Study Skills – Part III

In this short essay, I am going to tell you something that I didn’t do that I should have done. It’s called “Learning by Experience”. When I started graduate school, I vowed to get myself into good physical condition. I had a few extra pounds but nothing that was morbid obesity just about ten extra pounds. I had been a middle distance runner (10K) off and on with my best mile time being 6:25 and my best 10K time being 40 minutes but working in the chemistry lab and getting ready for graduate school had eroded most of my base-line mileage. I saw the pounds creeping on and I decided to “stem the tide” right then and there.

I joined a gym where loads of guys from the U.S. Navy JAG office worked out. Soon I was grunting and sweating with the boys. Those extra ten pounds quickly melted off and I would run 4 to 5 miles daily. My flexibility increased and my brain loved the extra perfusion of oxygen from those daily runs either outside on the bike paths or inside on a treadmill. My workout partners, all JAG guys, introduced me to weight training. Soon I was benching 125lbs and leg pressing 400lbs.

I loved swaggering into the gym in my baggy gym pants and muscle shirt. I would hop on the stationary bicycle for a 6-minute warm up. After a few stretches, I would start my circuit working legs first then arms and finishing up with abs. I wore a red scarf on my head and definitely sweat as much as the guys. When I reached 80lbs on the bench press, I earned a spotter. Nothing gave me more satisfaction then when the guys and I would take turns on the chin-up bar. (No other women came near the bar). My biceps and triceps bulged. I would put 400 lbs on the leg press and just work away with some nice hamstring stretches in between.

After my weight-lifting, I would take a soak in the Jacuzzi and then a dip in the pool. I am not much of a lap swimmer but swimming a few laps would bring my body temperature down and would keep my back stretched out nicely. My entire gym routine took about 2 hours from start to finish. I would get a protein shake in the juice bar and head back to my lab feeling powerful and refreshed.

The best thing about being in such great shape was that the discipline of working out carried over into all aspects of my life. I slept better at night with no stiffness in the morning. I easily ran flights of steps and could carry heavy loads with no problem. My clothes fit great. I had a solid study plan that had gotten me a 4.0 in my graduate studies. While I ran, I thought of new experiments and analyzed my data in my mind. Though my diet was not bad (I am not much of a junk food eater), when I was working out, it was excellent. I ate plenty of fresh vegetables, fruits and little meat.

With all of my energy, I was able to awaken in the morning, run a couple of miles with the Marines from the barracks down the street, and then bike 6 miles to school in the dawn. I would check my experiments and review my lectures for the day. I would then shower (I really sweat when I bike); change into my suit and lab coat, and then do my morning lectures. During lunch, I would hit the gym. After lunch, I would study and prepare more experiments or go to meetings. This was the routine of an assistant professor.

When I decided to attempt medical school, I knew that I needed to take the Medical College Admissions Test (MCAT). I had far more coursework between a double major in biology and chemistry with double minors in physics and math. My graduate work was in Biochemistry and Molecular Biology so those subjects were well covered. I knew that I needed to brush up on my verbal reasoning skills so I bought a review book and worked some problems daily. I also worked on my Physics too since it had been five years since I had taken General Physics. I was solid on the Quantum Mechanics but Classical Mechanics and Optics needed review.

My graduate comprehensive exams were also looming that summer too. We would be examined over the course of two days with eight hours of testing on both days. I studied for my comprehensives and studied for the MCAT at the same time. This turned out to be a great strategy. I simply made a review schedule topic by topic and checked off as I reviewed each concept. As a poor graduate student, I couldn’t afford a prep course so I purchased ($35) a huge review book called Flowers and Silver. It was money well spent.

After completing my comprehensives in June and getting my AMCAS application done, I knew I had one month to prepare for the August MCAT. I had stuck to my study schedule and my workout schedule. The funny thing was that none of my graduate school colleagues, except my best friend, knew that I was even interested in medical school. My best friend in graduate school was a neurosurgery resident who was working on his Ph.D. We had been study partners for the comprehensive exams.

On the morning of the MCAT, I hopped on my bicycle and rode the 6 miles to my testing center. It was great rolling off the hills at top speed and feeling the early morning wind in my face. My legs were strong and I imagined myself “smashing” that exam as I pumped up and down the street. I stopped into my favorite coffee shop for a morning cup of fresh “joe” and a high-five from the shop’s owner (a little Korean lady who always offered me encouragement).

I stood in line, dressed in my bike shorts and muscle shirt with my helmet and gloves. I stretched some but other than that, I was pretty relaxed. I could feel the tension all around me. As I got to the test room, I hoped for a seat next to the window because outside, there was a beautiful pink blossomed tree. I knew that I would be able to look up and out the window for a little mental break if the test was too much. My prayers were answered as I took my seat next to the window.

I moved through the Verbal Reasoning. My strategy was to do the passages that I found least interesting first and the things I loved last. I paced myself reading the questions first and marking the answers as I read through the passages. I paid close attention to punctuation, tone and critiqued in the margins of the test booklet. Soon this portion of the test was behind me. About ten minutes into the test, three young men, arose from their seats and left the test center. Was I missing something? The entire test went fine for me with my being able to figure out the “hook” behind each question. It was more like a game than anything else.

At the end of the test, I rode to my lab, checked my experiments and said a “thank-you” to God for giving me a nice day to ride and a clear head. From then on, I was stayed in great shape and kept working out clear up until the last day of medical school orientation. When classes started, I started studying and eating. My study group would feast on Nacho Cheese Doritos as we quizzed each other. By the end of first year, I had gained 30 pounds. My teaching over the summer and second year packed on another 20. By the end of medical school, I had gained 65+pounds and carried that weight around until my third year of residency.

After three years of standing and huffing up stairs, I vowed to get the weight off. I didn’t have two hours to work out daily but I made time for an hour workout even if I lost sleep. On my call days, I would walk the steps. Soon I had a good aerobic base but I am still working on getting my weight lifting back up to my level before. Even today, I work out at least four to five times weekly doing something. My gym opens at 5:00AM so I can get an hour in on the elliptical trainer if necessary.

In short, in medical school, I let my fitness level drop and endangered my health. I am fortunate to be able to get back to my previous level of fitness though the weight is not coming off as fast as I would like. I know that I won’t lose as much weight until I can get my running base back and I won’t pound my knees until I have lost another 20 pounds. That day is coming though.

In short, get a good fitness plan today, if you don’t already have one. It can be as simple as a 30-minute walk after dinner. Keep yourself in good physical condition and take an hour for yourself because you deserve that time. Physical exercise drops your stress level and makes everything in your life hum. I am having some “zone days” now that my physical condition is getting better and better. Having a good physical conditioning strategy is as important to your studies as your textbooks. Get moving.

Preparing for the Medical College Admissions Test (MCAT): Aim High!

A significant step in towards your goal of becoming a physician is taking the Medical College Admissions Test. This test, now offered on computer 22 times per year, is one of most significant hurdles for any prospective applicant. Your score on this exam in conjunction with your UNDERGRADUATE grade point average, will be the most significant factors in determining whether or not you will be accepted into medical school.

Now why did I put the word “undergraduate” is all capital letters? For significance and emphasis. Your undergraduate GPA is the grade point average that is most significant. Obtaining and pursuing a graduate degree in order to attempt to “shore up” an uncompetitive GPA is not going to be helpful.

Post bacc programs may allow graduates with no science or weak science backgrounds to obtain these courses and are quite useful for doing undergraduate “damage control”, but a graduate degree will not perform the same role. A special master’s program will enhance your application but often the pre-reqs for these programs are a competitive undergraduate GPA and thus if your undergraduate grades are weak, you may still need significant post bacc work to get yourself competitive for a Special Masters.

Now, back to the MCAT. This test will examine your ability to use the knowledge presented in the pre-med subjects (General Biology, General Chemistry, Organic Chemistry and General Physics) to solve problems. These “problems” as presented on the MCAT do not test your regurgitation of facts (in the manner that many undergraduate courses test) but require that you are able to do secondary thinking. You must apply your knowledge base to a problem.

Often students make a very grave mistake in thinking that obtaining an “A” in all of the pre-med courses ensures a competitive MCAT score. Because the testing manner of the MCAT is far different from the testing manner of most colleges, practice and preparation with the types of questions and the manner of questioning of the MCAT is required. Quite simply, the MCAT tests both your knowledge base and your test-taking skills base. The MCAT tests how you “think” and “evaluate” information as much as it tests your basic knowledge and fund of information. It is no surprise that the MCAT tests how you will evaluate information for the rest of your career in medicine.

Your preparation should include making sure that your knowledge base is adequate. This may be done with any means of good MCAT review books and commercial courses (expensive). The commercial MCAT-prep courses will provide their students with outlines of the subject matter that is tested on the MCAT. These courses also provide plenty of practice exams for making sure that their students are thoroughly with the MCAT testing procedures and manner of questioning.

In addition to the commercial preparation courses, the MCAT website http://www.aamc.org/students/mcat/practicetests.htm offers full-length MCAT practice tests for $35 each. There are currently five practice tests available for purchase. They are actual “retired” items from the paper-version of the MCAT. Purchasing one or more of these practice tests and taking these tests under actual exam conditions, can give you a very good idea of where you have weaknesses and where you should place your preparation emphasis. Again, a knowledge deficit can be strengthened with review of topics that you need. A test-taking skills weakness can be strengthened by taking test-taking skills courses (offered free at most universities).

A common mistake is for students to feel that they must “memorize” every test question presented in a book or course. By taking this approach, students wind up with major “burnout” by the actual test day. You simply cannot memorize every potential question that the MCAT can produce or offer.

Another common mistake is believing that there will be grammatically incorrect answers to questions that will be easy to spot. The MCAT is not constructed in this manner. Looking for patterns of answers will not be helpful in taking this exam. While you do need to be extremely skillful in your reading comprehension and observations, you still need a significant knowledge-base in order to to well.

Many students make the mistake of not actually reading the full question and all of the answer choices. They read the question, come to an answer choice that they think is correct and move on to the next question. There may be an answer further down the choices that is MORE correct and thus you need to read all of the possible solutions.

Another useful skill is being able to solve quantitative problems by using order of magnitude. Let’s say, you are presented with a physical science question that requires knowledge of a formula. If you are familiar with units and the order of magnitude of the numbers that go into a formula, you won’t need to do a complete calculation in order to choose the correct answer. In the case of more than half of the questions that I encounted on the physical sciences portion of my MCAT exam, I didn’t need to do the complete calculation once I looked at the answer choices.

In terms of the Verbal Reasoning and Writing Sample portions of the test, you want to have plenty of practice with reading and writing. It never fails that good readers are also good writers. Practice with the editorial pages of your local newspaper. See if you can pick out the arguement and propose a counter arguement. What is the hypothesis and what evidence does the writer show in support of that hypothesis. What is the writer’s conclusions and how does the writer tie all of his/her evidence that leads to a conclusion?

When you write your answers to the questions in the Writing Sample, the outline is Introduction where you present your thesis, evidence (next paragraph), evidence (next paragraph), counter thesis for arguement against and conclusion. You should write about 1 and 1/2 pages total on each of the subjects. You want your subjects and verbs to agree and you want your ideas as crisp and logical as possible. Again, spend some time in the Writing lab of your school where you can get critiques of your writing style.

Remember that you study for your coursework and review for the MCAT. If you have not completed your coursework, do not spend time away from your studies attempting to review material that you have not learned in the first place. Put your emphasis on thorough mastery of your Pre-Med courses while you are taking the class. When your class is complete, you can start your review if you wish. Allow plenty of time for review. This step cannot be rushed.

If you find that your review is not going according to schedule, cancel your test. It is far better to lose the testing fee than post a low grade. Again, allow yourself plenty of time to prepare, make a schedule and stick with it. If you cannot make a reasonable schedule and get your prep done, don’t register for the test.

Your planning for taking the MCAT should be one take and that’s it. DO NOT take the MCAT for “practice” and repeat for “actual grade”. The MCAT is not a practice test. One test take when you are thoroughly prepared and you are done. An application killer is several mediocre MCAT test attempts (whether released or not) and a mediocre score in the end. This is a huge “red flag” on your application.

You also cannot talk yourself out of a good performance. “I hate standardized tests and I am no good at them” can be self-fulfilling. If you thoroughly prepare and are thoroughly familiar with the MCAT testing manner, you can do well on this test no matter what you have done in the past. Talk yourself “into” a good performance rather than talk yourself “out” of a good performance. Also, don’t let the fact that the test is computerized unnerve you. The computerized test has the same knowledge requirements as the old paper exam and thus you still need the same knowledge base. If you have found this website, you have all of the computer skills that you need to take the computerized MCAT.

Resist the urge to believe that if you do not spend $1,500 in an MCAT preparation course, you are doomed to a low score on this exam. If you prepare thoroughly and analyze your performance on the practice exams ($35 each), you can do quite well on this test. If you NEED to have the experience of sitting in a prep classroom and taking their tests, then that $1,500 expenditure will be worth the money. Make no mistake, you DO NOT need a prep course but you do NEED solid preparation.

Finally, “Aim High”. The average MCAT score of medical school matriculants for 2005 was 29. That’s an average score. You don’t want to be “average” you want to be “above average”. Shoot for that 45. If you wind up with a 35, you are still well above “average”. Bottom line: “Aim High”.

Why I went to medical school at a later age.

Back in 1995 when I was a busy graduate student, I was happily contemplating my future career as a college professor. Even as a child, I knew that I wanted to be a research scientist. I had excelled in math and science in the English school that my Mum had so carefully chosen for my education. My Mum was very pro-active when it came to the education and enrichment of her children. She was my first and best teacher. She had taught me the value of an education and the value of observation. While directing the growth of her children on a self-sustaining farm, she made our 90-acre horse farm, a living laboratory for our education. Armed with this background, we were expected to excell at all things academic. The “buzz” around our evening meal was not about sports but about Einstein’s Theory of Relativity and higher mathmatics in addition to the fine reasoning of Immanel Kant.

Later, after I graduated from secondary school and entered university, I realized that I could trust my own observations and conclusions under the conditions of study. I approached every class with the vigor and demand for knowledge that my Mum had instilled in me (fostered with a healthy dose of curiosity on my part). I loved every second of my General Biology course and challenged myself to master every factoid that my professor presented. I never attended lab without careful preparation and continued with careful evaluation of every thing that I had observed. I was also very organized when it came to my coursework.

The first semester of my undergraduate freshman year, I took General Biology, General Chemistry and Differential Equations in addition to an English class on Critical Writing and review. I also played on the tennis team which required a fairly high demand on my time. Thus, I had to carefully set a study schedule and keep to my study schedule. When I started college, I knew that I was going to major in chemistry with an emphasis in the chemistry of the living.

I sailed through General Biology and General Chemistry with gleeful passion. I also loved my Differential Equations class as I explored the theories of solving these mathmatical equations. In addition, I honed my heavy flat serve and backhand volley that usually intimidated my opponents into submission. I had learned to play serve and volley with the boys so I generally dominated females who never came into the net. Most of the tennis games that I won were won on my fast, flat first service.

During my sophomore year, I took University Physics, Organic Chemistry and Histology. Again, my humanities courses consisted of a course on Early Puritain writers and History of American Thought. I had tested out of both classical and modern foreign languages haven taken classical Greek, Latin and Modern French while in secondary school. I also took a course in Applied Differential Equations (with the engineers). Physics became my favorite class and I loved Histology too. Histology provided a nice contrast from figuring out physics problems and mastering concepts.

During my junior year, I studied Analytical Chemistry, Advanced Inorganic Chemistry, Physical Chemistry, Advanced Analytical Chemistry (graduate-level mass spectromety and electro chemistry), Nuclear Physics and Atomic Physics. I spent most of my days in the laboratory and loved the precision of my coursework. I also began working on my honors project as an undergraduate researcher in the laboratory of one of the analytical chemists. Working in his lab honed my love of developing hypotheses and design of experiments. Most of all, I started to see the dawn of the use of mass spectrometry in the analysis of large biomolecules.

My senior year brought decision-making for me. I was torn between the graduate study of Analytical Chemistry and Biochemistry/Molecular Biology. My senior honors thesis had been on determining the detection limits and analysis of Snake Venoms by Matrix Assisted Laser Desorption Time of Flight Mass Spectrometry. By doing this project, I had learned much about biomolecules and the analysis of large biomolecules (proteins).

I decided to apply for graduate school in Biochemistry/Molecular Biology. I was accepted and received departmental funding to teach both undergraduates and perform my laboratory experiments. I was placed in the lab of a cardiologist who was working on oxidation-perfusion and low magnesium states. This lab was multi-disciplinary with immunologists, biochemists, biophysicists and chemists present. I thrived in this atmosphere. Here, I found a constant exchange of ideas and constant challenge to ask questions and research to find the answers to those questions.

My principal investigator requred his graduate students and reseach scientists to attend Cardiology grand rounds. It was during these sessions that my interest in the clinical applications of my research came to the forefront. I read as much as I could on cardiology, physiology and pharmacology. My PI loved my questions and one day suggested that I apply to medical school. “The worst thing that can happen is that you don’t get in”, he said. ” If that happens, you continue your work here”. He presented this as a “no-loss” proposition. This seemed reasonable to me at this point in my career. I could already see where the knowledge to be obtained in medical school would be useful for my research.

I took my comprehensive exams for my Ph.D in June, filled out my AMCAS and promptly took the MCAT that August. My MCAT study strategy was to study for my comprehensives (read, I didn’t have much of a strategy). On MCAT day, I hopped on my bike and rode the six miles to my test site. I got in line for check in and listened to Aerosmith and Toni Braxton on my Walkman. I was seated in a room next to a window where I could look up and see a lovely blooming cherry tree with loads of fluffy pink blossoms.

The first exam section was Verbal Reasoning. I scanned all of the passages and chose to do the ones that didn’t interest me first. I had little interest in psychology, history and sociology but loved science fiction and science. I scanned the questions and then read the passages underlining the key points that I needed for each question. I finished this section with time to spare so I just looked out of the window and enjoyed the view. I could totally let my mind wander far from this exam room and relax completely.

My next section was the Physical Sciences section. It was long but I had always worked these types of problems by using order of magnitude. I enjoyed the challenge of figuring out the hook for each question and supplying the answer. I found that I didn’t need to do very many calculations as I could clearly figure what was being asked by underlying key words and working the problems using order of magnitude. This section was my favorite and I worked each problem as they came. About ten minutes into this section, three young men got up, turned in their test materials and left the room. My next question was, “Am I missing something here?” “This is really not THAT bad”. Again, it was nice to be able to look outside for a mental break from the work.

The next phase was lunch time. I checked my bike and headed over to a small cafe where I knew the owners. After a light lunch of soup and tomato sandwich washed down with my favorite Diet Coke, I settled in the hallway ourside of the testing room with my Walkman and some Moody Blues. There is nothing like “A Question of Balance” to keep your head clear. I had chosen my music very carefully and made the right choices.

The afternoon session consisted of the Writing samples and Biological Sciences. I finished the tests, hopped on my bike and headed back home for a nap. Later that evening, I went to a disco with a couple of my mates and lost myself in the pounding music and Guiness stout. It had been a long day but it was over. No matter what, I was locked into whatever score I received and my application would be complete that October 15th.

My first interview invitation came on October 20th and my first interview was the last week in October. My last interview was in February. By my final interview, I was holding three acceptances and went on to acquire six out of six acceptances. To my astonishment, I had been hugely successful in application to medical school.

I don’t know why I was accepted and two of my friends did not make it in that year. One of my friends was the president of the Pre-med honor society (I wasn’t even a member) and the other had more publications that I and what I considered a better application. Both were also much younger that I. The only thing that I had beaten them in was MCAT score. Of the three of us, I had the highest MCAT score by far. My undergraduate GPA was strong (it had to be for graduate school) and I had held some interesting jobs (TV news producer, political campaign manager, environmental speech writer) in addition to my scientific work. I was also a pediatric, perinatal respiratory therapist (something that was hugely interesting to me at the time and easily obtained).

With that first acceptance letter, it hit me that my life was going to take a turn that I had not planned. I was going to add research physician-scientist to my career. I would teach, perform my clinical duties and research. To the delight of my uncle, I would follow in his footsteps.

I was never a “Pre-Med” student as an undergraduate. I certainly remember my classmates anguishing over receiving “Bs” in their science classes and grumbling about my performance since I really didn’t care that much about the letter grade. I was in the class for the information. It was funny how my focus on mastery of course material (because I had to KNOW this material to be a good scientist) made getting the grade more easily than calculating what my score had to be to get an “A”. My tests were my challenge to do better and better. If I destroyed a few curves along the way, it didn’t matter much to me.

In the end, I carried a large body of knowledge and a solid background into medical school where I could build upon that background. Little did I know, until the second week of lectures, that I would be baraged with more information and a short time to assimulate it. My absolute curiosity about all things human would be satisfied many times over and continues to be satisfied to this day. For me, medical school was the ultimate mental exercise with a limitless supply of interesting experiencs and facts. I had the time of my life and learned to love the craft of medicine, not to mention, that I have met some of the most interesting people along the way.