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

Posted on August 1, 2015 by marylbrandt

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.

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.

Photo credit

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

Photo credit

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!

This Year’s @drmlb’s Top 10 Gifts for Medical Students, Residents and Busy Docs.

Posted on December 14, 2013 by marylbrandt

This time of year, family and friends of docs and/or docs in training are looking for the last minute holiday gifts (if you are trying to have them shipped) or planning the trip to the store(s) for gifts.

Photo Credit

The one thing any busy person doesn’t have enough of is time. If you think about it in that context, you can find presents to support interests, fitness, studying (or just having fun) in a thoughtful way.

1. Someone to help clean their home. It is the most amazing present to come one once a week (or even once a month) to a house that has been cleaned by someone else. If there are family members who are willing (and it’s appropriate) you can put together a gift of cleaning supplies with a certificate for monthly housecleaning. If not, word of mouth to find the best person is usually the best way, and will often help you find someone who also does laundry and ironing. (a true gift!). There are professional services in every city as well that can be found with an easy internet search.
2. Something to help integrate fitness into their every day activities. If they don’t have a good bike to commute to school or the hospital (and this is something they would like) this is a great present. Don’t forget the helmet, reflective vest and very bright lights as part of the package!
3. A fast computer. If they have the same computer they had in college and you are able to do this for them, the time they will save in uploads will be very appreciated!
4. A smart phone or mini iPad (especially the new iPad air). Like the computer, if the phone they have is more than 3-4 years old, the upgrade will be much appreciated. The mini iPad (instead of the regular size) fits in a white coat pocket, which is why it’s ideal for anyone who wears a white coat. If they have an iPad, think about some of the more expensive medical apps. (or a certificate for the App store
5. Kitchen appliances to save time (and promote healthy eating). My favorites on this list would include a rice maker (which can also be used to steam meat and vegetables), a pressure cooker a slow cooker or the Krups multi-cooker. A blender is always a good gift (to make smoothies and soups). If you are feeling particularly generous, a VitaMix instead of a blender is much more versatile (and makes much better smoothies!).
6. Prepared meals. If you have family who love to cook, you can make a “certificate” for homemade food in freezable portions. If you can afford it, there are personal chefs who do the same thing. You can also give them a gift certificate for a grocery store like Whole Foods that has healthy prepared food or companies that deliver healthy meals (In Houston, it’s companies like MyFitFoods – but this varies from city to city).
7. Fitness equipment for home. For medical students who are spending a lot of time studying think about a FitDesk, FitBike or a treadmill desk. The standard stationary bikes, treadmills, etc are another option, but they are expensive and you have to really know that they are preferred over going to the gym (see #8). A less expensive but very effective gift would be a “fitness care package” with resistance bands, FitDeck cards, a gift certificate for running shoes, and other small less expensive gifts.

8. A membership in a local gym. You can also consider a certificate for group classes in spinning, yoga, or whatever they enjoy.
9. Time with family and friends. Think about a “certificate” for time together – maybe with restaurant gift cards or movie gift cards attached. A “certificate” for a monthly home cooked meal? If you aren’t in the same town, think about how to make it easy for them to spend time with their friends. If you know their favorite restaurant or hangout, see if you can get a gift certificate. If not, go for tickets to the local theater, one of the movie chains (find out which one is closest to where they live), or their favorite restaurant chain. If they have children, babysitting is a wonderful gift.
10. Whatever you can think of that makes gives them more time and/or will support them during times of stressful and busy work!

HAPPY HOLIDAYS TO ALL!!!

Photo credit

Last year’s suggestions on wellnessrounds.org

Organizing Notes in Medical School and Residency

Posted on November 9, 2013 by marylbrandt

Among my other educational roles, I have the real pleasure of teaching embryology for the Baylor College of Medicine MS1 class. Recently, while visiting with students before a lecture, I happened to see a set of notes on several of the students’ laptops. They had the slides from my lecture with additional notes, all organized to study efficiently. I asked them if they would mind sending me information so I could post it here since I thought this might be useful to other medical students.

The following is a guest blog from Samuel Buck and Sara Fish, both first year medical students at Baylor College of Medicine with assistance from Sam Rogers, an MS3.

There are several apps that make studying easier in medical school. In retrospect it would have been great to know about this the first day of class, so I’m happy to share them now. I use OneNote and EverNote but there are other apps I know other students use like Growly Notes. Here’s the key notetaking apps (and a few others):

OneNote – This is the program that I use for notes during class. Using OneNote, you can import entire power point presentations (even the notes at the bottom of each slide) into a single document and add your own notes and drawings as well. OneNote allows you to organize all the lecture materials and slides in one place. Word documents, powerpoints, PDFs, images, and Excel sheets can be placed in tabs in your “notebook”. From here, you can easily navigate, add your own notes and text, highlight, or draw on the slides. I usually use the draw functions to add arrows to radiographic images or to circle important points on slides. I usually organize my notes by subject but other students organize by date, with tabs for each block, each week within the block, and day of the week, and individual note pages for each lecture that day. Other students organize notes into separate digital “notebooks” by block or by course (i.e one for embryology, one for anatomy, etc) The most convenient thing about OneNote is that all of your notes are synced to a Microsoft SkyDrive (their version of the iCloud) so that you can access your notes on the iPad and phone. If I’m studying and ever need to consult my notes from class, I can just take out my iPad or if I’m on the go, my phone and reference the lectures or notes in a really organized fashion. Having OneNote on my iPad let’s me review notes when I am on the bus or in other situations where it’s hard to get your computer out. This is one feature that Mac users with Growly Notes (basically the OneNote equivalent) do not have since there is no Growly Notes app for the iPad. One of the most useful tools in OneNote is the find function. You can type in a keyword and OneNote will search your entire notebook and show you every instance when that word is used. This is very helpful because a huge number of documents can be scanned at once. Since many concepts in our classes overlap, it helps to make connections between subjects. For instance, if something is mentioned in embryology and you feel like you have heard that word before, but you don’t know where, you can search it and find the lectures in which it was previously mentioned.

Here are links to additional “tutorials” on using OneNote in medical school from the University of Kansas and UT Health Science Center in San Antonio that will give you more details on using OneNote to organize your studying in medical school.

som.uthscsa.edu/StudentAffairs/documents/OneNote_Presentation.pdf

www.kumc.edu/Documents/…/kumc-onenote-instructions.pdf

One of the most useful tools in OneNote is the find function. You can type in a keyword and OneNote will search your entire notebook and show you every instance when that word is used. This is very helpful because a huge number of documents can be scanned at once. Since many concepts in our classes overlap, it helps to make connections between subjects. For instance, if something is mentioned in embryology and you feel like you have heard that word before, but you don’t know where, you can search it and find the lectures in which it was previously mentioned.

Photo credit

EverNote – Although there are some students who use Evernote to organize their notes in medical school, I found that format is not really conducive to good organization of notes. I do really like the mobile layout of the app and I use EverNote extensively for “every day” note taking. Grocery lists, work out programs, random ideas, to do lists, jotting down an email or name I want to remember. One thing I really like about EverNote is that when you make a note, it generates a time and location stamp for the notes.

Photo credit

Growly Notes – This is probably the most popular note taking program for our class because it is made for Apple computers. I personally don’t have any experience with it as a PC user, but it has a great organization format as far as I can tell.

DropBox – Online file storage and sharing service that is very useful for sharing study materials between students. Our anatomy buddies group uses this extensively to share quizzes and study guides. It is a really great service, and DropBox will load thing directly to and from your personal DropBox, which is very convenient . One thing to remember is that it’s not HIPPA compliant, so if there is any patient information, it shouldn’t be put in DropBox

Google Drive – Not to be overlooked is the tried and true Google Documents. Whether it be study guides or notes, it’s hard to beat the convenience of Google Drive if your goal is mass editing and sharing. Sharing the link to your document is easy, and it can be set up so that anyone who views the document can also edit it. Just like DropBox, this isn’t HIPPA compliant, so don’t share patient information.

TurboScan – This is an app that takes pictures of documents and turns them into PDF files that you can email to people (or yourself) or upload to DropBox. I do this for all class handouts to have an immediate digital copy of any paper items we get in class or study groups. I can email files to myself and post them into my OneNote documents. I also use this app for personal finances. I take a picture of my receipts from grocery shopping and going out as well as my bills so that I can better budget myself and keep track of purchases.

Twitter for Physicians

Posted on May 2, 2013 by marylbrandt

I was asked to speak today on using Twitter in medical education at the 44^th annual meeting of the American Pediatric Surgical Association. I used Status Present, an incredibly cool software designed by Fred Trotter. As I talked using these “slides”, they were tweeted at the same time. It’s interesting to me that using this technology felt like a return to the era before Power Point, when talks were given by following “talking points” rather than slides. It’s not going to be applicable to all talks, but this was really fun!

Twitter in #meded for #pedsurg – a presentation which will be live tweeted and will then be posted on my blog wellnessrounds.org

I blog and microblog (Twitter) because I am a teacher. #meded

Once you learn the details (easy) Twitter becomes a new platform to teach (and learn) #surgery

Why don’t more #physicians use Twitter?

4 reasons #physicians don’t use Twitter 1/4: “I don’t get it” Link to my post on Blogging, Microblogging and Time

Twitter is NOT email. Twitter is NOT Facebook.

The best word to describe Twitter is “ephemeral”

Twitter is the surgeon’s lounge. Walk in. See who is there. Eavesdrop or join the conversation. Leave when you want.

4 reasons #physicians don’t use Twitter 2/4: “I don’t know how”

Two steps to start on Twitter. 1/2: Pick your @name (handle). Short is better. Professional is essential. How To Choose a Good Twitter User Name

Two steps to start on Twitter. 2/2: Dive in. Follow a few people, then look at who they follow. Getting Started on Twitter

#hashtags can be a specific event or topic (#pedsurg) or for fun #ihaveglutealischemia How To Use Hashtags in Twitter

Retweet = repeating the conversation you heard in the surgeon’s lounge.

Filter Twitter conversations by making or following “lists” How to Create and Manage Twitter Lists

Twitter 101: @name, follow @whoeveryouwant,, retweet what you like, follow (and unfollow) as you like, make lists #havefun

4 reasons #physicians don’t use Twitter 3/4: “I don’t have time”

Twitter is not email. You don’t have to read it all (you can’t). #lesstimethanyouthink

Minimizing wasted time on Twitter: 1) Make lists 2) Follow specific #hashtags

4 reasons #physicians don’t use Twitter 4/4: “I don’t think it will help me”

5 ways Twitter helps #physicians. 1/5 Breaking news. @cnnbrk @msnbc_breaking @BBCBreaking

5 ways Twitter helps #physicians. 2/5 Medical (and other) emergencies. @CDCemergency @Houston_Weather @BCMHouston @TexasChildrens

5 ways Twitter helps #physicians. 3/5 Following meetings and thought leaders @APSASurgeons @AmerAcadPeds @BAPS1953 #pedsurg

5 ways Twitter helps #physicians. 4/5. Efficient way to follow journals & journal clubs. @NEJM @JAMASurgery http://bit.ly/10W3Q17

5 ways Twitter helps #physicians. 5/5 Discovering important information in your field or other fields.

Ex: @JAMA Surgery Comparison of #CT scan and #Sestamibi for #parathyroid localization bit.ly/ZrZeMu #PTH #endocrinesurgery

Twitter is particularly powerful for #physicians in #meded

Twitter links #physicians to #meded topics, resources and people

Ex (tools for #meded) @amcunningham Electronic Clinical Logs/Portfolios for students lnkd.in/_vJPBM

Ex (resources) @bnwomeh Get free copy of ‘Paediatric Surgery: A Comprehensive Text For Africa’ at #eAPSA2013 reg desk img.ly/uuDF

Ex: (GME info) @TheNRMP Match Results Statistics for Pediatric Surgery & Pediatric Hem/Onc ow.ly/kBVAg ow.ly/kBVCS

Ex (meetings) @BrianSMcGowan Please join our #eapsa2013 conversation 2-4 PMET via Twitter – as we help pediatric surgeons embrace #SoMe! #hcsm #meded #eapsa2013

Twitter is an important tool for #meded

You can’t stay with a rotary phone in a smart phone world… especially if you teach. #Meded

“When medical students see an attending with a newspaper they think it is quaint” @LouiseAronson #DontBeADinosaur

How to Succeed in Residency: Studying

Posted on July 1, 2012 by marylbrandt

Today is the “official” first day of residency. If you are one of the ~16, 000 new interns starting today I have good news and bad news. The bad news is that you are already behind in terms of what you need to know. The good news is that you can come up with a plan that will make a big difference. If you are a PGY2 or greater, this is a great time to reapply yourself to your studies – even if you let it slide last year.

“The best time to plant a tree is 20 years ago. The second best time is today.” Chinese Proverb

Photo credit

As an intern or resident, you learn your specialty from a variety of sources. Each of them is important. Some of your studying will be just like medical school with your gluteus maximus in a chair (or feet on a treadmill or ischial tuberosities on a bike or an exercise ball) reading a textbook. But the rest of what you learn is absorbed as you make rounds, attend conferences and take care of patients.

The challenge is organizing what you learn.

Sometime this week you will do your first central line, or see a case of bile gastritis, or attend a conference where they discuss a patient with a rare fungal infection. The amount of new information you will learn in these first few months will truly be astounding. But how is what you learned going to be available to you 8 months from now when you see the second patient with the same unusual infection? How are you going to be able to review what you have learned when January rolls around and its time for your in-training exam? At the end of your residency, will you be ready to take the boards?

There is no right or wrong way to create a system for studying clinical medicine, but there are a few principles that will help.

1. Record what you learn as you learn it.

There’s no way around it. If you really want to learn clinical medicine, you have to make notes. Until there is a good digital solution, start by going to work every day with blank 3×5 cards in your pocket. When you learn something on rounds, write it down on a card. When you look up something related to a new patient you are working up, write it down on a card. Make it brief, legible and to the point. If there are “hooks” (i.e. the patient had a tattoo of a star on his face) put it on the card. It’s how our brains remember. If there is specific information that identifies the patient, do not lose your cards! (It’s a HIPPA violation). To be safe, it’s better not to put patient names, ID numbers, etc on the card.

There is no way any trainee will see every disease or condition in their specialty, but being comprehensive in your studying will help. For example, let’s say you admit a patient with dyspnea and an arrhythmia who turns out to have a Morgagni hernia. This is rare, and it’s not likely you’ll see multiple cases during your training. You make a card on how the patient presented and another card on what the treatment was. But then you go to the literature and find a case of man presenting with an acute abdomen from a torsed accessory liver lobe in his Morgagni hernia and another case of an octogenarian who presented with dyspnea and constipation. You have now created “virtual” patients in your mind that add to your pattern recognition. Most importantly, you do it at the time it means something.

One other important thing – don’t ever use scratch paper with plans to copy the notes later. It just won’t happen. Make the notes once, no matter how bad they look!

2. Be comprehensive.

Find a major textbook in your field and write down every topic it covers. (BTW most textbooks are available at the library in electronic form, so you don’t have to actually buy the book) Make it your goal to cover the textbook in a year. Come up with a system to monitor your progress. This is the time to pull out your “Type A” personality to your advantage! Make a spreadsheet and check off topics as you study them and make notes for later review. But – don’t read the chapters in the order of the table of contents. If you are on call tonight and see a patient with pneumonia, read the chapter on pneumonia tonight. If you have time to make notes, great. If not, make your study cards from the chapter tomorrow. The idea here is to read each chapter once and make notes that are complete enough for your review so you never have to go back to the chapter again to study.

Alternates to the 3×5 card system

Use 8×11 pieces of paper to record what you learn. Fold them up in your white coat pocket. Scan them with something like Scannable and then save the pdfs in Evernote with key words so you can search for them later. Don’t put more than one topic per page or you will have trouble organizing them to find information later.
Use your phone. We are on the verge of having facile enough (and small enough) handheld digital devices to do this just as well (or better) than my 3×5 card system. The problem is being able to make your notes on the spot because the device isn’t with you. It never works to plan to make the notes later and, as I said above, it never works to copy notes. There are just too many things you’ll be writing down to make this work. If you figure out a good way to use your phone for this, please let me know!
Use your computer. There’s no reason you couldn’t type 3 lines of what you learned and email it to yourself, add it to Evernote, or save it directly to the cloud. The advantage of cloud storage is that all your notes are available all the time and are searchable. Just remember, most cloud storage like DropBox is not HIPAA compliant! Don’t put any patient identifiers in the notes if you choose to use the cloud.

3. Stay curious.

Being excited by what you are learning will always make it easier. “Set up habits that encourage, and don’t squash, your natural curiosity: Look up answers to your questions, not just subjects you are instructed to read about.”

“The very first step towards success in any occupation is to become interested in it.”

William Osler

Photo Credit

3. Repeat. Repeat. Repeat.

Learning is iterative. You don’t really know something until you have studied it multiple times over a period of a month or two. Don’t make your notes, file them away and pull them out the week before the in-training exam. Sit down once a week and just glance through them all. Develop a system that lets you review them 24-48 hours after you make the notes, a week later, a month later, and 3 months later.

Photo Credit

“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” William Osler

Starting Internship (I know what you are worried about)

Posted on June 24, 2012 by marylbrandt

I sat at the table this week with our new interns and the outgoing chief residents. Listening to our new interns as they asked questions, I realized everyone starting their internship has the same fears, whether or not they express them: Will I kill or hurt someone? Will I look stupid? What if they find out I’m not as smart as everyone else? Will I get divorced/separated/alienated from my friends? Will I gain weight? How am I going to find time to take care of myself?

Drawing credit

What you are feeling is normal. Every doctor who ever started an internship felt exactly the same way. The best way to manage your (healthy) fear is to have a strategy. I’ve written in the past about how to succeed as an intern. But if I were going to condense that advice into three easy rules (for every day except your day off) it would be these:

1. Read at least one section from a textbook in your field every day

2. Learn something (in detail) from at least one patient every day

3. Do something to take care of yourself every day

Read at least one section from a textbook in your field every day.

Your goal for the year should be to read a major textbook in your field cover to cover. You don’t have to buy the physical book. It’s fine if it’s on line or downloaded onto your iPad.

Once you have the book, make a list or spreadsheet of all the sections in all the chapters. For most textbooks, it’s probably going to be a list somewhere between 150 and 200 topics. When you look at the 48-50 weeks you will be working this year, it works out to basically a topic a day (with some days for review).

The real goal is not just to read these topics, but to really learn them. So, when you read, don’t just skim. Read to learn. That means taking notes – and reviewing them.

Put a chart on the wall with the list and give yourself a gold star when you finish a topic if you have to, but find a way to make sure you cover all the topics (at a steady pace) during the year.

Photo credit

Learn something (in detail) from at least one patient every day.

It’s really easy, as an intern, to get caught up in the work and forget that you are fundamentally here to learn – not to provide service. Make it a daily habit to learn in detail about one patient in your care. It will overlap nicely with your goal to read a complete textbook. When you admit a patient with pneumonia, read the section (and make notes) on pneumonia and then check it off your list.

One other important point (that none of us like to hear) – You will make mistakes. Be humble, be honest, and learn from your mistakes. The mistakes you make (and maybe more importantly your “near misses”) are absolutely your most valuable teacher. When you do make a mistake, use it as the topic you will review for the day. You are going to be really upset but be easy on yourself. Being upset is the mark of someone who cares, but don’t let it escalate beyond a healthy response. Talk to your mentors and senior residents. They’ve been there.

Photo credit

Do at least one thing to take care of yourself every day.

This may sound trivial, but it’s not. If you can, try to eat well, get some exercise and be social every day. At a minimum, though, pick one specific thing you are going to do for yourself and then do it.

Eat well

Get Some Exercise

Be social

Getting Ready to Start Medical School

Posted on April 28, 2012 by marylbrandt

It’s one of the most common questions asked by soon to be medical students…. “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 meets all 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.

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 your 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.

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!

Link to 9 Ways To Make Bike Commuting Easier

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.

lauren-on-bike1 — Link to Learn to Love Cooking (and Save!!

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.

111511WEB_BCMCookingClass_rev — Why Doing Nothing Is One of the Most Important Things You Can Do

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!

Studying For the USMLE Step 1 Exam

Posted on February 4, 2012 by marylbrandt

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 4^th 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

Posted on January 1, 2012 by marylbrandt

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

How To Succeed In Medical School

Posted on July 28, 2011 by marylbrandt

Yesterday was the first day of orientation for the new medical students at Baylor. One of our traditions is to announce the winner of the DeBakey Scholar Award at the beginning of orientation. The DeBakey Scholar award is one of the most prestigious awards given at Baylor; it is awarded to the rising senior whose academic success and character best emulates Michael E. DeBakey. This year’s award winner, J. Mason Depasse, was asked to give some advice to the new class of medical students. His remarks were so exceptional I asked his permission to post them here.

Welcome and congratulations on your admission to Baylor College of Medicine. My name is Mason, and I spoke to many of you during your interview day and second look weekend, when I told you why I loved Baylor. I hope that, after your retreat, you are already beginning to love it here as well. You made an excellent choice, and you will appreciate that more and more as you progress. I could go on and on about what makes Baylor great, but today I’m not here to talk about that. Today, I’m here to talk to you about how to succeed in medical school.

I remember my first day of orientation, and I know the mix of anxiety and excitement you are all feeling. I’m sure you have been told about the flood of information coming your way, and many of you may already be bracing yourself for the impact, particularly those who have had time away from biology or those who have an eye for a highly competitive specialty. While nervousness is perfectly natural, I want to stress that, when the material starts building up – and if you remember nothing else from this talk, remember this – you should not panic. Don’t freak out. People from all manner of academic backgrounds do it every year, and no matter what you’ve been doing or studying for the past four or ten years, you will get through it. It might take a little elbow grease, but you’ll make it.

To help you get started on the right foot, I’ve compiled a short list of things to keep in mind as you begin the basic science curriculum.

First and foremost, try to keep up. This is far harder to do than it may sound, but try your best not to procrastinate. The easiest and most reliable way to successfully tackle any seemingly overwhelming task is to break it into stages, and absorbing the enormous volume of information in basic science is no exception. In college, most of the testing in the sciences focuses on concepts, particularly for upperclassmen. You studied a set of rules for how to calculate electric fields and… something about nucleophiles, and you demonstrated that you could apply those rules. You all have the aptitude and the study skills to succeed in those courses, or you wouldn’t have gotten into medical school. Unfortunately, these skills will not be as effective here because you can’t outsmart basic science. You can’t do it. It’s a whole world of knowledge, and as our professors told us, you just “gotta know it.” You have to put in the hours, and keeping up with the material by regular studying makes this manageable. Get into a routine, and try to stick to it. And when you get a bit behind, and we all get behind at times, catch up as soon as you can.

Second, find a way to study that works for you. This may sound obvious, but I’ve seen students become concerned that they are not in a study group, or aren’t making flash cards, etc. But study groups and flash cards may not work for everyone. There is no “wrong” way to study; if it works, then you’re doing it right. Your PRN leaders can give you all manner of suggestions for study tips and tricks, and you should feel free to try them out. You have a practice diagnostic exam before your first set of real exams, and you should use it to determine whether your method is working. But even when you find a strategy you like, your study method may not always work. Medical school is a long haul, and there are a lot of different challenges to face. Keep in mind that succeeding here is about adapting and persevering in the long-term. I wasn’t always happy with my performance, I was frustrated at times, but I found that it’s not worth beating yourself up about it. Adjust and prepare for next time.

Third, use your resources. Your professors will provide you with documents and powerpoints of their lectures, and these will sufficiently cover the material. However, you may find it helpful to supplement your reading with outside sources. Don’t overwhelm yourself, but there are all manner of texts and reviews available. Even looking over a topic in First Aid, the Bible of USMLE Step 1, can be helpful for solidifying your knowledge. Furthermore, don’t be afraid to ask for help. Baylor has a culture of cooperativity. Your classmates, your PRN leaders, upperclassmen, and professors are all here for you and will be happy to provide advice and support.

Fourth, stay balanced. Medical school can be very demanding, and it is easy to burn out if you don’t take care of yourself. Go out with your friends. Join IM sports. Go to the gym. If you’re applying to orthopedics, go to the gym again. Whatever you do, take a break. Two productive hours of studying are far more effective than four hours of staring blankly at the same page. Believe me, I know. There will be weeks along the way during which you will work a ridiculous amount of hours and balance isn’t really feasible, and when those come along I recommend trying to make it up afterwards.

Finally, once you’ve gotten settled into a routine, be aggressive. You’re here because you want to be physicians, and you’re paying through the nose for it – though not quite so much at Baylor. Thankfully, you chose an institution with just about every opportunity for research, service, and clinical experience that you can imagine. Seize them. Join student groups. Email professors you want to shadow or work with in the lab. Go to Ben Taub and learn how to start IVs and suture. When you’re on clinics in what feels like forever from now, I want you to remember that you are the only member of your team who is paying to be there. So get your money’s worth. Know your patients, and I mean really know them, and imagine that you are making all of the decisions. Think of your own treatment plans, and ask questions if yours differs from the final one. Medical school shouldn’t be four years you just have to get through in order to become a physician. Don’t let medical school just happen to you. Medical school is your chance to sample the spectrum of clinical medicine and gain the experiences necessary to begin forming more concrete career goals. So once you’ve got your rhythm going and you’re comfortable with your routine, I strongly encourage you to get out there and explore.

J. Mason Depasse, MS4