Physiology

Physiology is the medical school course that links cell biology, physics and biochemistry with the function of systems in the human organism. Under a classical curriculum, this course is usually presented second semeter of first year after biochemistry is completed. In a system-based and PBL-based curriculum, this course is presented system by system or topic by topic.

Physiology demands that the student have a thorough grounding in the basics of physics as much of this course revolves around cardiovascular functioning (plumbing), respiratory functioning (gas piping) or renal functioning (more plumbing). Often students have difficulty with physiology because of the math utilization requirements in terms of being able to understand diagrams and interpret graphical data. In terms of USMLE Step I, physiology is one of the heavily tested subjects and thus is the major course of first year that must be thoroughly mastered for a good USMLE Step I score.

The major components of physiology are Cardiovascular, Respiratory and Renal. The minor components are G.I, Endocrine/Reproductive and Musculo-skeletal. Many schools present Neurophysiology within the context of Neuroscience and thus this important component is out of the second semester physiology course and under its own course. USMLE Step I generally focuses on Cardio, Respiratory or Renal with plenty of diagrams for interpretation.

As with Biochemistry, it is vitally important not to fall behind in your physiology course. The best way to avoid falling behind is to organize your study of this discipline carefully at the beginning of the semester. Your syllabus is your first stop. As soon as you get the syllabus, look at the manner in which the course is divided. It is usually along the lines of Cardio, Respiratory/Renal and everything else. This usually follows first test, second test, third test and final.

• What is the subject matter headings for each lecture?
• How much material will be covered in each lecture?
• What are the objectives for each lecture?
• How much reading is expected for each lecture?

After you have looked at the topics, you need to make a list of any terms that you encounter in your reading and define them. Physiology will present loads of new terminology such as “homeostasis, positive-feedback systems, negative-feedback systems, futile cycle etc. You need to be thoroughly familiar with every term that you encouter in this subject and try to link function with structures that you studied in Gross Anatomy.

As with Biochemistry, you should prepare for each lecture. Physiology is one course that you really do not want to be going into lecture “cold”. In order to avoid this try doing the following before the lecture:

• Skim the syllabus and assigned reading noting topics, graphs and any tables.
• Look at the previous lecture and see how it ties into the material to be presented.
• Read the text and make a note of which topics are emphasized as outlined in the syllabus objectives for that reading.
• Listen to the lecture taking any notes and fill in any gaps as quickly as you can.
• Study your lecture on the evening after and repeat the above steps.
• On the weekend, review the entire week’s lectures with your main topic index next to your lecture notes. Answer the objectives out loud as you move along.
• If you have difficulty with a topic, make an appointment with your professor and have a list of specific questions or things that you do not understand.
• Try to organize a study group and meet together once a week so that you can test your understanding of the topics.
• If old exams are available to you, look at how the material is tested but do not memorize the old tests. Your study group is a good time to review old exams.

If you fall behind, go immediately to where the class is and do the above. Do not try to catch up during the week and you may fall further behind. If you fail a test, let that material go and move into the next block with even more resolve. You will get another chance (during your USMLE Step I study) to review and go over the material that you didn’t do so well on so let it go for the present.

Don’t make the mistake of believing that every student is “getting” physiology except yourself. Many medical students have difficulty with this course. Physiology can be burdensome as it is presented within the context of the rest of your coursework which is demanding. If you are having difficulty make sure that you are in the professor’s office during office hours and taking advantage of any tutorials that are available to you. There is always a course in medical school that is going to demand more attention at one time of another. It may be physiology this week but neuroscience next week and microanatomy the week after. Adjust your study up or down within the context of mastery of the material but do not neglect anything. Ask for help when you first think you need it and keep asking for help until you master the course.

Pay very close attention to the graphs and figures in your textbook. Often there are many nuggets of testable materials directly from these pictures, graphs and tables. Read the captions and make sure that you understand what is presented. Lecture the material back to yourself or make summary lectures/drill tapes (don’t re-listen to class lectures) that you can listen to while you work out. Having a discussion with yourself is a good method of mastering physiology.

Your physiology textbook can be a great asset. The major texts are Guyton & Hall , West, Berne & Levy or Tanner & Rhoades. They are all comparable but Guyton is the master of cardiovascular physiology, West is the master of Respiratory Physiology and Berne/Levey are masters of pretty much everything else especially neuro. If your text is difficult to understand at first, stick with it before you move to an alternate text. (Consult your instructor on this). Sometimes difficulty reading a textbook happens because you do not have a purpose in your reading. If you use your syllabus to organize your material before you go to your reading, you have purpose in your reading.

In terms of review books, you need to thoroughly master your coursework before you attempt to review. That being said, Costanza, BRS physiology or NMS Physiology can been helpful if you are having difficulty seeing the big picture. Do not substitute a review book for your coursework. You have to learn your coursework before you review for USMLE but having a solid review book like Costanza can be an excellent adjunct to your daily work.

Finally, don’t beat yourself up because you are stuggling with anything. Find any means that you can to get this material mastered within the context of your course. If Physiology is your “problem-child” at the time, give it more attention on the weekends but do not neglect your other courses during the week. Keep up with everything and organize, organize and do more organization. Time-management and organization are always the keys to the mastery of anything in medicine. Don’t talk yourself out of getting this subject matter under control. In the long run, you will find that a bit of struggle makes you that much stronger overall.