Medicine From The Trenches

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

Taking Stock of the First Semester

For most people in school, it’s the end of your first semester of something. That “something” might be your first year semester of medical school, college, clinicals or even the first half of your first year of residency. With the end- of -year holidays brings a time of reflection and adjustments for most people. My first thoughts are to tell anyone who is doing a first semester “post-mortem” to make sure that you don’t forget that you actually were able to survive your “first”. The next thing to do is to figure out what might need to be tweaked, removed or started. For most folks, no major changes are needed but don’t be surprised at how a small adjustment in one area can reap huge benefits in others. It turns out that life just works in that way.

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.


16 December, 2011 - Posted by | academics, first-year, organization, study skills, success in medical school | , ,


  1. I know this is an post is old, but I just saw your blog recently. The problem I sometimes have with eating lighter meals is that my body tears through the meal and 2 hours later (like clockwork), I can’t think because it feels like my blood-glucose levels are dipping low. I have a diagnosed impaired glucose tolerance, that I haven’t followed up on in many years so I’m sure my issues stem from that.

    I just wish I could eat more responsibly and not lose the ability to focus. Right now, I tend to eat reasonably with regard to fat but go a little too much on the carbs/proteins. I work out regularly (when I don’t have a sprained ankle like right now) so it doesn’t impact me too much. Honestly, my biggest issues come from eating a crappy breakfast. If I screw that up, I pay for it the rest of the day.

    If I have to study later in the day and away from the wife/kid, I usually turn to the fast-food gut-bomb to ensure I can make it a few hours without bonking.

    Comment by Tony | 16 February, 2012 | Reply

    • To Tony:
      You KNOW that you have an “impaired” glucose tolerance which may be worse since you didn’t follow up on your original test. With this being said, you take each hour of each day and choose to eat in a matter that is healthy for your body. Your body doesn’t get food unless you choose to eat it therefore as easily as you choose “fatty/sugary” fast food, you can choose complex carbs and non-concentrated simple sugars that “tank” your blood sugar. Wishes do not make this happen but actions make this happen. You have acknowledged that you have a problem, now take the time and make the decisions that will benefit you most so that your grades (and you health) do not suffer. Good luck.

      Comment by drnjbmd | 16 February, 2012 | Reply

  2. Hi Dr. NJBMD,

    Thanks for your post. I am a first year med school student at an osteopathic medical school. I consider myself a weak standardized test taker, so I would like to start preparing for the USMLE during the summer after my 1st year. What advice/suggestions do you have for me? Should I start doing USMLErx or UWorld questions during the summer? Or go through all the practice questions in the board review series books?

    Also do you know where I can find practice questions to prep for NBME Shelf exams in Physiology, Gross Anatomy, Biochemistry and Histology?

    Thanks a lot!

    Comment by Sandy | 24 December, 2011 | Reply

    • To Sandy:
      You actually don’t have much knowledge base to begin USMLE Step I prep during the summer after your first year. Running questions isn’t going to be as useful as you would believe because you lack at least half of the knowledge base that any reveiw sites would expect you to know. As a result of your lack of knowledge, you become facile at memorizing questions but not actually doing much meaningful preparation for USMLE Step I. A better strategy would be to review your course materials (and any specific subject matter that you didn’t do well in) from the coursework that you just completed to reinforce your knowledge base of the material that you previously learned. Other than the osteopathic manipulations, there isn’t much difference between the basic science of osteopathic medical school and allopathic medical school.

      The question sites are most useful when you have a complete knowledge base. If you believe you DO have that complete base then you would be able to skip your second year. If your school used a traditional curriculum (as opposed to an integrated or systems-based curriculum) then you would be wasting money online question sites. The single-subject prep books for those subjects that you listed above do contain NBME-type questions. Find any one-subject book series that you like (BRS, NMS, High Yield etc) and use those books. Except for Physiology, the other subjects (biochemistry, Gross Anatomy, Histology) are pretty low yield for USMLE Step I. In terms of Gross Anatomy, if you know and understand the “blue-boxes” in Moore’s Clinically-Oriented Anatomy for medical students (Big Moore), you will have more than enough anatomy review for USMLE. Good luck.

      Comment by drnjbmd | 24 December, 2011 | Reply

      • Hello Dr. NJBMD,

        Thanks so much for your advice. I’ve heard from others that to do well on the USMLE, you really have to understand the concepts rather than memorizing a lot of information. How do I ensure that when I am studying for my classes that I am actually understanding and being able to apply the concepts to different scenarios rather than just memorizing information?


        Comment by Sandy | 30 December, 2011

      • To Sandy:
        When you are answering questions on your course exams, can you pick out why the right answer is right and the wrong answers are wrong? Can you see the information that is in between the questions? Can you link new information as it is presented to you in class with information that is already in your knowledge base? I can memorize the TV log or the phone book but does that add to my medical knowledge base? Understanding means that you are able to incorporate, integrate, simulate, synthesize and correlate information as you add it to your knowledge base. There isn’t much regurgitation needed if you get into the habit of looking at the implications of what you are learning. The rest falls into place.

        Comment by drnjbmd | 30 December, 2011

  3. Thank you for this post. I can really relate to it. I often find myself dwelling over mistakes made in the past but I’m finally trying to tackle life one day at a time. I also appreciate the advice you give to your patients about the importance of nurition. I have found that most people actually do not know about the importance of diet and how to choose food wisely when grocery shopping so it is important for doctors to educate their patients and I thank you for doing so.You are an inspirational doctor.

    Comment by 7billiontravellors | 19 December, 2011 | Reply

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