques of reading books using U.S. medical university students

    to memorize large amounts of information . As they prepare for lectures , practical exercises and exams. Do they make Spurs ?

    Question 2 )

    How to allocate the time and learn the 20 days set by these medical schools.
    How to read and understand and remember the following books on these subjects
    1) On – Pharmacology
    First book Kharkevich 700 pages in 2005 ;
    2nd Workshop on Pharmacology of 250 pages .
    Learn by heart as 200 questions and 200 prescriptions in Latin , with annotations .
    2) In Microbiology –
    How to read and understand and memorize the book:
    First book in Zverev VV Medical Microbiology in two volumes, 1000 pages .
    2nd book LB. Borisov Medical Microbiology 743 pages
    3rd book AA. Sparrows Medical Microbiology 336 pages.
    4th book Borisov. A guide to laboratory work in microbiology 128 pages.
    5th book Vorobiev. Atlas of Microbiology 214 pages.
    Learn by heart as 600 questions .
    3) Histology
    How to read and understand and remember the following books:
    First book YI. Afanasyev histology , cytology and embryology 737 pages.
    Second Atlas 450 pages.
    The 3rd Workshop on histology , cytology and embryology 360 pages .
    Learn by heart as 820 questions .

    Question 3 )

    I have some problems in school , on the grounds that the schedule of the school day is very overloaded classes. I come from a study late in the evening to prepare for

    the lessons very little time from 1-3 hours .
    At home in the subjects asked a lot to learn , and objects in the week 5-7 . In one subject , by asking to learn every lesson of 30-45 pages of the book , as of 20

    pages Manual of laboratory work , Atlas of 30 pages, and up to 40 slide lectures, and write a summary.
    Many subjects and topics in the head do not fit ( not remembered as not to have to memorize to do on the spur employment) .
    My questions to you:
    A) How to develop medical subjects .
    B) How do you memorize medical books , lectures, and atlases .
    C) Did you make notes from books, listening to audio books if you are on medical subjects.
    D) Did you use flash cards to memorize.
    E) Do you earmark key words , terms, definitions and formulas to memorize when medical books . Or do you write them out in a book, and repeated .
    F) Or did you just read many times as the information itself is not remembered .
    G) Also, how do you properly allocate their time to manage everything .

    Question 4)

    How to learn to read and remember not to be distracted ?
    How to stuff your hands in pharmacology , microbiology, histology.
    Pharmacology I can not write prescriptions, I did not get to learn the recipes , the classification of drugs , remember many of the terms . I was in the Latin

    language assessment 3 .

    In Microbiology – I can not emphasize the most important in the text books of 700 pages . For each class we are asked 45-50 villages on the textbook and 30 pages for

    the workshop . In these books, a lot of terms and definitions is beyond difficult to learn.

    In Histology – This is the case also in addition there should be for each class to learn 30 pages histological atlas and textbook pages 50-65 .

    How to study these subjects (lectures, notes , references ) as to consolidate the knowledge obtained from these studies.

    After this lesson, I come home and check your records and try to remember what we were told in class and lectures. Rather vague memories erased by 80-90 %. Log all too

    do not have time .

    Trying to cook on the Syllabus to the next lesson in the books but the answers to the many questions I do not find . What I’m trying to find something on the Internet

    , in the found information is not accurate .

    I’m trying all the collected information (materials) to the next lesson to learn but the memory to fail . Today Learnt information by 60-80 % in the morning is 5-15 %

    of what you have learned and read .

    I come to class before practice trying to remember something . During the response, you can squeeze out of me only 20-30 % of what you have learned . We have to run

    for teachers and retake subjects.

    The mood of the total 0 .

    Maybe there are those among you who have finished medical university or studying there.

    Please give advice on how to properly learn how to teach the book, lecture notes so you can then recall learned on the machine . How to fix the information (

    theoretical and practical ) .
    How to repeat information . How to properly allocate your time.

    I also noticed that when the lecturer quickly say something as if I fall out of the conversation, ie, do not have time to understand it quickly , thus at the end of a

    memory is 1-5% of the explanation of the occupation.

    Sometimes I ask again type what you said 3-5 times. And I am ashamed of myself .

    Also, while watching the movie. The girl from the movie dictated instructions how to do something and address city houses and apartments at a rapid pace . I tried to

    remember what she said and I did it 5-6 times , only after I twist the record now 5-6 times as long as the film did not remember the girl said the word. This phrase

    was only address city apartments and houses at a rapid pace.

    Also, everything I’m going to pass the USMLE Step 1 exam by a licensed physician in the United States in the coming year . May be among you there are those who have

    passed this way. Is it possible to preparing for exams and learn the language in parallel with the level Beginner, or does not work out . Should I start to read the

    medical literature or grammar should pull a couple of months in a course and learn some words and terms . I barely read one page English language literature Publishing

    Kaplan for 3 days . I subscribed to a bunch of incomprehensible to me words and terms from the text and tried to translate. United all these words in the text and

    tried to bring the translation to the original text , but understood the main essence . Used Google translator and not pocket medical dictionary for 12 Millennium

    words. Speed ​​reading my small for the reason that I have the level of English Beginner. Do I need to pull in parallel with reading or speaking skills at first is not

    necessary. How can I speed up my process of preparation and pull parallel language . As you plan your day for the whole year of preparation. And what are the

    techniques and methods of preparation and fine you know.

    Could this mean that I reject what is ?

    And how to help yourself in these situations?

    Comment by Vasya | 28 November, 2013 | Reply

    • To Vasya:
      I believe that you are asking me how to master a large volume of study materials efficiently? To answer simply, divide your work into smaller chunks and make a list with check marks. As you master each chunk, check off what you have done so that you don’t keep going back over material that you have previously studied before you have looked at everything. As you study each of your chunks, make a summary in the margin of what the mains points of your study would be. If you have been given objectives, then let them be your summary points. After you have covered the material in its entirety, go back to the summary points and see if you can recite them. If you can’t, then review the material again. Don’t make the mistake of believing that you have to rote memorize everything on a sheet of paper. You have to recognize the concepts and know them well enough to be able to apply that knowledge. The key to building a strong knowledge base is repetition and making relationships between the material that you previously learned with the new material as it is presented. Every time you review something that you have learned, you see more insight and you see how the material is linked to new material. This works with anything and any subject. Good luck.

      Comment by drnjbmd | 28 November, 2013 | Reply

  2. Hi Dr. NJBMD,

    Your post was extremely helpful. I am still trying to fine-tune my study skills and habits. You suggest doing the assigned reading before lecture—-would you also take notes on the reading in the text before lecture? Or read the text quickly before lecture and then take notes on the text after lecture?

    Also what do you think about reading from the text for Gross Anatomy? A lot of people say just read the Board Review Series book for Anatomy and learn the structures through the Netters or Rohens Atlas rather than read huge books like Moore’s “Clinically Oriented Anatomy” or Drake’s “Gray’s Anatomy for Medical Students.” My school assigns pre-lecture reading from “Gray’s Anatomy for Students” but I stopped reading it because it was too verbose and took me a long time to get through.

    Thanks a lot!

    Comment by Tom | 6 December, 2011 | Reply

    • To Tom:
      If your school assigns readings from Gray’s Anatomy,then read the assigned readings. You don’t have to read and memorize every word but you should do a quick skim, then read (1/4 page at a time) and recite what you have just read. You can put a summary note or two down on a sheet of paper (see my post on studying and note taking) but don’t read the material as if you had to recite it back verbatum. Do your reading before attending lecture so that you know the “high topics” of each lecture and you know where you can find extra material if needed.

      You then can go to the lecture with some knowledge of what’s important and how the lecture will flow. This allows you to listen to the lecture in a “learning mode” rather than a “reactionary mode” (less efficient). At the end of the lecture, quickly fill any anything that you missed. When you get home, review and learn the lecture for that day. You can quickly preview the previous lectuere (should have already learned this), the review and learn the present lecture followed by your preview work – reading the text- for the upcoming lecture. Review everything learned during the week at the end of the week. By the end of the week, you should know the material cold so that the week before test day, you are just reviewing (not learning).

      While Gray’s Anatomy is very dense, you don’t have to read and memorize every word. Learn to preview -look at the main headings and how the material is organized, read- 1/4 page at a time, review after each section that you have read making a quick summary note in the margin of the book or on a separate sheet of paper. It shouldn’t take you more than 15-20 minutes to do your textbook reading once you get a level of efficiency. Good textbook reading takes practice and more practice. Yes, you will be slow at first but you will pick up steam as you practice. My “review book” for Gross Anatomy was “Baby Moore” Moore’s Essential Clinical Anatomy as the Board Review Books do not have enough information or detail. They are for “review” which you can’t do until you have mastered the material in the first place.

      I always caution students about having a ton of review books around that they are trying to memorize while studying for course exams. Review books are great between semesters (if you are paranoid that you will forget things) and for board review but you have to know your coursework in the first place in order to review it. Good luck.

      Comment by drnjbmd | 6 December, 2011 | Reply

      • Thanks a lot for your post Dr. NJBMD. How do you prepare for Gross Anatomy lab practicals? My strategy is to first study all the structures we need to identify in lab in a Netter’s Atlas, then I take my Netter’s Atlas and go to the cadaver and see if I can identify everything. Is this a good strategy for studying for gross anatomy practicals? Also what did you do to prepare before gross lab? We are usually assigned reading from Grant’s “Dissector.”

        Thanks a lot!

        Comment by Tom | 7 December, 2011

      • To Tom:
        There is a post on this blog with details about preparing for Gross Anatomy exam.

        Comment by drnjbmd | 8 December, 2011

  3. Just what I needed.

    Comment by Everyday In Medical School | 6 November, 2011 | Reply

  4. Dr.nj, I’m a high- school senior and I need an interview with a doctor, because I was assigned to write a research paper about my proposed career (pediatric surgery). It would be an honor if I could have the opportunity to interview you by email and ask a few questions

    Comment by Demetra Mensah- Bonsu | 4 November, 2011 | Reply


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