Med School Confidential

by Robert H Miller

  Work-study programs

  The work-study program is better suited to undergraduate education, where your copious amounts of free time could be applied to campus jobs. The reality in medical school is that your free time is so limited that you just can’t take on a regular campus job; any outside work requirements are a distraction to be avoided if at all possible. If work-study is your only option, try to find a way to make the experience both a source of tuition money and an opportunity to get involved in research or other activities on campus that can further your education and strengthen your resume. Most med students who do work-study end up working for the note-taking services compiling lecture notes. If you’re considering signing up for a workstudy project, be realistic about the time requirements. When possible, talk with students who have done the same type of job to assess its feasibility.

  Loan Repayment Programs

  Financial-aid considerations do not end once your grants and loans have been secured. There are also a number of ways to get your loans repaid for you. One of the more common is a commitment to the armed forces. By signing up for a branch of the military for a period of years, you can get the armed services to pick up the tab for medical school. If you’re interested in the military, this can be an extremely cost-effective way to go. Be aware, however, that your choice of specialty or the location of your training may, in part, be dictated by what the military needs. Research these programs carefully before you sign up. Another repayment option is the National Health Service Corps. This federal program offers loan repayment to med students in exchange for a period of service in a medically underserved community. For primary-care doctors attracted to rural living, this can be an extremely attractive and cost-effective approach.

  BUDGETING

  Figuring out how to fund your tuition and expenses is only half the battle. The other half is being conscientious about managing your personal finances while you’re in school. After tuition is paid, there’s usually only a relatively modest sum left to live on. Through careful budgeting, you can not only keep yourself in check and minimize your debt burden but you can also effectively stretch your dollar. Remember, though, med school is a demanding experience—it’s neither healthy nor fun to try to survive on ramen noodles and free saltines from the nurses’ station. You have to grant yourself some semblance of a regular life.

  Be especially careful about your use of credit. The credit card is often the medical student’s nemesis. It becomes frighteningly easy to charge your worries away, blithely ignoring the ever-escalating balances. You can’t defer these payments, and the rates are astronomical Do not be tempted. If you cannot control your credit card spending, cut your cards up immediately. There’s simply no quicker way to get yourself into a deep financial hole. If you’re having trouble living within your budget, talk to your financial-aid advisor to get advice.

  “My advice is not to spend excessively in school,” Pete advises. “Live simply so that after medical school you can simply live.”

  RECORD KEEPING

  Perhaps the most important thing you can do with respect to your financial aid is to keep good records. This is confusing stuff, and the stacks of statements alone can become overwhelming. Develop a clear understanding about all of your funding sources, make files for each one, and keep up-to-date on the terms of the funds, how much money you owe, current rates, current repayment terms, and whom to contact with questions. Ideally you should review your financialaid package at least annually with your financial-aid advisor. (You will likely have to do this anyway, since you have to complete a new FAFSA each year.) In between these annual checkups, you should consider starting each school vacation by visiting your aid files and making sure your paperwork is current. Good planning in your final year of med school will also ensure an easy transition to internship and beyond.

  CHAPTER 12

  Getting Off to the Right Start in the Preclinical Years

  The beginnings and endings of all human undertakings are untidy.

  —JOHN GALSWORTHY

  GETTING OFF ON the right foot on day one is crucial. We’ve already laid out a series of strategies for setting up your life and getting your feet under you before school begins. We’ll now move on to provide a road map of classes and actual, day-to-day survival tips.

  As mentioned previously, there are many different flavors of medical-school curricula. The following sections will describe a traditional curricular approach. The systems and problem-based approaches used in some medical schools are variations on this theme, but they ultimately rely on presenting the same knowledge and roughly the same progression of ideas and understanding.

  GOAL OF THE PRECLINICAL CURRICULUM

  The goal of your preclinical curriculum is to provide you with a logical foundation of medical knowledge. In your first year, you will start with the fundamental structure and function of the body—Anatomy and Physiology. These courses will take you from the functional organelles of individual cells all the way through complex arrangements of tissues and organ systems. In the second year you will begin to study the impact of disease on the body—Pathology and Pathophysiology. You will also begin to develop a framework of Therapeutics. Each of these subjects will be covered in more detail in the next chapter. As dry as some of this can be, mastering this material is fundamental to your success, as it provides you with the knowledge base you will call upon for the rest of your career.

  ESTABLISHING A STUDY STRATEGY

  It is essential to develop and adhere to an effective study strategy from the outset. As mentioned in chapter 10, taking the time before school starts to think about the way you learn best can provide useful insights into the most effective way to handle the mountain of information that lies ahead of you. That said, there are three basic approaches to learning in medical school, represented by three typical medical students: Larry, Curly, and Moe. Follow the examples below to see these approaches in action.

  Larry the Lecture Hound

  Larry is a straight arrow who grew up wanting to be a doctor. He got accepted to medical school right out of college and is eager to jump in. He went to every class he took in college and was a teacher’s assistant. He was captain of the soccer team and president of his fraternity. He wasn’t much of a reader in college but managed to glean everything he needed from lectures, even without taking notes.

  Now Larry has leapt into his med-school classes.

  “Whoa, these classes are different! The lectures don’t quite cover everything, and they move so fast that detailed notes are tough to take.”

  Plus Larry is in lectures six hours a day. He tries to review his notes before the weekly quiz but they are fragmentary and incomplete, and often he can’t see how the minutiae fit into a bigger picture.

  Then someone tells him about the note-taking service. Turns out that guy in the back with the video camera isn’t some film-school geek shooting a documentary. He’s actually a classmate whose workstudy job is to videotape all lectures and catalogue them for the lecture service. Furthermore, Larry notices that every day there’s a different person sitting next to him with a laptop, typing away. Turns out this person is adding daily notes to the detailed course outlines, which are also catalogued for the lecture service.

  Hmmmm!

  A lightbulb goes on for our friend Larry. He can sit in class and glean what he can from the lecture. Then he can review the detailed notes from the note-taking service. For any concept that still doesn’t make clear sense, he can fast-forward to that portion of the videotape and review the professor’s comments on the subject. Finally, because the lecture notes are integrated into the course outline, he can identify which areas weren’t really covered in class and (gulp) hit the books to cover these concepts.

  The only problem with Larry’s approach is that all of this will take hours every day. Larry has just experienced the stark reality that most people go through in their first few months of medical school—this ain’t college anymore. The volume of information is
much larger. Lectures alone won’t cover all the material, so you are forced to do a major portion of your studying independently in order to assimilate and understand the information and how it fits together. Not only will you be required to use the information on tests, but you’ll quickly realize that you are building a pyramid of knowledge, and unless you put these fundamentals securely into a foundation, the subsequent concepts and information won’t make sense.

  But Larry’s plan to rely on the note service and videotapes is, in fact, an excellent one. It will provide a structured and detailed review of the information, and it is well suited to the learning style that he adopted in college. However, he will also have to develop the discipline and fortitude to actually sit his butt down and review the notes and the videotape every day after classes to keep himself up to speed.

  After a few weeks of stumbling around, a lot of coffee, and one embarrassing episode of anxiety-induced diarrhea, Larry evolves his new study strategy into a very efficient learning tool. He’s signed on to the note-taking service, and he’s now got it down so that he can review a given lecture in about half an hour, make a list of concepts that he’ll want to go over again later, and even look over the outline for the next day so he can anticipate what’s coming.

  “What worked best for me was being able to read before class, find a way to stay awake in class, and then review the same material that evening,” Chris explains. “Mostly I just ended up rereading the note set as often as possible.”

  Curly the Curious

  Curly is a bit of a bookworm. He can quote you Tennyson’s poem “Odysseus” in its entirety, even, or perhaps especially, after a few too many beers on a Saturday night. He was an English major in college, but he also seemed to excel in a smattering of science classes. He traveled after college working and writing his way through Latin America. In Guatemala, he met some folks that were staffing a rural medical clinic and needed an extra hand. He said he’d be able to help for a week—and stayed for three months. He was incredibly compelled by the work and by the satisfaction and gratification of healing. He decided to think about medical school.

  Back in the States, he enrolled in his local college to take his premed classes. They were a drudgery, but having read his way through the major works of Western literature in college, he was adept at burying himself in the books. He found that the classes gave him a good overview, but to really master the material he had to go through it on his own, synthesize it into his own summary, and regurgitate it to himself. He was often to be found deep in the bowels of the library or curled up at home, head bowed in a book, making notes hour after hour. He excelled in his premed classes. He was almost embarrassed when he was named Organic Chemistry Student of the Year. Before he knew it he had completed the premed classes, applied, and found himself staring at a letter of acceptance to his top-choice medical school.

  As we join Curly, he’s up to his eyeballs in the first weeks of medical school. He’s tried going to lectures, but finds them alternately boring, confusing, and poorly presented. He takes little information home that he can apply.

  “Okay,” he says. “It’s time to head for the stacks.”

  He finds a quiet, windowless corner of the library and piles the textbooks up around him. He cracks the first one and sets in reading. Two hours later he’s covered the first twenty pages—one-fourth of the first lecture in the first class.

  “Uh-oh,” he says.

  If he continues at this rate, some librarian will find his dead and decaying bones years hence, still glued to the chair, only partway through the reading for the first semester. It’s time for Curly to adopt a study strategy.

  Eventually Curly discovers that the university bookstore has a wide range of review books that summarize the salient points of the texts. He finds he can digest these rapidly, then easily turn them into an outline of his own. Admittedly, they miss some of the finer points, but he finds he enjoys going to the textbook to investigate the details or even pulling up a good review article from the New England Journal of Medicine. He tries to look ahead on the outline and identify lectures he should probably go to, but after a few weeks and some calibration, he finds he can cover the material and be adequately prepared for the tests and still go to only half the lectures.

  “I realized early on that I did not learn well in lecture format,” Ben admits. “I had to read things and put them together on my own to really learn them—so I cut down my lecture attendance and spent the time reading in the library. This was somewhat of a gamble because I was unplugged from the specifics being transmitted in class, but I think I learned much better. I think it’s important to figure out how you learn best and try to focus on that method. There’s just not enough time in the day to do it all.”

  Moe the Meeting Man

  Moe’s a great guy. He’s fun, friendly, social, and sensitive. He seemed to do a bit of everything in college. He was a serious student who excelled in his premed classes, but he also played Ultimate Frisbee and managed to get out quite a bit. He was a teacher’s assistant during his junior and senior years in college, and he also did some tutoring at the campus center. He found he enjoyed the work, and, perhaps more important, every time he endeavored to teach something to someone, he found that he understood it a little bit better himself. He also noticed that during his premed classes, he particularly liked and excelled in the lab sections, in part because he had some excellent lab partners and they all had a blast working through the experiments and writing them up. In fact, to Moe, the labs were the only part of his premed classes that weren’t a chore.

  Upon arriving at med school, Moe astutely befriends his Anatomy group. He’s happy to find they’re all engaging, personable folks, and everyone seems to enjoy working together. They’re all smart—in fact, one of the disarming things about the first few weeks of classes has been discovering just how alarmingly smart some of these folks are. However, Moe finds he can certainly keep up with the pack, and it’s very clear everyone is struggling under the gargantuan load of information. Within the first two weeks Moe and his Anatomy group agree they should set up some regular study sessions to review. At first they just review Anatomy lecture and lab, but they quickly discover they should expand their scope to include their other classes.

  Over time, they evolve a fairly organic format for their sessions. The exact format varies with what they’re covering, but in general they meet initially and divide up the material to be covered, then arrange their next meeting. They spend the intervening time going to classes and preparing the information they’re assigned. At the group meeting they each present their area of review. Some folks make diagrams, some folks develop mnemonics, and some folks make worksheets. As each person presents, he or she gets peppered with questions from the rest of the group. Over the space of several hours they are able to concisely review the entire block of material, and everyone gets handouts and notes to take home to study later.

  Then the first Anatomy test hits.

  Moe walks in feeling confident, knowing he and his group have reviewed the material in depth and have done a good job with the dissections. He breezes through the first ten questions because they cover a section of the hand that he himself presented to the study group. His clever, albeit lewd, mnemonics quickly leap into his head, and the diagrams he made help him connect all the pieces.

  So far, so good.

  But when he moves on to the forearm sections, he starts to get stumped. His friend Jane presented the material at study group, and it all seemed clear at the time. But now her diagrams seem fuzzy in his head, and while he can remember the phrase someone used for a mnemonic, he can’t remember what it stood for. Is that tag on the flexor digitorum profundus, or is that the flexor carpi radialis?

  Uh-oh.

  Wait, that could be a nerve, not a tendon . . .

  Oh, man.

  Sweat starts to bead up on Moe’s forehead. He tries to remember the lecture, but the professor flew through the diagrams from the textbo
ok, so his notes were sketchy at best.

  Needless to say, Moe does not do particularly well on the first Anatomy exam. The good news is nobody does. Nobody ever does well on the first Anatomy exam! But he does notice that the Anatomy Lab group next to his seems to excel. This is odd, since they don’t talk much and don’t seem to work well together. He sees them at all hours distributed in different parts of the library, working individually. Hmmm . . .

  Moe reviews his test results and is pretty bummed. He aced parts of it, but in whole stretches he got next to nothing right. He feels there’s no way he can survive a semester of this. He and his group studied for hours before the test. Everyone had produced such excellent, detailed study guides. If he didn’t learn it then, how the heck would he ever learn it?

  Drowning his sorrows in a cup of joe and trying to summon enthusiasm for the coming day’s onslaught of lectures, Moe runs into an upper-level student he knows. She asks him how it’s going so far.

  “Great!” he says. “Except . . .” and he fills her in on the first test.

  She actually laughs.

  “Man, I remember bombing that test,” she says. “I cried for an entire night. I was sure I was unfit to be a medical student, let alone a doctor. Then someone gave me the one piece of advice that saved me, and continues to save me to this day: don’t study the information, own it. Study groups are great, but they can be passive. If you work with a study group, you also have to work through the information yourself because your study group ain’t gonna be there on the test helping you with the answers.”