After enduring hundreds of lectures during medical school, I’ve noticed a few things that professors do (or fail to do) during lecture that drive me crazy.  I’ve often asked myself, “How would I lecture to medical students?”

With that in mind, here are a few guidelines I’ve come up that I hope to follow whenever I get the opportunity to lecture.

I will:

• make sure all animations, videos and internet links work before I start the lecture.
• limit the number of PowerPoint slides to something reasonable. We’ve had lectures for which we were given 180 slides. For a fifty minute lecture.  That is an average of 16.67 seconds per slide. Poor trees.
• finish the lecture on time or even a couple minutes early.
• ask multiple choice questions during the lecture. While most of these are based on negative things lecturers have done, this is something I have really appreciated. It gets us thinking during the lecture and gives us an idea of the type of questions that will be asked on tests.
• speak with a little passion about the topic! I will avoid a monotone voice for an hour.
• throw in a couple jokes, even if they are really cheesy.

I realize this list makes me sound like a whiny med student. Which is true! Med students are really good at complaining, myself included! But regardless it feels good to get those out there.

Do you have any lecture pet peeves?

I made the mistake recently of estimating how much debt I will have when I graduate from medical school. Once I crunched the numbers (repeating a couple times just to be sure), I looked at the sum and had one thought- seriously?

So… the number was about $250,000. This was not surprising. I had a vague idea I would owe this much. But after really making the effort to estimate that number it became much more real to me.

That sort of debt is difficult to conceptualize. Right now the numbers are just numbers. I see them, and they register in my brain, but what do they really mean? What does six figures in debt mean for me?

Right now my debt has very little impact on my life. The numbers are worrisome but I do not have to worry about paying anything now or in the near future. The only way it interferes with my life is if I think about it. And then it makes me a little anxious.

Why the anxiety? Because even with a salary that puts me in the top 5% of wage earners in the United States, $250,000 in debt will take a long time to pay back.

That debt hanging over me as I think about my future work as a physician feels like a burden, like a lack of freedom. Let’s say an opportunity presents itself to work three months internationally. Will I have to pass it up because I won’t be able to afford the loan payments while I travel?

Will this debt influence my specialty decision? Because it is very much a reality that making twice as much means I can pay off my debt twice as quickly. Is it crazy to consider this when choosing the type of medicine I want to practice?

What does it mean for medical students and medicine in general? How will other students act facing the same situation?

Unfortunately, I don’t have the answers to these questions. What do you think?

In small group the other day we were discussing lupus (aka Systemic Lupus Erythematosus) and the physician leading the group started listing off all the ways the disease can affect the body. He concluded by saying,

“Basically, if you understand lupus, you understand medicine.”

So there you go.

Which obviously reminds me of this:

Apparently in the real world, sometimes it is lupus.

P.S. What’s going to happen if you click the Wikipedia links Jan 18.

Wow, that went by so fast.

Writing went by the wayside this semester as I became bogged down in difficult courses. And I was so motivated at the beginning! The best laid plans…

Anyway, I wanted to write a brief overview of the semester to give you all a taste of what to expect in the second year of med school.

In general, the course difficulty shot up a notch or two. This actually started late last year when we started with our systems courses, the first being Neuroscience. This last semester included Infectious Disease, Hematology-Oncology, Cardiovascular, Behavioral Medicine and Respiratory.

Cardio and Hem-Onc were the hardest for me, although Infectious Disease was a rough way to start the year. Cardio physiology was brutal and will definitely be an area of focus for me as I think about Step 1.

Agh, Step 1. It’s like an evil shadow always lurking in the back of your brain. While very few of my fellow students have actually started studying for it officially, it is a topic that seems to come up in conversation often. And it is always there when you’re studying. Countless times I have considered glossing over something I didn’t really want to put the time into when the thought that I could be missing an opportunity to master something for Step 1 enters my head. This usually motivates me to push on.

Clinic was a welcome relief from the monotony of lectures. I am looking forward to continuing that and honing my physical exam and interviewing skills.

Overall, the semester was a success. I passed all the courses. I feel refreshed after winter break. While posting on this site has trailed off, I actually have a several posts that just need finishing touches. So expect some fresh material!

Wishing you all the best this New Year!

(Photo Source)

Medical school often seems like serious business. Life and death situations, daunting exams, all night study sessions: it all sounds a bit heavy, no?

A recently released memoir shows us it doesn’t have to be this way. Through self deprecating humor and his talent for telling a good story, Dr. Anthony Youn exposes the lighter side of med school with his book In Stitches.

After receiving a copy and thoroughly enjoying it I asked Dr. Youn if he would answer a few questions about In Stitches. He was kind enough to agree and his responses are below. Enjoy and be sure to check out the book!

What was your inspiration for writing "In Stitches?"

First time out, I decided to shoot for the stars. I set out to write the definitive book about growing up Asian American, going through four years of medical school—all true, unadulterated, unfiltered, behind the scenes, warts and all—and becoming a doctor. I think, ultimately, In Stitches represents what medical school really is.  Medical school can be laugh-out-loud funny, shocking, heart-breaking, and heart-warming. That’s what I wanted In Stitches to be. I’m gratified by what readers and reviewers have said so far. They’ve called it “disarming,” “fast-paced,” “hilarious,” and “touching.”

Who are some writers you look up to and how have they influenced your writing?

I can honestly say there is no one person whom I would consider my favorite writer.  However, I’m a big fan of the depth of Atul Gawande, the humor of Wade Rouse, the imagination of JRR Tolkien, and I can’t forget my good friend (and co-writer) Alan Eisenstock who wrote a fantastic book with the late Robert Schimmel, Cancer on $5 a Day.  As you can see, I enjoy a lot of different types of books!

Towards the end of the book when talking about plastic surgery, you say "I like the variety of surgeries that you do. I like doing re-construction where you can really see changes. I love the immediate gratification. I love that you don’t have to wait for lab reports or anything else to to see the results of your work. And being a plastic surgeon is very creative, very artistic. I also believe that a plastic surgeon can change a patient’s life." With the experience you have now, is there anything you would change or add to that statement?

Not a thing.  At one time or another I considered many different specialties, including orthopedic surgery (these jocks of medicine wouldn’t be interested in a skinny nerd like me), general and trauma surgery (I nixed this one the moment I saw a sixty-year-old attending stumble out of a call room at 2 a.m. for a trauma), psychiatry (my fear of falling asleep on a depressed patient mid-session cancelled this one out), and family practice.  To me, none of these compared to plastic surgery, truly the only specialty that really inspired me.  The field of plastic surgery is so broad, with such a variety of procedures and patients to treat.  I love my field and wouldn’t change my specialty for anything.

What sort of perspective can you offer students who are struggling through medical school?

When you are done with work, do things you enjoy. As physicians-in-training, you are accustomed to delayed gratification. I think the turtle in Kung Fu Panda said it best, “Today is the present, and that’s why it’s a gift.” Find moments of happiness in medical school. And once you finish med school there is no excuse to delay. Enjoy yourself, because the worst is over.

Do you have any plans for another book?

I would love to write another book, probably about the horrors and humor of residency, fellowship, and starting a medical practice from scratch.  At this point, though, I’m focused on the release of the paperback version of In Stitches, due Feb. 14, 2012.  Once the paperback comes out, then I hope to begin writing the sequel – a real-life House of God!

Thank you for responding Dr. Youn, I am looking forward to the next book!

This is a guest post from Eric who blogs at Medical Student Syndrome. Eric scored a 248/99 on USMLE Step 1, which is an excellent score. He was kind enough to share his methods for scoring so well. Enjoy the post and read more at his blog!

A few months ago I took the USMLE Step 1 exam. This is a comprehensive exam covering pretty much everything a medical student is expected to learn the first two years. It is a daunting exam. It is a long exam. And it can even become a pretty emotional exam if you allow it to take control of you. For all of you first and second year medical students who are curious/worried about this exam, let me preface this post be telling you a little bit about myself. I scored a 248/99 on this exam. I was extremely satisfied with that score, and I actually felt that I scored outside of my range. I also do not feel that I am of above average intelligence. As a matter of fact, I can be flat out stupid most of the time. But I worked extremely hard for that score. I studied relentlessly for this exam with a focus that rivals that of a Buddhist monk. And to be honest, you need to be focused and determined in order to score well on this exam. So let’s get into it. How do you score well on this exam?

The first thing that I realized about this exam, and that you should realize as well, is that the people that write this exam don’t really give a s#*t about your dreams, where you came from, or why you want to be a doctor. They don’t care that you want to be an oncologist because your nana died of cancer, or that you want to be a dermatologist because you had bad acne in high school and no one wanted to go with you to prom. This exam is designed for one reason: to make sure that the people who are going into their clinical clerkship years know enough information to hopefully not end up killing someone. This exam is a quality control measure, and for good reason too. Because let’s face it, if your mother came into the ER with fatigue and easy bruising, you’d want to make sure that the student/resident/attending knows what the hell they’re doing or they just might miss her leukemia. But this should get you a little pissed off too. Since this is a pass/fail exam that every medical student must take, the people that make up this exam are the gate keepers and hold all the keys.

Even more ridiculous is that the people who made up this test decided to grade this exam on a point system which incidentally allowed it to become a major pillar in your residency application! So start getting a little pissed off. Get a little fire in your belly. And turn that anger into determination! Start telling yourself that you’re going to get a 299 out of spite for the people who are forcing you take this exam in the first place. “Oh, you’re telling me that I have to pass your ridiculous exam? Well not only am I going to pass it, I’m going to dominate it. Take that Mr. Man!”

I should also mention that if you happen have entitlement issues or feel that you are “truly gifted” because you achieved honors in your M1 biochemistry class, lose that now or you’ll end up like this one kid I know. This individual told everyone that he wanted to do dermatology. He honored every 1st and 2nd year class, but got so caught up in his own accomplishments that he felt that the Step 1 exam was beneath him. He didn’t employ a smart study schedule and ended up getting a 228 putting him in a poor position for a dermatology residency spot. That being said, I’ve seen some really intelligent people fail this exam and some extremely unintelligent people pass this exam. What sets them apart is hard work and a smart study schedule.

Okay, so now you have the mindset and the determination to dominate this exam. Now you need to figure out what and how to study. My school gives its students up to one month to study for Step 1. Other schools will vary, but find out how much time your given to study for this exam as soon as you can, because it will factor into how you budget your time. That being said, I would suggest beginning to study for this exam during your winter break of second year. During my winter break, I pulled out my embryology book from M1 year and went through all of the high yield material that coincided with the embryology chapter from First Aid for the USMLE Step 1 (see later). I was thankful that I did this, as it saved me valuable time when it really came time to study for boards. Obviously, you don’t have to study embryology during this time, but study something from your first year of medical school with which you had trouble. Next, after your winter break, try to allocate at least one hour a night to a subject from your M1 year. For example, I set aside an hour to either physiology or biochemistry every night. This time added up; and by the time June rolled around, when it was time to really study for boards, I knew everything about biochem and phys.

Now let’s talk about Step 1 resources. There are two books and two other resources out there that I personally feel are a must need and that anyone who doesn’t utilize these books for Step 1 is an idiot.

1. First Aid for the USMLE Step 1: This book contains what I believe to be 90-95% of all material on which you will be tested. That’s good. That means that if you can master this book, you will more than likely pass the exam. It is very well put together and is updated annually so only the most high yield concepts are covered. Now if you’re wondering, “My friend gave me his 2010 edition. So, I’m covered, right?” The answer to this question is – maybe. Even though the book is updated every year, there are little changes from edition to edition. But I would highly suggest just buying the newest edition when it comes out in the winter. To prove my point, let’s just look at the math: 4 years of medical school costs around $250,000. This book costs about $30. So buying a new First Aid book will contribute to 0.012% of your overall debt. $30 is a drop in the bucket as far as I’m concerned. Plus, one of the biggest factors in your residency application is your Step 1 score. So if you want to be a competitive applicant, you want to get the best Step 1 score possible, right? So get the newest edition even if you already own last year’s edition. One more thing about First Aid for the USMLE Step 1 – if you can get a .pdf file of this book in addition to the book itself, that may be helpful. I personally found it easier to search through the .pdf file than the book if I was looking for something specific. For example, instead of flipping through numerous pages looking for the effect of loop diuretics on serum calcium, I just typed in “loop” and “calcium” in the search bar of my .pdf application and the exact page I was looking for came right up.

2. Rapid Review Pathology 3rd ed. by Edward Goljan: Okay, this book is the bible for pathology. Dr. Goljan’s anal-retentiveness to mechanism of disease goes hand-in-hand with what Step 1 will ask you. Many questions on the Step 1 exam are asking you about mechanism of action. This book does a great job in laying out how disease processes work. Plus, this book comes with a discount for USMLE consult which is a pretty good Q-bank to go through when you’re trying to understand key concepts (if you’re so inclined to purchase it).

3. Dr. Goljan’s Rapid Review Lectures: I don’t care how you get these lectures, just get them. And make sure you listen to every lecture too. Dr. Goljan does a great job explaining the mechanisms of pathology, makes his lectures entertaining, and gives you confidence in your ability to understand some really difficult concepts.

4. USMLEWorld Q-bank: Don’t get any other question bank. It is almost unanimous that this is the best Q-bank for Step 1. There really isn’t any other Q-bank out there that is even close to measuring up. The only downside is that this resource is somewhat costly. It runs $99 for 1-month, $135 for 2-months, $185 for 3-months, $299 for 6-months and $399 for 12-months. I bought the 3-month subscription and that was enough time for me to go through every question thoroughly. I would suggest going through this Q-bank twice before your exam if you can because it contains such high-yield material and very well written questions.

So what should you do with these absolutely essential materials? Use them! When you are studying during your M2 year for your cardiology exam, crack open Goljan’s Rapid Review and read the cardiology chapter! After that, crack open First Aid and read that cardiology chapter! Familiarize yourself with how these topics are covered in these books during your M2 year; that way, when it comes time to answer a question on congenital heart disease for boards, not only will you know the answer but you will also know the page number on which it was located and the illustrations that were on that page. Also, when you are driving to and from your school doing nothing, why not use that time to study? Throw Dr. Goljan’s audio lectures on your iPod (or your Zune if you’re weird like that) and listen to a GI lecture before your lecture on Inflammatory Bowel Disease at your medical school! And depending on how long you purchased your Q-bank, go through the Q-bank questions that cover the material you are going over in class.

Okay, so now some other things that you may or may not want to purchase:

1) Rapid Review Biochemistry by Edward Goljan: This book is short, sweet, and to the point. If you had trouble with biochem, or just don’t remember any of it, this book may be of some value. This is how I relearned biochem for the boards, and I don’t think that I missed a biochem question on my exam.

2) Cram app for Mac and iPhone (or any other flashcard app for that matter): A portion of boards is about memorizing esoteric facts. What’s the antidote to heparin? What congenital heart defect is seen with lithium use? What receptor does ipratropium act at? Studying for these questions is easy if you have flash cards. But I found that standard flash cards are annoying to make and cumbersome to carry around. So instead, I decided to make flash cards on my laptop with the application Cram. After making flashcards in this program for my Mac, I was then able to transfer them to my iPhone using the iPhone Cram app. This was great to have because it allowed me to learn all the drugs that cause congenital heart defects while standing in line at Chiptole, or antidotes to drugs when I’m eating lunch.

3) High-Yield Neuroanatomy by James Fix: This is not a bad book to have if you struggle with neuroanatomy, neurophysiology, and neuropathology. I’ll say that the neuro chapter in First Aid is more than enough, but this book explains a lot of difficult concepts (something First Aid does not do so well). Again, I would consider getting this resource.

Other resources out there include these board review classes. Programs like Doctors In Training (DIT), Falcon, and others offer a Step 1 review course for a substantial fee. These courses have their pros and cons. I would say that the best quality of these review courses is their structure. For example, I purchased DIT for my Step 1 studies for the simple reason that I didn’t trust myself adhering to a strict study schedule. I knew that if I would try to study on my own, that I would fatigue after a week or two and consequentially wouldn’t have used my study time wisely. DIT solved that for me. They provided a 15 day online review course that forced you to go through First Aid for the USMLE Step 1 in a very methodical way. Now, you may be asking yourself, “Why would I pay someone to talk me through First Aid?” My answer to that is – exactly. Paying for these courses is equivalent to paying someone to read First Aid to you. And I must say, I found DIT extremely boring. As a matter of fact, by the end of the course I was surprised that hadn’t sustained permanent brain trauma from pounding my head against my desk. So just to reiterate, I feel like these courses are really designed for the people who can’t adhere to their own study schedule. But please investigate for yourself, as you might like what they offer.

Lastly, I would like to address your lifestyle during your month of studying for this exam. Studying for 6-12 hours a day, every day, can be absolutely grueling. The keys to surviving this month are finding a daily routine and having good health habits. It should be no surprise that these should go hand in hand. During my month of studying, I forced exercise into my daily schedule. 4-5 days a week I would run for at least 30 minutes. I bought organic foods, drank smoothies, made salads, drank plenty of water, and forced myself to get at least 7-8 hours of sleep a night. I know that this may sound trite, but I felt that it really did make a difference. Studying for this exam takes a toll on your body, so doing all of the right things to make yourself feel better helps. Consider including good health habits into your study schedule.

So that’s about it. That’s what I did to study for Step 1. I hope this was of some benefit. If you already feel overwhelmed, don’t stress out. Just begin to study early, gain some self-confidence, and you’ll be fine. I wish you all the best on your future studies. If you have any questions, please feel free to email me at medstudentsyndrome@gmail.com, and please check out my blog, http://medicalstudentsyndrome.blogspot.com.

Last Monday we started a Hematology/Oncology or Hem/Onc. The Friday before we finished Infectious Disease. After a week of Hem/Onc I am beginning to realize how difficult it is going to be to switch between classes so quickly.

You just start to get into a groove, everything is starting to click, then boom you’re done and onto a different course. New professors, new material and a whole new approach to studying.

This last week was hard but I think I’m getting a grip on Hem/Onc. It is more conceptual than ID which means less brute force memorization. This is a change of pace I appreciate. But it is still an adjustment.

Do you readers have any advice on how to adjust to the changing pace of second year?

Last week I started seeing patients in an actual clinic!

I will be going to the same clinic every other week for the rest of the year. Second year students at Creighton are spread out at clinics throughout Omaha. My preceptor is a pulmonologist who is great to work with. She asked me questions but I never felt interrogated and was eager to teach.

Seeing real patients and real disease was a welcome change from memorizing dozens of bugs and drugs and trying to apply them to fake cases. In clinic we saw a couple people for respiratory infections. Each patient was different and the doctor had to consider allergies, prior lung disease and likely cause of the infection in deciding the antibiotic to treat with. We had learned all this in Infectious Disease, but seeing it in practice was incredibly refreshing.

I was able to interview one patient on my own and it actually went really well. It helped that the patient was very nice and easy to talk to, a thoughtful way for my preceptor to ease me into seeing patients.

Tomorrow is a different story however. Tomorrow is my Infectious Disease final. Yikes. Wish me luck!

Fellow med students- what was your first experience seeing patients like?

Check out these pieces by Stephen Gaeta, a med student who recently finished his PhD.

Titled: Beat Poetry

Titled: Extra-Ocular

These prints and more can be purchased at the Street Anatomy Store. I am quite fond of Beat Poetry, maybe it will be hanging in my office in the near future?

Also, you should follow the Street Anatomy blog if you get a chance, it is awesome!

Here is a brief run down of my first quiz of the second year which was yesterday.

• Thirty-four lectures covered
• Forty questions
• Fifty minutes to complete the “quiz”
• One weekend spent studying which I will never get back
• One passing grade for me

All in all, I can’t complain. Infectious Disease is fascinating stuff, but the volume of information is difficult. I feel like I’m still recovering from the quiz but we’ve already had five more lectures that I need to keep up with.

Fire hose… yeah.