Moe’s friend is right.
Moe had sat through hours of study-group presentations and felt like it all made sense at the time, but he’d only flipped through the lecture outlines and the handouts from the group in preparation for the test. When push came to shove at test time and he was standing in front of the cadaver, he could not reproduce any of the information he had not directly prepared himself. Maybe this group thing wasn’t working out so well after all.
For the next test, Moe tried to prepare all on his own. He found at test time he had a much better overall grasp of the material. However, there had been so much to review that despite spending every waking hour with his nose in a book, there was just no way he could master all the information himself.
Over the next few weeks, Moe and his study group evolved their style into an efficient machine. Others in the group had reached the same conclusion: the relatively passive nature of the group-study approach meant that unless you took time to test yourself and master the material presented by others, it was wasted effort. So, in the end, Moe’s group scaled back the number of hours they spent in group study, attempted to develop useful, high-level study aids for each other, and spent a lot of time testing and retesting each other. This overall strategy ended up working very well with Anatomy, and it was easily adaptable to other courses as time went on. Moe still studies with his group, but he has also come to appreciate the hours he spends mastering the material and owning it. He finds if he reviews, memorizes, and tests himself even before the study-group meeting, he takes more away from the study group, and he can better use the group time to rely on his peers to explain the concepts that are toughest to him. Since they all have different areas that challenge them, they manage to efficiently uncover and smooth out the major bumps on the curricular road.
“I got by with a lot of help from my friends,” Deb says. “We had a small group, five of us, that got together regularly before tests and studied. Occasionally someone would have flash cards or make up a flow sheet or chart to share with the rest. Mostly we would go over old exams and the questions would spark discussion or point out weak areas we needed help with. Among the five of us, someone would usually know the answer or be able to explain away the confusion.”
Obviously, these are just a few whimsical examples of different medschool study strategies and the advantages and potential pitfalls of each. You will no doubt craft your own. The important point here is not what type of studier you are nor what strategy you ultimately adopt. The important point is recognizing that you will be challenged by the material in med school like you’ve never been challenged before, and it is crucial that you think about and develop a working, effective study strategy early on in your first semester of med school.
It should also be noted that none of the strategies outlined above adopted one of the critical long-term survival strategies endorsed by many of your mentors—using the USMLE board review books as you go along. You will be required to pass the USMLE Step 1 and 2 Exams while in medical school. These will be major rites of passage, so you may as well prepare for them as you go.
Get a good Step 1 book in the first few weeks of classes and make a habit of digesting the relevant material and testing yourself on it as you go along. Make some flash cards that you can use to review both for your class exams and for the USMLE.
All of us wish that we had done this earlier. Learn from our mistakes. Start now.
DECIDE ON A SCHEDULE AND STICK TO IT!
Your study schedule will be almost as individual as your study strategy. You will likely have classes from about 8:00 A.M. to 2:00 P.M., so you’ll have to fit the rest of your studying and the rest of your life around these hours. Plan on a minimum of three to four hours of independent study a day. Figure out a way to include some time for yourself, preferably by doing something athletic like going to the gym. Determine just how much sleep you can survive on and still remain healthy and productive. Finally, look ahead in your schedule and plan to take blocks of time off—a day away visiting family, or a weekend camping with friends. These will be relatively few and far between, but the anticipation of these breaks will give you hope and something to look forward to during your long hours at the books.
“I am a night person and would routinely stay in the library until it closed,” Adam notes. “I would spend Saturday and Sunday mornings doing nonmedical things, and study in the evenings.”
“I would often exercise after class, have dinner, and then study for a few hours,” Kate remembers. “I tried to leave one weekend night for social events and was committed to studying the rest of the time. I also made sure I got plenty of sleep.”
A typical schedule for a day could go something like this: you might get up around 6:00 A.M. You’ll eat a quick breakfast and catch up on any last-minute reading. Say you leave the house around 7:00 and head to campus, getting there around 7:15 or 7:30. Cup of coffee in hand, you’ll spend a few minutes catching up with friends or reviewing the upcoming lectures before they start. Classes will probably run from 8:00 to noon; several days a week, you’ll have labs from 1:00 to 3:00 or 1:00 to 5:00. You’ll usually grab a quick lunch while doing some reading, then head home after classes to spend a few hours with your family or friends. Many students try to do as much studying as possible during regular daylight hours and thereby maximize their at-home free time. Sometimes this works, sometimes it doesn’t. Many times you’ll get a number of good productive hours in, either very early in the morning or in the afternoons, and then do nothing at night. Other times you might start studying at around 7:00 P.M. and work until 11:00 or 12:00. If you’re a group studier, your evening sessions will frequently take place back on campus. You may work for a few hours preparing outlines and questions, then get together as a group and go over material for a few hours. Finally you’ll hit the sack, and get up next morning to start all over again.
That arrangement would cover most of the week. On the weekends, you’ll probably try to take a full day off, but usually this will amount to about a half day off on Saturday and a portion of Sunday. By Sunday afternoon, stress will usually get the better of you and you’ll find yourself back on campus getting ready for the week ahead.
Over time, your body will adapt and you’ll find you can function pretty well on four to five hours of sleep a night, providing you have the opportunity to catch up every ten days or so. This fact will allow you to adapt to crunch times like exams when you will stay on campus studying until 2:00 or 3:00 A.M., and then be back in class at 8:00. Allnighters work for some, but you’re often too wiped out the next day to focus and actually learn. Caffeine will become a mainstay for most. Exercise may be frustratingly sporadic, but at least try to get outside as much as you can, and remember, the more exercise you get, the more revitalized you will be. Some of the most successful students were the ones who are able to adhere to a regular fitness regimen. You simply cannot underestimate the impact regular exercise will have on your well-being and performance during these incredibly stressful times.
“I think the biggest challenge is to keep from feeling overwhelmed,” Chris says. “All I can say is, don’t try to look too far ahead. Just keep focused on what is in front of you and the rest will take care of itself.”
A STUDY TECHNIQUE TOOLBOX
Here’s a quick list of tools the mentors used to build their knowledge base in medical school. You may want to consider adopting them as well.
Flash cards
Mnemonics (the raunchier the better!)
Diagrams and drawings
Old tests for sample questions
Revising and rewriting your notes
Commercial course outlines and reviews
Listening to taped lectures and reviewing prepared noteservice notes
CHAPTER 13
The First Year: Normal Systems
Our own physical body possesses a wisdom which we who inhabit the body lack.
—HENRY MILLER
THE FIRST-YEAR CURRICULUM is all abo
ut understanding how the human body is supposed to work. Much of this material will seem a long way from any clinical application, but it will provide a critical context for the classes to come. Your core anatomy training will include Embryology, Human Gross Anatomy, Cellular Biology, and Histology. Mastering these classes will require that you learn a completely new language of anatomical terminology while at the same time developing a multidimensional sense of spatial and structural relationships of the different pieces and parts. Not an easy undertaking, but it’s fascinating stuff. Your Anatomy course will doubtless be an experience you will recall for the rest of your life. The rigors of managing such a staggering volume of information, the challenges of surviving new classes with new classmates, and the emotional impact of dissecting a human being will inevitably leave an indelible mark.
Your core physiology training will focus on developing an understanding of the function of individual organ systems and the overall symbiotic function of the body. Course work here will likely include Human Physiology, Biochemistry, Genetics, and Nutrition. It is, for obvious reasons, vitally important that you understand completely the normal function of the human body before you can begin to address the impact and management of disease—and that’s the rationale for the organization of the traditional curriculum. Your course work here will build on your growing understanding of anatomy and yield functional insights. The human body is an intensely dynamic machine, and an appreciation of physiology in action is truly awe-inspiring.
THE FIRST-YEAR COURSE WORK
Anatomy
The human body has thousands of named structures. By the end of your first year of med school, you will be required to identify, relate, and understand a good portion of these structures, which are distributed across the eight major systems of the body. Unless you were a taxonomist in college, this information will likely all be relatively new for you. In fact, even if you took an Anatomy and a Physiology class in college, you will be surprised how differently you will study it in med school.
One of the first and most crucial differences will be the presence of a human cadaver. You and your dissection group of four to eight students will examine this body from stem to stern over the course of your Anatomy class. Many people are nervous about this experience, which is understandable. Day one will be difficult, full of surprises and new experiences.
Most med students have never scrutinized a dead, naked body up close.
Whatever the lecturer says to you during the first twenty minutes will be a blur as you stare down in front of you and think, “Oh my God, it’s a dead person.”
Your first day of Anatomy Lab will be your first truly quintessential medical-school experience, and one that you will remember for the rest of your life.
After the first twenty minutes of adjustment, though, you must face the task at hand. At first, the scalpel will seem awkward in your hand, and the skin will have the heavy, leathery feel of preserved flesh. But after a few hours you will get the feel of the tools, and the diagrams in your dissection manual will begin to come alive. Tissue planes will make sense as you gently pull away layer upon layer of structures, identifying and labeling vessels, nerves, tendons, and the like. At the end of the first session, you will emerge from the lab with the smell of formaldehyde in your nose, with your head spinning, and with no idea how you will possibly be able to get through an entire body at the painstaking pace you took today. The short list of structures you and your group identified on this day will seem confusing and poorly connected.
Take a deep breath. With time, you will begin to formulate a framework for all this information.
Pay attention, during the first few days, to the general introduction to anatomy. Develop a clear sense in your head of the organizing hierarchy. Use a chalkboard, a white board, or a blank sheet of paper and make sure you can reliably diagram the eight anatomic systems and some of the basics under each one. This diagram represents the systems-based view and will be a fundamental organizing principle for every single anatomic fact you learn.
As you begin to delve into the details of each system, however, you will rapidly arrive at the conclusion that there are at least two other perspectives beyond the systems view that will be fundamental to your mastery of anatomy.
The first is the structural perspective.
You must spend time understanding and memorizing the new vocabulary of structural relationships. You must learn to describe the location and orientation of any given structure. It’s great to know that the bladder is part of the urogenital system, but it’s even more important to understand that it is a pelvic organ and not a peritoneal organ, that it sits directly posterior to the pubic symphysis, that it is surrounded by the vesical fascia, and that it is supported inferiorly by the pubovesical ligament and pelvic fascia. You must know where the ureters that carry urine from the kidneys enter the bladder. Most important of all, you must develop a three-dimensional memory of the bladder and all its parts and connections so that, as you learn more and more facts about this system and its many subcomponents, you can visualize and understand the structural interrelationships. This is not an easy thing to do. You must take time to study diagrams, dissect the parts from your cadaver, and prove to yourself that you can essentially recreate the anatomy for yourself.
Finally, you must learn to put system and structure together to develop a functional perspective of anatomy.
In order to reach out your hand and bring the day’s eighth cup of coffee to your tired lips, your central nervous system must recognize the image of coffee in your brain, recognize emotions of longing, and send signals down your motor cortex, through your spinal cord, and out via your brachial plexus nerves to the flexors and extensors of your arm, forearm, and hand. The nerve impulses will trigger a muscular contraction that will shorten the muscles and in turn put tension on tendons, which will then pull on bones. The bones will articulate on joints held together by ligaments. As your muscles fire and your arm moves, your nervous system will come back into action, visually observing the progress and calibrating the nervous impulses until, hallelujah, your hand contacts the warm cup, the cutaneous nerves in your fingertips register a firm warm shape, you grasp the cup, bring it to your lips, and take a long, sustaining drink.
Pretty cool, huh?
The problem is, your body does about a billion different things, and each is a delicate and well-orchestrated ballet of multiple systems and their interacting structural components. It is as complex as it is awesome, and you’ll need to know it all.
The trick, of course, is figuring out how to piece all of this knowledge together and develop an efficient way to process, catalogue, and master this immense amount of information.
First, don’t panic.
Although it will feel like you could never possibly master even a third of the material you’re expected to know, you will—just as legions of medical students before you have done. Surround yourself with the course outline, a couple of anatomy textbooks, and a stack of blank paper. Reflect on the first week’s worth of material in the course outline and get a sense of what systems and structures you’ll be expected to know. The outline is more than likely organized around the systems model. Understand the system and how its major components relate. Make a checklist of the specific anatomic structures you are expected to know.
Once you’ve done that, hit the anatomy texts. Most people use Frank Netter’s exceptional atlases. You may also find alternate texts such as Grant’s Anatomy or Gray’s Anatomy of the Human Body useful to provide a couple of different pictures and views of the same structures. As you study the texts, don’t get overwhelmed by the extraneous structures you’re not expected to know. In fact, many folks highlight the required structures in their textbooks so they can focus exclusively on them. Closely examine the drawings and describe to yourself in proper anatomical terms the location and structural relationships of the item in question. Memorize, memorize, memorize.
Make drawings and label them. Copy pictur
es from the text, white out the labels, and then rewrite the labels from memory. Make flash cards. Quiz yourself constantly. Work with your study group to come up with memorable and creative ways to remember the facts.
Live, eat, and breathe anatomy. It is, after all, the cornerstone of medicine.
If you master the systems and structural perspectives, you will surely do well in your Anatomy course. While functional view is also a critical component to your understanding of anatomy, the majority of it will actually come from some of your other course work—primarily Physiology, as well as Cellular Biology and Biochemistry. If you’re lucky, your Physiology and Anatomy classes will be integrated and this functional perspective will be presented simultaneously. If not, take those same concepts you’ve worked with in Anatomy and extend them as you delve into subsequent course work.
“I did not like the members of my Anatomy group very much initially—most of them were very intense,” Carrie recalls. “They all thought they wanted to be surgeons and used to fight over who got to dissect. When we were doing the head and neck section, they brought in head lamps, so we could see better. Everyone else in the class thought this was ridiculous and called my group ‘team surgery.’ I often felt intimidated during class and did not feel it was a good learning environment for me. I tolerated my group, but I did most of my studying/learning after class with a few friends. The funny thing is that none of them went into surgery. And, by the end of med school, I was actually very close friends with some of them.”
Physiology
Med School Confidential Page 16