From our anonymous insider…
Exam week covered cardiopulmonary physiology, anatomy and clinical skills. Pharmacology remains the most dreaded topic. Despite this universal struggle, two-thirds of the class appear comfortable with the pace. We know what to expect. We realize that the exams are meant as a stop-safe. If one of us fails the exam, typically a score less than 60%, it is a wake-up call that we are not on-track for the final judgement: Step 1.
The other third of my classmates are nervous wrecks. They are so concerned about what they need to know that they forget about learning. Four percent of the class failed and will have to retake the exam next week. Most of these individuals had adhered to Anita’s strategy of focusing on “High Yield” material, defined as material frequently included on the Step 1 exam and therefore in McGraw Hill’s First Aid for the USMLE Step 1. The First Aid summary figures are worth reviewing the day before the exam, but it seems that “High Yield”-minded individuals quickly forget a substantial amount of the information. These individuals go blank during discussion of some aspect of the patient case that was in the previous block, for example, an enzyme involved in a urea cycle disorder.
As soon as the exams were done, classmates were able to reflect on their experience. We agree that the tested block was much more enjoyable than our first block, which was devoted to clinical applications of molecular pathways, many of which students were exposed to in pre-med required courses and MCAT studying. The tested block was our first foray into predominantly “clinical” material: physiology and pathophysiology. We also got to use our stethoscopes!
After my second exams, a few things I wished I knew on day one:
- find a good textbook
- learning begins after lecture
- study early, study consistently, repeat
Most of the class reads the suggested Costanzo’s Physiology (“I have a date with Costanzo tonight,” is a common inside joke), but I preferred the more in-depth Medical Physiology (Boron and Boulpaep).
Twenty percent of the class no longer goes to lectures because they find it less efficient than independent study. I continue to go to hear the clinical vignettes. Some lecturers are down to an attendance rate of less than 30 percent. Maybe medical school costs could be cut considerably; Jane and and I agree that we could learn everything besides anatomy and clinical exam skills using Web-based and library resources.
The job of a medical student is to study. Many of us got through undergraduate exams by cramming the night before. This purge-in, purge-out mentality does not work in medical school. Curiosity becomes the most valuable asset in medical school. The depth and breadth of information requires constant dedication to translate understanding into retention. My search for immediate answers to questions is challenging for classmates because I don’t have a smartphone right now. Jane suffers the most with my endless questions: “My ankle evertor muscles are sore. What muscles are those?” (Fibularis brevis and fibularis longus)
Statistics for the week… Study: 35 hours. The library was still packed when I left at 10:00 pm most nights this week. Sleep: 8 hours/night; Fun: Learning on Saturday that I’d passed!
“They are so concerned about what they need to know that they forget about learning.” When I was in college and doing some of the pre-med courses and it seemed to me that a lot of my pre-med classmates were just focused on asking the professors what was on the exam and how to get the highest grade. They were not so much motivated by understanding the biology/chemistry/physics/etc but to game the system for medical school applications. I kind of found that sad. And I also thought it was a bit worrying that these people would be treating patients one day. They were probably smarter than me (I decided to go into biology instead!) but they didn’t seem to be compassionate people nor have a passion for science that I thought doctors should have. But maybe medicine really needs super driven people anyways since the whole training process from star to end, especially for specialists, is really gruelling when you think about it.
Interesting point re skipping lectures because that is an inefficient way to learn. If schools were designed efficiently, probably at least anything after high school, most learning would be done outside of the classroom, reading, studying, trying to figure things out yourself, with a limited amount of time in the classroom where the students ask the teacher to explain what the students cannot figure out themselves.
As far as I can gather practicing doctors forget all this studied stuff. Foreign doctors aren’t study grinds like American doctors and probably don’t learn as much, and they make less than half as much, but they are just as good at keeping people alive.
American doctors make it through this gauntlet and then mostly just dish out whatever the pharma reps tell them to.
Boron and Boulpaep Is my favourite physiology text. Med students here seem to like Ganong but I do not. I wish I had Costanza for the jokes though… All that said, specialized texts in the area (West’s respiratory physiology etc) are even better though not always as integrated.
Also, while “high yield” focus is not a good strategy remember that these guys have done their undergrad study where they should have enjoyed their science. Now they have to become clinicians.
And I thought future MDs were (slightly) better than other students… I definitely know too much to be optimistic about any field.
funny story re: med school from a while ago, took grandma for some tests and two fresh out of school docs had no idea how to use some tool necessary to collect skin tissue sample. First time they’ve seen it in person. The nurse was no help at all, no older doc in sight, so I offered my phone & google. Their collective brain managed to sort it out somehow without consultation (the procedure is very simple and takes about 5s total). I just couldn’t hold back from my normal student-teacher dynamic so I just kept laughing and encouraging them to figure it out. Grandma was a grateful test subject, didn’t care what happened to her or hear anything they said anyway so no harm done.
Except, for the first time it really made me doubt the quality of healthcare system if students come out clueless on the basics and there is no constant supervision. Formally there obviously should be but I’ve been told they’re left on their own quite often. Not quite the “problem based learning” I was expecting.
@Matt K
“Also, while “high yield” focus is not a good strategy remember that these guys have done their undergrad study where they should have enjoyed their science. Now they have to become clinicians.”
Should have.. but maybe not. Have a look at this editorial in NEJM by two clinicians on data sharing:
http://www.nejm.org/doi/full/10.1056/NEJMe1516564
Amazingly, they lament several things, such as being proven wrong by people who reanalyze their data (!) :
‘A second concern held by some is that a new class of research person will emerge — people who had nothing to do with the design and execution of the study but use another group’s data for their own ends, possibly stealing from the research productivity planned by the data gatherers, or even use the data to try to disprove what the original investigators had posited. There is concern among some front-line researchers that the system will be taken over by what some researchers have characterized as “research parasites.” ‘