First Semester Advice: Studying for different classes

In my opinion, what's harder than learning the presented material in the first semester is determining the best study strategies to master the material.  A good baseline is to continue to do what worked for you in undergraduate and make adjustments from there.  I like to condense the lecture slides into 1-3 pages on blank sheets of paper.  Sometimes this takes up too much time, and takes away from review, which hurts my score sometimes.  However, after I review the notes I created 3 or 4 times, I feel that I have a thorough understanding of the material.   This ensures that I am connecting the information and it makes it much easier for later review and quickly finding out information when doing practice problems.  Any major diagram I draw out.  It took me a while, but towards the end of first semester, I realized that I'm a much more visual learner than I ever would of imagined.  I had taken the assessment test for learning styles and visual was never top of the list, but through experimentation I realized that diagrams stick in my head the longest.

Whatever you study strategy is, just make sure you are actively studying.  Don't simply read through the slides over and over.  Add notes in the margins, create questions, create diagrams, flowcharts, make connections between other lecture materials, etc.  A good measurement is that when you're studying and your mind is elsewhere, thinking about music, dinner, classmates, etc.  than you're probably not actively studying. 

Also make sure you are group studying at least one time a week.  The group I like to study actually has sections every night from 7-9 where we recap what was presented during lecture.  I don't go every night, but it's nice to have that option.  Many times you will feel like you're "not ready" to go to group study.  Don't worry, you never will be, it is an opportunity to feel in gaps in your learning, not for you to prove how smart you are.  Actually the times I've felt the dumbest in group are the times I've learned the most.

I've been asked to write on the best study methods for each class, so I'll try to describe which methods gave me the best results for first semester.

Anatomy:

Anatomy will undoubtedly be the subject that takes up most of your time during first semester.  Initially, I made the mistake of seeing the 3-5 hours of anatomy lab as time taking away of studying for lecture material.  It took me a while to realize that the best learning from integrating lecture material while actually finding and touching the structures in lab.  Anatomy lab practical are only worth 5% of the grade, while the mini exams are about 12-20% of the semester grade.  Therefore, it's easy to fall into the trap of thinking that more time should be spent in the books rather than at lab, but the students who do the best on the mini exams, which include many anatomy questions, are those who are also do well on the Anatomy lab practicals.

The most effective learning will come in the anatomy lab.  Be prepared for dissection by watching the prosection videos a couple of times.  Making a quick and simple drawing of whatever body part we were dissecting helped me to visualize and remember where the nerves, vasculature, muscles, etc. should be.  Consistently go into the anatomy lab.  I got the best results when me and a friend went in Saturday mornings and reviewed the dissections we did for the week.  Be able to identify the same structures on different bodies, as you never know which body will be used for the practical exam.  

Biochemistry:

I had success drawing out pathways or making flowcharts.  Know the rate-limiting steps and where a disruption in the pathway would likely cause pathology.  Also, go to Smolanoff's office.  He has many slides, many which aren't important, but pay attention to what he emphasizes or repeats during lecture. Know your amino acids, which ones are basic, acidic, hydrophobic, hydrophilic, etc.  There are mnemonics you can find from a google search.  Don't worry, organic chemistry, will not play much of a role.

Microanatomy/ Histology:

Repetition, repetition, repetition.  Microanatomy can be very detailed, so be sure to pay attention to any bolded or color text in the lecture powerpoints.  You simply have to keep going through the material, start with understanding the overall picture and gradually add more and more detail.

Physiology:

I like Physio, because it is very conceptual.  There is not much memorization involved, as opposed to Anatomy.  I liked supplemental sources such as BRS or Khan Academy for Physio as they presented the same concepts in different ways.  Not as much repetition is necessary, once you understand the concepts.

Behavioral Science:

This is the easiest subject, the "marshmallowy" topics of medicine such as be kind to your patients, treat them with respect, listen, etc.  Also some of the social work, sociological, and cultural aspects of medicine. This subject can be a gift or a curse.  I do best when I tackle these lectures first, and make sure they are reviewed early on when studying for a mini and also right before the mini.  The questions are generally easy, but it is easy to just put off studying for behavior science and lose easy points. 

First Semester Advice: Study Materials

Here are a list of books I would recommend from first semester, you can likely buy these off someone currently on the island, there is a "RUSM Craigslist" on facebook that you should search for and join.  If your prefer electronic books, you can easily find someone with these books on a hard drive.  These books are also available in the library for check out for two weeks at a time.  I haven't used many books, as all the information you need for the exam will be on the professor's powerpoint slides during lectures, however if you can fit in the time, reading the supplemental books will help to cement the concepts presented and improve your understanding.

Review Books:
First Aid for USMLE step 1: Considered a necessity for STEP 1 exam by most students.  It is very broad with limited detail, however it is a good guide to determine what is the most high yield information.  As you progress through semesters you should annotate the book with your own notes.

BRS:  I would recommend this series for any subject.  It is a series with small books for various subjects (Physiology, Behavior Science, Biochem, Anatomy, etc.) with detailed questions and great explanations.  These questions are more difficult than the ones you will have on exams, but it is good for reviews and testing your knowledge.

Anatomy:
Clinically Oriented Anatomy: Buy it. This is where many of the lecture slides will be from, as this book includes the clinical correlates that the professors like to ask questions about.

Grant's Dissector: Buy it.  This will be your guide for anatomy dissections.  There will be copies in the Anatomy lab to look at.  However, it is good to have your own copy so you can read ahead before dissection begins.

Netter's Clinical Anatomy: Buy it.  This is the Gray's Anatomy for our generation.  This book contains great drawings that professors used during exams and during lectures.

Netter's Clinical Anatomy Flashcards:  These are great for quick review and repetition.

Biochem:
Principles of Medical Biochemistry (Meisenberg):  Dr. Meisnberg is a Biochemistry professor, so many questions come from this book.  It is also concise and well written, and will be utilized throughout your time at Ross.

Microscopic Anatomy:
Langman's Medical Embryology: Small and excellent review book for embryology.  It will definitely clear up the lecture material.  I rented it from the library for the embryology lectures, however I would recommend buying it.

Youtube Channels:
I find that youtube videos can serve as a quick broad introduction to different lecture materials
Khan Academy:
Has videos on many medical subjects in collaboration with Stanford University.

Anatomy Zone:
3D videos on various neurovasculature, muscles, bones, etc.

Armando Hasundugan and Handwritten Tutorials:
Easy to replicate, handwritten, short videos covering most subjects.  Good for previewing organ systems and understanding the overall picture.

Ipad Apps:
Essential Anatomy or Human Anatomy Atlas 3D:
I've never used these apps, however I've heard great things about them.  Essential Anatomy has slightly better reviews.  Good for 3d visualization of the structures you will be dissecting

iAnnotate:
Must have for those planning on taking notes with their apps.  I also use it when doing the professors' practice questions, as it saves the annotated files, so you can easily go back during exam or finals time and review the questions you got wrong.

Other than these, I haven't looked at any other books, so I can't speak on them.  I hope this helps some.  Subscribe to receive a notification whenever new blogs are published.

First Semester Advice: Orientation Week

I am writing this post based on the suggestion of a reader, once again feel free to email me at theblackjacksparrow@gmail.com with any questions or suggestions.  I'll attempt to create a series of post geared towards the incoming first semester students.

I will start off with saying that entering medical school is undoubtedly one of the biggest decisions one may make in their life, and it comes with a great deal of pressure, expectation, or anxiety for the future, especially when entering an international medical school.  It is important not to look at medical school as a means to an end of becoming a licensed physician, but look forward to enjoying the journey, as most can look back and realize that the four (more or less) years of undergraduate work was not as long as it sounded when first going into college.

Your first experience on campus will be a week long orientation of things such as tours around campus, introduction to the printing system, school administration, etc.  This week and the week before it (if you choose to come to the island the week before orientation starts) will be accompanied most days by an island excursion that is organized by the school.  I would definitely recommend attending these tours, as it will be the best opportunity to meet your future classmates.  This will be the time where people are most open to meeting new people and are unoccupied with major studying obligations.

AMSA Suture Lab

Suturing is a practice that all doctors must learn, not just surgeons, as suturing is done by general practitioners as well to assist in the closing and healing of a wound.

 Yesterday, AMSA (American medical student association) put on a beginner's suture lab for its members.  The instructor was very helpful and was previously a medic in the Army, so he had plenty of experience.  We had a chance to suture pig's feet together after making an incision longitudinally.   I learned how to tie a basic surgeon's knot and to put in basic horizontal sutures.  I also was able with some help to do  vertical and horizontal "mattress" sutures, which are used for deep subcutaneous gashes.

 

In the short hour and 20 min. I found myself getting better, and lost track of time doing the sutures.  It is an important skills, and like anything else must be improved with much practice.  I can assuredly
say that suturing pig's feet is much more fun than eating them.

High Fructose Corn Syrup

The seemingly unavoidable chemical that's slowly crippling the health of many in America is high fructose corn syrup.  Simply paying attention to labels on what they eat will lead the average American to realize that he's consuming large quantities of this sweetener.  The The Omnivore's Dilemna is a book that provides an in-depth account and cause of the drastic switch in the American diet.  It mentions the governments' subsidizing of corn as the primary driving factor for the surge in high fructose corn syrup additives.  Since the farmers were getting subsidized for their corn production, they produced more of it than ever before.  The sugar accumulated after processing the corn is higher in fructose than naturally found in most foods.

The potential problem with high fructose is its quick metabolism.  As opposed to glucose, fructose  must be phosphorylated before being broken down to be used for glycolysis.  This leads to the usage of phosphates on fructose that would otherwise be used towards making ATP for energy.  This causes a decreased metabolism.  Additionally, fructose bypasses PFK-1 controls in the liver, which are responsible for converting glucose to glycogen (branched form of multiple sugars) for later use.  Instead of being converted to glycogen, as is the case for glucose, fructose is stored directly as triglycerides (fats).  These two components are causes for the increase in obesity seen in America, as most diets are composed of fast foods and processed foods with elevated levels of high-fructose corn syrup.  Granted, fructose is high in naturally sweet foods such as fruit and honey, these were historically seasonal treats consumed in moderation.  In addition, these natural foods are not high in calories, so they are not as readily converted to triglycerides as high-fructose corn syrup added to foods already dense in calories; the ratio of sugars plays a role in metabolism.  Our body has the mechanism to compensate for low levels of fructose, however this drastic increase in  high-fructose corn syrup to most processed foods is leading to a health care crisis.

Glitch in the Matrix

A few things I’ve learned or reaffirmed for myself the last few weeks:

·      Habits and routines are the buffer for periods of low willpower

·      Exercise is the best start to the day

·      Tomorrow never comes

·      Medicine is a calling

   Just trying to get back on a steady schedule.  The last few weeks have been fairly unproductive for me.  After being disappointed by my last test score, it led me to reevaluate how I’m spending my time and what I want my schedule to be like in the future.  However, the scheduling part kind of got neglected.  I usually am most productive when I know what I want to accomplish that day.  Beginning the day on a whim more often than not concludes in a mediocre day as I did not have any idea of what I wanted to accomplish that day and therefore no gauge of it the day was successful or not. My best days begin with exercise in the morning.  In the morning, because otherwise I feel like it will take up too much time out of my day at night or afternoon.  In the morning because it leaves me liberated during the afternoon and night to accomplish what I want to without any interruption.

   

I began to stay up really late and wake up when my body felt like it.  In reality, I was afraid to set expectations in fear of not reaching them and thus avoiding the disappointment of setting those goals.  It’s been said that each action is done in an attempt to avoid pain and gain pleasure .  Thus in neglecting my scheduling it was a physiological trick to avoiding dealing with the disappointment of not reaching a set goal.  You can’t fail to reach a goal you never set.

    

One mistake I made was reading part of the four-hour workweek by Tim Ferris.  Not the best book for someone in my position.  It served as a quick reminder of things that I would not have the opportunity to do as a medical student.  It was slightly disheartening hearing about someone talk about designing a lifestyle that allows for 4-hour work weeks and his adventures traveling to various countries and mastering different hobbies all while running a business from his laptop.  And I am looking forward to 80 hour weeks in residency, long nights on call, and days being subjected to rapid-fire questions commonly known in the medical profession as “pimping”  by attendants.  This thought, albeit selfish, lingered for a while.  Would I have time to dabble in writing, travel, try potential business opportunities, piano, learn Spanish?

  

It was then reminded why I got into medicine in the first place.  Learning about fascinating advancements in medicine daily and the complexity of the body. Dedicating my time to helping someone restore their health gives purpose to my time at “work”.  I enjoy what I’m learning in the classroom and during clinical activities and look forward to implementing these teaching on actual patients.   

  

Well, back to studying…

Testosterone Replacement Therapy

Testosterone Replacement Therapy has been a subject of much research and use among fighters and the general population.  Recently, a top condender, Vitor Belfort has been missed out on a title shot for use of TRT which has recently be banned by the Nevada athletic commission.  Other fighters, such as Dan Henderson and Chael Sonnen have also been affected by the banning of TRT.

The increase in use has had mixed receptions from those who just want to see exciting fights at all costs to those who believe that TRT diminishes the integrity of the sport of mixed martial arts.  Many times the acceptance of drugs such as TRT are accepted based on the quality of marketing.  Their marketing scheme has made TRT be perceived as something other than steroids, which it is.  Testosterone is a major steroid that contributes to the secondary characteristics that are associated with men, such as: sperm production, sex drive, large muscles and deep voices.

Many of the commercials on TV market towards those with decreased libido.  The question "Are you suffering from Low T?" has become more and more popular.  TRT has become big businesses, and the prescription of this drug for decrease sex drive has become an increasingly accepted form of treatment.

One effect of TRT is the increased production of RBC's, which is initially a good thing for those in MMA, as they will have increased oxygen flow thus increased stamina, which can be a great thing when standing toe to toe with someone trying to take your head off.  However, this also increases the volume of the red blood cells that the heart must pump throughout the body, and this may lead to a deadly combination especially when considering how physically fatiguing MMA can be.  An article in the "Journal of the American Medical Association" even reported an increase of 30% in deaths and heart attacks in older men.  However, these results are disputed by various sources such as in this Harvard article.  TRT

Should TRT be banned in the interest of promoting fair competition or the in the interest of preventing cardiovascular problems?  Will the banning of TRT simply lead to the advancement of the use of similar, possibly synthetic hormones?  Should contact sports simply just be a laboratory for the advancement of human performance, do you as one comedian put it... "just want to see a MF fly."