Study Tips for First Year Medical Students

Yesterday was my first embryology lecture of the year to the new MS1s at Baylor College of Medicine, as well as the PA, DNP and Genetic Counseling students. For years, I’ve been including a few slides at the end of each lecture to help with the transition to medical school. Yesterday’s lecture ended with tips on how to study. I promised the students I’d share these slides in a written formate. I realized sharing them here might be the most appropriate way to do that!

Medical school (or any high volume graduate school) involves a dramatic change from what students have previously experienced. As you know, if you read this blog, I believe there are a lot of “tools” that can help students “thrive, not just survive

The biggest change for many students is it really isn’t about the grades anymore. It’s about studying for the patients you will be caring for in the future. That means really learning the material, not just knowing it for a test.

Even though there is still a lot unknown about how the brain works to learn material, what is certain is that it is a physical process. You create new synapses when you experience or learn new things. As they are repeated, these synapses get stronger and stronger.

So, to organize the advice, I’ll share some basics, some specifics and then a little refinement.

Learning this volume of material at this level of complexity is about consistency. You can’t run a marathon by running 20 miles every weekend. This is no different. You need to study every day (except one). One of our great teachers at Baylor, Dr. Clay Goodman, tells our students that they have signed on for a 60 hour a week job. (which roughly means 1-2 hours of studying for every hour in the classroom). If you map out your week as a 60 hour job, it will work a lot better than ever trying to “catch up.”

The SQ3R system is the best system I know to learn what you need to know during the basic sciences. So, how do you translate the SQ3R system into practice?

The night before lectures, spend 30-40 minutes skimming the lectures. No “studying”. Be curious. What questions are going to be answered during the lecture? How is it organized?  (BTW “Mike” is a fictitious patient with muscular dystrophy that Dr. Goodman uses in an introductory lecture to show how everything you learn in medical school matters – from the DNA to the psychosocial context of the family)

This 30-40 minutes is basically the “S” and “Q” of the SQR3 system.

  • SURVEY to get the big picture
  • QUESTION = what questions are going to be answered during the lecture? What else do you want to know to really understand this? (write them down!). Do not try to look up anything now.

During the lecture stay ACTIVE. Don’t sit in the back row and look at FaceBook – even if the professor is reading the slides.* You’ll need to take notes for this to be really active. Put the questions you want answered on an outline you prepare the night before lecture and fill it in during the lecture. Use mind maps or other powerful visual aids to learn. Click here to get to my post on taking notes during basic sciences.

*(If you are a lecturer who does this, stop it! – otherwise you are guilty of “death by PowerPoint.” Find someone who is a good lecturer and ask them to coach you.)

After the lecture, you move on to the 3Rs. Now you get down to the real studying. Read through the printed notes (or slides). Did everything get answered? MAKE NOTES that synthesize what you learned.

Review. Review. Review. Here’s the deal. Medical school is a lot like learning a new language.  The first part of basic sciences (anatomy, physiology, embryology, etc) is learning the vocabulary. The second part of basic sciences (diseases, pharmacology, etc) is learning the grammar. When you get to the clinics, you are practicing the language until you are fluent. “Flash cards” such as Anki are great at learning “vocabulary”. They are terrible at synthesizing and learning connections and concepts.  That’s why you need a single page summary of every lecture. The summary is the “forest”, your notes (plus or minus flash cards) are the “trees”. If you really want to succeed, you need both. BTW, I made the class repeat (out loud) after me (twice) – “You cannot learn medicine from Anki alone.” (It’s on tape. I really did this.)

Here’s an example of a single page summary of the embryology lecture I gave the class yesterday. I spent time to make this really look nice – more time than you will want to spend. It doesn’t need to be typed, it doesn’t need to be particularly legible to anyone but you, but take the time to do these summaries!

Did I already mention that you need to review?

This is probably the single most important slide I show when explaining how to best study in medical school. It’s the basis of many apps in medical learning, including the NEJM Knowledge+ courses. There are two really important points in this graph.  First, it takes at least 5 repetitions to really learn something. Second, they have to be spread out in a logarithmic fashion over time.

Here’s how to do it. The first three repetitions should be same day, next day and 2-3 days later. The more times you review it, the better, but it should at least be 1 week later and 3 weeks later.  More is better.  Plan another review a month later and three months later, too. For the Type A folks in medical school (i.e. all of you), make a spread sheet!

 

Another thing about our brains and learning.  Pushing through for hours without rest is as stupid as thinking you can build up your biceps by doing an hour of uninterrupted reps. Speaking of reps… use “study reps”. Get an app if you think it will help. 50 minutes of studying.

Stop studying for 10 minutes (no matter how engrossed you are) when the alarm goes. Repeat.

People sitting next to you in your study areas are going to look like they have it more together than you do.  It might be true… but it probably isn’t.  If someone has a study technique that looks like it will work for you, by all means try it!  Just don’t change too often. I was a liberal arts major in college. If you come from a non-science background, the first 6 months are going to be a little tougher on you because you have more “vocabulary” to learn but don’t worry, after that you’ll be caught up,

Read this slide. Believe this slide. The most important point on this slide is the last line. You cannot make those physical synapses you need to really learn without 8 hours of sleep.

Keep notes about what works for you and what doesn’t. Everyone is a little different, but you will find a system that works best for you through conscious effort.

It’s like running. Some of this is just “time on feet”. Remember the 60 hours a week job concept and you’ll do fine.

I end with this slide to remind my students that there has to be balance for this to work. Most of what I tell my students about finding and keeping that balance is in this blog, so feel free to use the word cloud to the right or search for what you might need. Please contact me if you have a specific question I can answer or if you have an idea for a new blog post.

Welcome to the best career in the world! We are all happy you are here!

 

 

 

 

 

Top Ten Tips on Starting Medical School

Starting medical school is one of the most exciting moments in a physicians career… but it can be a little daunting!  This talk is one I gave recently to the college students in the Baylor College of Medicine Summer Surgery Program.  In addition to talking about how medical school is different from college, I also included my top 10 tips for successfully making this important transition.

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How To Study in Medical School

Congratulations to all the first year medical students who are starting or getting ready to start medical school.  As you will soon seen, from day one there will be an overwhelming amount of information to process and learn … much more than any you have seen during college. It’s going to take a new strategy!

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Unlike college, the information you learn during your preclinical studies will be important when you take the first part of your licensure examination (Step 1) and when you start your clinical rotations in 2 years or so, and when you start your residency.

It’s not just about learning this information for your exams, it’s also about creating a system to organize this information for the future.

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What should an ideal system let you do?

  1. Hand write or type your notes
  2. Highlight and annotate notes to make them more easy to remember
  3. Import images, pdfs, powerpoint presentations or other digital information
  4. Review the notes on your phone or iPad as well as your computer
  5. Revise or reclassify notes as you learn more
  6. Make sure your notes can’t ever be lost or destroyed

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What “notes” should you use to study?

  1. Use the notes provided by your professors, usually in the form of a powerpoint presentation or pdf of the presentation. Many students download the presentations into OneNote and annotate the slides during the lecture. If you use this system, it will be very important to make a one page summary of the key points. Going back to review each slide is very time consuming and not a good “juice to squeeze ratio”. (the effort you put into it is not worth what you get out of it).
  1. Take notes in class or to review like you did in college (highlighters and all!). If you choose to do this, use the SQR3 method or the Cornell note taking method to prepare i.e. don’t come in cold to class. Write down the big topics to be covered, and come up with questions you expect to be answered in class. The key is active listening!
  1. Try mindmaps. Your brain doesn’t organize things into bullet points. If you use colors, images and this more “organic” organization, it’s amazing how much you can remember. Like mnemonics, the more outlandish the images and colors, the easier it is to remember.   You’ll find an example of a mindmap to learn about pilonidal disease below. Note, for example, that the image for obesity is a stick of butter surrounded by fat globules. It’s creating your own images that makes this so powerful. Even though you can share mindmaps, or use software to create them, it’s more effective to draw your own.
  1. Handwritten may lead to better learning…. Worth thinking about!

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How should you organize your notes?

Here’s where it gets fun. Organizing notes with Evernote is the best way I’ve found (ever) to do this.  Evernote is an app for your computer and phone/iPad that allows you to store “notes”. But, the notes can be a lot of different formats:

  1. New notes, typed directly into the software
  2. Imported notes from OneNote or a powerpoint presentation
  3. Scanned notes. Evernote has an amazing free app called Scannable that converts any document into a pdf using your phone. So. if you draw a mindmap, doodle about the anatomy of the rotator cuff or have a typed handout from someone, you can scan it into EverNote.
  4. Photos of whiteboards, paper notes, images.
  5. Videos, like your professor showing you how to examine the knee for instability.
  6. There is an Evernote “web clipper” that can be used on your computer to download any webpage.
  7. Audio notes. You can record a review for yourself and save it as a note.

 

Other advantages to using Evernote

  1. You can share notes with others
  2. You can find information by searching. Both typed and handwritten words will be recognized.
  3. When you store a link to a video it’s active, so you can click and go directly to the site.

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What should I do before I set up this system?

  • Start the notes now – even though you don’t have the system in place.  Listen actively and take notes actively. Make sure you create one page summaries of every lecture. Keep these to scan in when you start your account.
  • Download Evernote for your Life | A Practical Guide for the Use of Evernote in Your Everyday Life by Brandon Collins and read it before you create your system. This ebook is concise, easy to read and will explain why you can’t think about EverNote as a “filing” system in the usual sense.

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A few other words of advice

  • Create your Evernote account with an email address that will follow you through your training. (By the way, if your personal email now is sexyguyfromthecity@gmail.com, it’s time to get a new and more professional address!)
  • I’d create one huge notebook called “Everything I need to know to be a doctor” (just kidding.. but don’t fall into the trap of creating a lot of different notebooks, either.)
  • When you start, be very deliberate about your tags. You don’t want to end up with “Penicillin”, “penicillin” and “penicillinV” as three tags for penicillin… Decide how to standardize your tags before you start i.e. when to capitalize, generic names of drugs only, etc.
  • Evernote is not HIPPA compliant.  Don’t EVER put any patient information (including photos) that could be identified.
  • Go ahead and spend the money for Evernote premium. You’ll be using all the storage and the bells and whistles.

What Big Magic Can Teach Those Who Serve

“Do what you love to do, and do it with both seriousness and lightness.”*

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On the flight home yesterday I finished Big Magic: Creative Living Beyond Fear by Elizabeth Gilbert (She’s probably known to you for her NY Times Best Seller Eat, Pray, Love). For me, one of the overarching messages of her book was this – When you see what you do as your vocation (from Latin vocātiō, meaning “a call or summons”), and not just your job, it will transform how you view your work – a concept which I believe may be necessary (but not sufficient) to treat or prevent burnout.

As I read her thoughts on how to live a creative life, I realized that there were other ideas  that applied to physicians, physicians in training and others who serve:

 

Just show up. Every day.

“Most of my writing life consists of nothing more than unglamorous, disciplined labor. I sit at my desk and I work like a farmer, and that’s how it gets done. Most of it is not fairy dust in the least”

Learning and practicing medicine (or any other field) means showing up – really showing up – every day. Everyone in the first year of medical school learns that it is different than college. Cramming for exams is not only ineffective, it’s just wrong. You are no longer studying for a grade on a test…. it’s now about the patients you will take care of in the future. The same holds true during residency and when you begin your practice. It’s not just when you are a trainee.  Part of the “work” of medicine remains “unglamorous, disciplined labor”… keeping up with the literature, going to teaching conferences when you could be doing something else, finishing your hospital charts, being on call.

But the work of medicine is also about showing up every day in another sense, too – truly showing up for the people who rely on you – no matter what. That, too, can be “unglamorous, disciplined labor” when you are tired or stressed.

“Work with all your heart, because—I promise—if you show up for your work day after day after day after day, you just might get lucky enough some random morning to burst right into bloom.”

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They are your patients… from the first day of medical school until you retire.

Most of all, there is this truth: No matter how great your teachers may be, and no matter how esteemed your academy’s reputation, eventually you will have to do the work by yourself. Eventually, the teachers won’t be there anymore. The walls of the school will fall away, and you’ll be on your own. The hours that you will then put into practice, study, auditions, and creation will be entirely up to you. The sooner and more passionately you get married to this idea—that it is ultimately entirely up to you—the better off you’ll be.”

Caring for others gives us joy but also gives us the responsibility to know the best thing to do for them. Whether you are a first year student, 3rd year resident or a PGY35 attending, we are all still learning. “Life long learning” is not just a phrase, it’s the reality of what we do.

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It’s called the practice of medicine for a reason.

“It’s a simple and generous rule of life that whatever you practice, you will improve at.”

Learn the art of deliberate practice early. Deliberate practice, to use a musical analogy I learned in Cal Newton’s fantastic book So Good They Can’t Ignore You: Why Skills Trump Passion in the Quest for Work You Love, doesn’t mean playing the piece from start to finish 20 times in an hour. It means spending 55 minutes on the small section that you struggle with, repeating it 100 times before you play the piece through once. It means instead of reading the comfortable material on the anatomy of the kidney, you deliberately tackle how the nephron works. It means that instead of doing the computer-simulated cholecystectomy 10 times you spend an hour tying intracorporeal knots in the trainer. Find the thing that is not easy and practice it over and over until it becomes easy.

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There is Peril in Perfectionism

“There are only so many hours in a day, after all. There are only so many days in a year, only so many years in a life. You do what you can do, as competently as possible within a reasonable time frame, and then you let it go.”

One of the greatest attributes of those who care for others is their devotion to the people they serve. But perfectionism, taken to its extreme, is dangerous. Extending your time to study for Step 1 beyond what is reasonable to try to get a higher score, revisiting decisions about patient care to the point of anxiety, worrying that your GPA has to be perfect are all counterproductive. The motivation to do well is like a cardiac sarcomere – a little worry will make you more effective, but stretched too far, there won’t be any output at all.

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Curiosity can overcome fear.

“No, when I refer to “creative living,” I am speaking more broadly. I’m talking about living a life that is driven more strongly by curiosity than by fear.”

It’s something most students don’t realize, but no matter how long you practice medicine, there are days when you are afraid. It takes courage to do what we do. Remember, being courageous is not an absence of fear, it’s being able to do what’s right despite the fear. I agree complete with Elizabeth Gilbert that curiosity helps. When you have something that doesn’t go the way you expect or frightens you, instead of beating yourself up (“I should have studied more”….”I could have made a different decision”…etc…etc) become curious. If you are thinking about a complication, commit to finding everything you can about the procedure and how to prevent complications. If you didn’t do as well on your test as you thought you should, look up different techniques to study, take notes, and remember information, and go back to make sure you really understood what was being tested.

Even more powerful than curiosity is gratitude. Fear and gratitude cannot exist at the same moment. Try it – the next time you are about to snap because your EMR freezes be grateful that you can see the computer, be grateful you have work, be grateful you have been trained to help other human beings …and see what happens.

“We must have the stubbornness to accept our gladness in the ruthless furnace of this world.”

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Your worth is not the same as your “success”.

“You can measure your worth by your dedication to your path, not by your successes or failures.”

Wow…. This one is so important.

It’s not what you make on Step 1. It’s not how many cases you do, how many patients you see or how much money you make. This concept is taught by every religion and philosopher I know – for a reason. Be devoted to doing the best you can and to forgiving yourself (and learning from it) when you fall short.

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One last thing….for medical students trying to choose a specialty – forget about finding your passion.

This is a little longer quote than the others, and mirrors a similar message in So Good They Can’t Ignore You: Why Skills Trump Passion in the Quest for Work You Love .

Find something, even a little tiny thing, that makes you curious (or fills you with wonder) and follow it. Dedicate yourself to following that curiosity and it will likely lead you to your career.

“May I also urge you to forget about passion? Perhaps you are surprised to hear this from me, but I am somewhat against passion. Or at least, I am against the preaching of passion. I don’t believe in telling people, “All you need to do is to follow your passion, and everything will be fine.” I think this can be an unhelpful and even cruel suggestion at times. First of all, it can be an unnecessary piece of advice, because if someone has a clear passion, odds are they’re already following it and they don’t need anyone to tell them to pursue it…..I believe that curiosity is the secret. Curiosity is the truth and the way of creative living. Curiosity is the alpha and the omega, the beginning and the end. Furthermore, curiosity is accessible to everyone…..In fact, curiosity only ever asks one simple question: “Is there anything you’re interested in?” Anything? Even a tiny bit? No matter how mundane or small?….But in that moment, if you can pause and identify even one tiny speck of interest in something, then curiosity will ask you to turn your head a quarter of an inch and look at the thing a wee bit closer. Do it. It’s a clue. It might seem like nothing, but it’s a clue. Follow that clue. Trust it. See where curiosity will lead you next. Then follow the next clue, and the next, and the next. Remember, it doesn’t have to be a voice in the desert; it’s just a harmless little scavenger hunt. Following that scavenger hunt of curiosity can lead you to amazing, unexpected places. It may even eventually lead you to your passion—albeit through a strange, untraceable passageway of back alleys, underground caves, and secret doors.

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*Italics are quotes from Big Magic: Creative Living Beyond Fear. Since I read this on my Kindle, I don’t have page numbers!

 

 

It’s the First Day of Medical School – What Should I Do?

I’ve written before about what to do before medical school starts, how to study in medical school and strategies for succeeding in the basic sciences. But how do you put this information about organizing your studying and your day into a system that works?   Everyone will have variations on how they do this, but there are some fundamental principles that apply to all.

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Don’t get behind

From day one, the material matters and, from day one, it is voluminous. If you get behind, it’s really hard to catch up.

Study, don’t just read and reread.

You have to actively engage this material and review it (multiple times) to really learn it. You are no longer studying for a test, you are studying to take care of other people. The SQ3R method is used by many students, but there are other systems as well. What is important is to develop a system that works for you.  One tool used by many students is Anki, software that allows you to create electronic flashcards to review key points.

Tips on active studying from UCSD

Tips on active studying from the University of Utah

 Use going to class as time to “study”

One of the important components to active learning is to review the lecture material before it is presented.  This is the opposite of what most of you experienced in college, but it’s key.   Survey the handouts or slides and make a list of the important points to be covered. Stay actively engaged.

p.s. You can’t learn medicine if you are on Facebook in class.

Create a summary page for each lecture

Include the big concepts, and key points. Include specifics that are stressed by the professor, but avoid listing all the details. You may choose to hand write this, but most of you will come up with an electronic format and will organize the class notes, and your summaries using One Note, Growly or an equivalent software. Although your personal notes are fine on the cloud, don’t put copyrighted material or your professor’s slides where other people can see them (it’s illegal).

Begin with the end in mind

In the long term, what you are learning (yes, all of it) will be applied to taking care of patients. In the slightly less long term, you will be tested on this information on the USMLE Step 1, a high stake exam and the first part of your medical license.   Although some dedicated time to study for Step 1 is important, having a system to really learn the material in your basic science courses is by far the best way to do well on this exam.

Don’t sacrifice sleep.

If you don’t sleep you don’t learn as well. Organize your schedule so you get at least 7, but preferably 8 hours of sleep every night.

Eat well, play hard and stay connected.

Clay Goodman,MD the Associate Dean of UME at Baylor, tells our first year class that the first year of medical school is a 60 hr/week job. They need to get up in the morning and “go to work”, using the afternoon and evening to study. He then points out that if they work 60 hours and sleep 56 hours (8 hours a night) they still have 52 hours to work out, spend time with family and friends and do whatever else they want.

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So, what should you do the first day of medical school?

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Here’s what your schedule might look like…

The night before – pack your breakfast for the morning break and lunch for the next day. Review any posted slides – survey them to understand the “big picture” and use them to start your summary of the lecture. Write down what you don’t understand from the slides (yes, at this stage it may be every line… but that will get better!).

7am – wake up (If you prefer morning workouts, you can get up earlier and workout before class)

7:30 Grab a piece of fruit or a smoothie if you don’t like to eat an early breakfast. (If you are ok with it, eat the full breakfast now, but whatever you do, don’t skip breakfast)

8-12 Attend class – Stay engaged. Take notes, make sure the questions you asked yourself in the review are answered, raise your hand and ask questions if they weren’t. Eat your breakfast or a snack at the 10 am break.

12-1 – Lunch with your classmates. Play foosball, talk, or just eat, but take a real break.

1-5 Study. One hour of studying for each hour of class is about right for most people.   This may need to go until 6 or 7 if you have afternoon labs.

7 – Workout and then make and eat dinner. Working out is an important part of self-care. Exercise is essential to decrease stress and also will help you avoid the “freshmen 10”. Your dinner should be healthy, not processed, and definitively not Ramen noodles. Make sure you have fruits and/or vegetables at every meal.

9-10 Look over tomorrow’s lectures and start your summary pages for those lectures. Once you are a week or two into this, you’ll be adding in reviews of material from previous weeks on a schedule.

10-11 Read a novel, watch TV, decompress.

11 Go to sleep!

You are starting on one of the most amazing journeys any human being can have… enjoy it! Don’t forget to keep a journal and take photos (but not of patients). The first time you actually interview a patient, put on your white coat, hear a heart murmur or take a test in medical school are just that … the first time. Write about the experience.

Let me know in the comments what other advice you have for the students starting medical school this summer!

 

 

Getting Ready to Start Medical School

This morning we had a group of medical school applicants at Baylor for a “second look”. They asked some very good questions including the question that prompted me to write this post:

“What should I do to get ready to start medical school?

Set up your environment

The amount of material you will be asked to master in your first year of medical school is more than you’ve ever been asked to master before.  You have to approach it with a different strategy than you used in college.  One critical component of this strategy will be to keep up with the material – starting from the first day.

If you try to hook up your cable, organize your electricity and straighten out parking at your apartment during the first week, you will fall behind.  Take the time to come explore your new environment and get settled in at least a week before classes start.  A week doesn’t sound like much to miss, but it’s a significant amount of information in medical school! One of the important tasks to check off the list during the week you are settling in is to set up your study area.  Make sure you have a computer that will meet your needs and an area to study that is pleasant, ergonomic and comfortable.  Most students find a dual screen to be very helpful as you are moving through notes and slides to study.

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You’ll be spending 1-2 hours studying (at a minimum) for every hour of class.  Given the number of hours you’ll spend studying, you might want to think about an “active” desk that lets you stand, walk or pedal as you study.

Develop (or strengthen) an exercise habit

Use this summer to develop a daily exercise routine that you can take into your new (and crazy) schedule.  Your goal for the summer should be to develop a balanced exercise program (cardio, strength training and flexibility) that works for you.  If you’ve never done any strength training, hire a trainer and learn about it. If you develop a balanced exercise routine this summer, it will be much, much easier to continue this once you start medical school or your internship. Commit to doing at least 30 minutes of exercise a day this summer and it will be a lot easier to continue once the pressure of school really kicks in.

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Running is one of the best (and most convenient) cardio exercises for medical students and residents (because it’s cheap, efficient and effective)  Use this summer to become a runner. If you hate running, find another good cardio exercise habit to develop instead – but pick one!

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If you don’t own a bicycle, think about getting one.  There will be places to ride for fun when you have time off.  You can also use your bike to commute to school which is a great way to sneak in exercise and save money.

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If you don’t know how to cook, learn.

Good nutrition is an important part of doing well academically.  It’s hard to concentrate and learn if you are eating junk. There is one simple trick to eat well during medical school: Learn to cook.  This is a skill that will become progressively more important as you enter your clinical work in medical school and then move on to your residency training.

Learn some basic skills to cook simple things.  If you have good cooks in your family, have them teach you.  If you don’t have family members who can teach you, find cooking classes near you and sign up.  Many high end grocery stores and gourmet stores offer classes for beginners – look on line for classes near you.

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Come to medical school rested.

Do not study. Seriously.  We will give you what you need and nothing you can do this summer will make it any easier.  It’s far more important to arrive rested and ready to go than to try to learn material that may or may not be relevant. Take a real vacation (or two). Visit family and friends – take a road trip and connect with people you haven’t seen in a while  Hang out on a beach, go for some great hikes, read some great novels.  Sleep in late, eat well, and just rest!

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Studying For the USMLE Step 1 Exam

The USMLE Step exams are important.  Even though they weren’t designed for this, many residency programs use these scores (especially Step 1) to decide who to interview for the NRMP match.  By far and away the best way to decrease the stress associated with this exam is to be prepared when you take it.

The best way to study for Step 1 is to start the process early.  As soon as you can (now, if you are in the first year!) look at examples of Step 1 questions.  This will give you an idea what to expect and will guide you in how to organize your studying.  The strategy for Step 2 will be similar.   Do this systematically – keep notes on your computer or in a notebook, or use the 3×5 card technique to make cards to organize and review later.  Whatever system you choose to use, be consistent.  You really can’t “cram” for the Step exams – it has to be a review.

In addition to developing a systematic approach to preparing for Step 1, it’s a good idea to spend dedicated time reviewing for the exam.  If your schedule allows, taking a full month or two to prepare for this exam is probably a good idea.  If it doesn’t, spread it out over more time, but devote the same amount of time.

The following recommendations are from two 4th year students on how to review for Step 1.   Use specific ideas that fit you, leave the ones that don’t.  There are many ways to succeed and not all of these recommendations will apply to you.

  • First week: Read quickly through First Aid cover-to-cover
    • This reminds your brain of everything you’ve ever studied and gives you the book’s lay-out
    • Read complicated or new information out loud
    • By reading out loud or skimming/reading quickly, it should take  about 6 days
  • Second week: Start UWorld as arranged in First AID
    • 46 “randomized” questions per set (2 methods of organization below)
      • Choose the organ system on the right hand side of the menu screen but not any subset groupings;
      • Alternatively, do biochem, behavioral science, and micro questions separately (everything for which there is a section in FA)
        • Then move onto organ system and the associated anatomy/physiology/ path/pathophys
  • Don’t worry about time at first, but ultimately you should be well under an hour/block
    • Practice good test-taking strategies
    • Read the last line of the question, skim the answer choices, read the full question for necessary buzzwords/data
    • No phone/gmail/chatting etc. during this time (it’s your “exam” time)
  • Take a 10 min break after answering all 46 questions
    • Do all the activities you put off – check your texts/email, go to the bathroom, read ESPN/NPR per preference, etc.
  • Review the answers from the 46 q block
    • Keep the 45-50 min “ON” study time (no distractions! No phone/email!) & 10-15 min “OFF” (see above)
  • Look up anything you don’t know / can’t explain to yourself
    • Make sure you really understand the explanation, but don’t get bogged down
    • Annotate any crucial information into First AID, using First AID as your primary textbook & notebook
  • Repeat above cycle until you have completed all q blocks for that organ system
  • Review associated First AID chapter (cardio, GI, etc)
    • Go over your freshly annotated chapter by yourself or with a study partner
      • “I sat down with my BFF and we took turns explaining each page & our annotations, covering details the other might have missed and adding mnemonics/stories.”
      • Review related annotations from other sections (micro/biochem/BS, etc)
      • Optional: listen to the related Goljan section while driving/exercising/etc
  • Repeat: Q-Block –> Review –> Annotate –> Q-block…etc… until you have completed all organ systems
  • Arrange some question blocks by topic (biochem/micro/etc)
    • You will already have completed all of these questions, but it is easier to review the First AID chapters for biochem/micro/BS if you take a couple question blocks to focus your mind
    • If you are consistently performing poorly on a non-organ based section, you can always interrupt your “organ based learning” and focus on your weak area for a couple of days using the above format (qs, review, annotate)
    • Identify weak areas based on score data & personal comfort
      • Retake question blocks, answers & related First AID chapter
  • If you have time during the last 2 weeks, as you go through First AID and your annotations in FA, write down everything you don’t know (don’t get stressed out if you end up writing a lot of stuff down…I think I had 1-2 pages handwritten front and back per section at this point). Then study only your notes and stop looking at First AID. The rationale behind this is that you don’t want to spend too much time rereading the stuff that you are 100% sure you know at a time when you should be focusing on what you don’t know. Note: you may need to start this while you’re still going through UWorld questions, but I think it’s worth your time.
  • Last Week:
    • Review First AID from start to finish with emphasis on weaker areas
    • Continue with random blocks of questions or NBME purchase exams to keep in “practice question shape”
  • Last couple days
    • 2-3 days before:  review behavioral sciences, write down any formulas for memorization, cram “regurg” factoids/formulas/graphs, cram the things in your notes that you still don’t know
    • Day before: NOTHING
      •  Hang out, relax, distract yourself, go to a movie…
      • You’re not going to change your score for the better by studying/stressing now (but it might make you fatigued the next day)
      • Pack your bag with all your documents, directions, First AID, notes for the next day (& lots of food) so you don’t have to worry in the morning
      • Try to sleep (you’ll be nervous but do your best!)

       

PRACTICE EXAMS

  • There are many opinions on how to best use practice exams.  The timing of them is as much an emotional consideration as a fact-based or practice based benefit.  Here’s one way to organize the practice exams that has worked for some students:
  • 2-3 Weeks into studying: Free NBME practice exam
    • Get a sense if you are on track, this score will underestimate you’re final score
      • If close to your goal, the score can be reassuring that you should keep doing what you’re doing
      • If significantly lower, the score can be motivation to pick up the pace/cut out distractions

       

  • 1 week before the exam: 2x 4 block UWorld practice exams
    • I took all 8 blocks back-to-back to simulate the exam experience (timing of breaks, fatigue, etc)
    • Do NOT review the answers on the same day, in fact, you should probably take most of the next day off to recover
    • Use the results as a comfort that you are on track (my actual score was 1 pt off my practice exams —- and despite fatigue & feeling like my second block of 4 was worse, I actually got identical scores throughout)
    • Look at the stats and focus on any weaker areas (my weakest areas became my strongest by the actual exam)

     

  • Last week: fee based NBME Exams
    • I paid for NBME 7, which tells you your estimated score, your percentile in each area, and reproduces the questions you answered incorrectly (but does not give you the correct answer) – again, within 1-2 pts of my final score
    • I worked through many of the exams (some easier, some harder than the my step) during the last week as a way to practice the random mix of qs….I found it helpful
    • Some of the questions on the NBME practice exams were on my REAL Step exam

 

BALANCE!   You’re job is study and do well on this exam —- but it can be very stressful, even just on a subconscious level.  For most people it works better to really structure your time.

Keep work hours:  go to a library/coffee shop/school on a regular schedule

  • 8 am – 5 pm (5/7/8 pm…whatever you decide)
  • Taken an hour off for lunch & hang out with friends
  • Go home & be DONE until the next day (get good food & sleep!)
  • Keep a life
    • Partner, work-outs, family, etc. should be in your life every day
    • Take at least one day off a week at the beginning

 

RESOURCES

  • First AID & UWorld: you must use & love these, everything else is just bonus
  • Others (Wiki, BRS, textbooks, Goljan, etc.)
    • Resources other than FA and Uworld will not help your score significantly.
    • Use them to explain specific questions or concepts from UWORLD or FA that you don’t understand or can’t remember
    • Use them if for some reason you have a ton of extra time and already know FA and Uworld like the back of your hand
    • If you choose to use external resources, BRS physiology and the first part of Goljan Rapid Review Path (through the neoplasia chapter) might be worth your while, but seriously don’t worry if you don’t have time to get to them.

 

Traci Fraser and Natalie Gwilliam, Class of 2012, Baylor College of Medicine


The Best of Wellness Rounds 2011

HAPPY NEW YEAR TO EVERYONE!

Advice for interns

Why I hardly ever drink diet drinks

How to choose your specialty

What to do on your day off

Studying basic sciences – strategies for success

Studying clinical medicine

Getting (and staying) motivated to exercise

How to succeed on clinical rotations

Gifts for medical students and residents

Why I’m spending more time on Twitter

How not to have sore feet after a day in the hospital

Thoughts From the White Coat Pocket – Part 2

Last week was the White Coat Ceremony at Baylor College of Medicine.  As part of the ceremony, several upper classmen are asked to address the entering class, speeches that we call “Thoughts from the White Coat Pocket”.

Good evening ladies and gentlemen. Dear colleagues, let me introduce to you: your first white coat. Brand new, tailored for your size, just came out the plastic bag – it is a pretty cool object to own.  Let me assure you it is far more than that.  This inanimate, fairly non-complex thing will soon become an integral part of you. It will determine greatly how you see the world and how the world sees you, even when you are not actually wearing the white coat.

First of all it is a symbol. It is a symbol of relying on scientific evidence for patient treatment, symbol of honesty and respect, symbol of healing, of trust, of being non-judgmental and accepting. Whatever specialty you choose, everyday you will be dealing with people. Many of those who will come to seek your help will do it on the worst days of their lives. Yes, they will be angry, upset, confused, tearful and cranky and from this day on, you no longer get to turn and walk away or let them figure it out on their own. They will be there to see you, not you as a person, but as someone who wears the white coat, thus capable of making things better…

Because you white coat is also a shining armor that was strengthened by the reputation and effort of multiple generations. This armor will make you stronger than disease, often, but not always stronger than death.  You can hide your fear behind the white coat, it is ok. You’ll learn how to ask uncomfortable questions and how to deliver terrifying news. And you will have many opportunities to be scared: your first day of rotations, your first delivery, the first: “Doctor, what do you want to do?” from a nurse. And, believe me, you will hear these words much earlier than you expect…

And, of course, the white coat is a magic cape. It makes hearts beat faster, it suddenly makes it ok for people to discuss most personal things with you, they will believe in your superpowers, because I don’t know how otherwise explain the call from my former co-worker with a request to cure his dog’s arthritis.

Some may say that this white coat is short, because our knowledge is not so impressive yet. Perhaps, but I view it as foundation. We have not build a house yet, but the moment this white coat touches your shoulders – you’ve started. And when you see your first patient at your preceptors office, remember that although you don’t have the letters MD after your name yet, you, just like, your preceptor, have an obligation to be respectful, empathic and knowledgeable.

So, do you feel those butterflies in the stomach? It is a great feeling, so hold on to it. It is similar to falling in love. You are starting a relationship that is going to last a life time. It is going to have ups and downs, routine, exasperation    and fatigue, but stay determined and work for it. Stay motivated, true and inspired. You are in one of the most exciting professional fields. And I know you have dreamt about it for a very long time. Today, finally, it is official. Congratulations!

Katya Jordan, MS3

Thoughts From the White Coat Pocket

Last week was the White Coat Ceremony at Baylor College of Medicine.  As part of the ceremony, several upper classmen are asked to address the entering class, speeches that we call “Thoughts from the White Coat Pocket”.

When I think back about my white coat ceremony 4 years ago, I remember being really worried about what outfit I was going to wear that day. I went through every tie and shirt combination at least 10 times. Eventually I just decided this occasion was too big of a deal and went out and bought a brand new outfit…which I never wore again. I must have taken a million pictures in it…I mean I needed just the right lighting, a smile that said “I’m a professional young doctor with a great bedside manner but could also be an extra on a daytime soap opera,” and if I cropped the picture just right you couldn’t even tell it was a short white coat. Admittedly, it was my Facebook picture for almost a year, marking the beginning of a great journey. Little did I know that both the pristine, little white coat and I would never be the same.

See the funny thing about the white coat is that it changes just as much as you do during medical school. I remember the first day of preceptor for PPS1. I was so proud to wear it. To my shock and horror, that same day a 15 year old boy with a bad stomach bug would defile my coat. I scrubbed it, took it to the dry cleaners, and yes even sent it to my mother. The coat was clean, but something felt different about it…the coat had changed…I had changed. It no longer represented the promise of clinics. It had seen it’s first battle with disease and survived, and a part of me was proud of that.

My little white coat would not see battle again until my second year during my first day of clinics. I woke up that morning and had my best friend take once again a million pictures for Facebook. It was that year that the coat and I transformed again. It was no longer a symbol but rather a tool that I could not live without. During my internal medicine rotation, it held my books, my stethoscope, my penlight, and my history and physicals as I anxiously waited to present. During surgery it held my trauma sheers, bandages, and my granola bar to get me through heart transplants. During psych, it distinguished me from the patients so they didn’t put me away! I couldn’t live without it and a part of me didn’t want to think of a world where I didn’t have 4 massive pockets. True story – I once put a Venti iced coffee in the pocket of my white coat and walked from BCM to Ben Taub with no spillage….these coats are indestructible!

Then something happened this year. I started my sub-intern month on the brink of being an MS4 and decided to leave my coat in the team room. These were MY patients, I was the acting intern and I needed to go into battle without my security blanket. The white coat and I grew apart…and I started needing it less and less. This trend continued as I began my fourth year and started taking more responsibility for my patients. Suddenly the coat felt too small, it could hold my stethoscope and my books, but it could not hold all the responsibilities I was going to face next year.

I will always be grateful to my short white coat. This is a very important day for all of you, take care of your coats and remember what they stand for. When you wear them you are representing BCM and all the generations of amazing physicians this school has produced. And when you get to your fourth year and feel those pockets getting heavier, when your coat feels small and you are ready to take on the challenges and joys of being a first year doctor…that’s when you know you are ready for the long coat.

Welcome to the family BCM class of 2015 and Congratulations!

Tony Pastor, MS4