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.

It’s On to Medical School!

You have managed to go through the medical school admissions process and you have selected the school that you will attend. At this point, approximately two months out from actually starting classes at medical school, what are some of the things that you might want to place in order? Graduation from undergraduate is behind you and those wonderful celebrations are over. It is now a good time to look at some of the basic necessities that you are going to need in order to start your freshman year of medical school off on a solid foundation.

Have you found a place to live? The ideal “home” for a freshman medical student should include, a bed (mattress on the floor doesn’t work well), a desk with good lighting (preferably in front of a window), a bathroom with both tub and shower, and some manner of kitchen facilities. If you are doing the “dorm” situation, a small-refrigerator and coffee/tea pot are bare essentials if you don’t have access to a kitchen or kitchenette. Other “niceties” are a sturdy bookshelf for organizing your textbooks, a filing cabinet for papers and notes (2-drawer is fine) and a comfy chair with reading lamp for change of position. A large-sized dry erase white board (60-incher) is good for concept mapping and writing down upcoming test dates etc. You can fall asleep while looking at one of your concept maps. Leave the telly at home but an MP-3 player and radio are good to keep on hand.

You won’t be spending loads of time in your “crib” so you don’t need to load up on creature comforts. You home should be something of a sanctuary but you don’t need to spend thousands of dollars on furniture for your apartment and an interior decorator. You will be basically doing the three “Ss” in your apartment(shower, study and s–t) and rushing out of the door on most days. Even on weekends, you life is going to center around your studies for the most part. If you have a family (or significant other person in your life), then you may need to make more sophisticated provisions but in essence, medical school is going to make your life pretty simple and fairly routine.

Your home should be an easy commute to your medical school. Hours of sitting in traffic or hours of driving to and from school are a very bad idea. There will be days when you are just exhausted and traffic/commuting will be the very last things that you will want to contend with; not to mention having enough energy to hit the books and notes after you have battled traffic. When I was a freshman medical student, I had a 45-minute subway ride into the city each day. I used that time to preview lecture material or just relax and listen to the sounds of my environment. I definitely would not have put that much time into driving. Before starting third year, I moved much closer to school and my clinical rotation sites.

Most of your time will be spent in and around school. You will attend classes and you will study your notes and books in the evening on a daily basis. The more information that you have to remember, the more organized you want to be in every aspect of your life. I planned as much of my day as possible around my classes and study schedule as I became the ultimate multitasker. It was always my goal to get ahead of my professors and stay ahead of them as much as possible. This task became the goal of my organization skills.

If you have an automobile, you need to scout out parking as soon as you hit town. It may work out that you end up parking your car further away from your school and getting a short but brisk walk to school and a secure parking spot that you can count on. At my school, parking was such a premium that taking the subway daily was a better option for me until third year. It just wasn’t worth the money to park or the worry that my car might be broken into as several of my classmates discovered. If you school has safe and secure parking, again, park far and walk more. Your nerves and stress level will appreciate the extra exercise.

On weekends, I would drive into school for sessions in the Gross Anatomy lab or study groups. Since I didn’t have to deal with traffic on the weekends, driving made more sense those days. Having the car also gave me an option of finding a great restaurant for a good meal as a reward for getting my studies done.

I also made sure that I had at least three months of expense money in my savings account for any emergency. Things that might come up would be your financial aid being delayed or an extra expense that you didn’t budget for. I kept a very strict budget and could account for every penny of my expense money. Again, not having to pay for parking saved loads of change for me. I also had the option of working on holidays which added to my stash of emergency cash. I would work any holiday as keeping up with my studies gave me holiday time as extra days. In addition, holiday pay was very very lucrative for me. (I was a registered respiratory therapist with a specialty in pediatric critical care). I did not work during the regular school session no matter how thin the budget was stretched. It was difficult but my studies came first.

During the summers between my first and second year and between my second and third year, I had either a paid position (in addition to my contract work) or a paid fellowship. I would leave a couple of days to do absolutely nothing but I could not afford to do too much vacation during these summers. The summer between my first and second year, I was a peer tutor for our pre-matriculation program. The other summer, I had a pathology fellowship. In both cases, I furthered my career and honed my knowledge which proved great for boards.

Food turns out to be a fair expense for most medical students. The worst thing that you can do is rely on fast food. It has too much fat and you end up paying with your health and energy level. I would limit my eating out to once per week and explored the ethnic restaurants of my city. I would eat Vietnamese, Ethiopian, Jamaican, Thai, Japanese and Cambodian food every Saturday evening. My study group loved to go for breakfast (or Sunday dinner) at a nearby church. We would get a good home style meal and support the community which, loved having a table of hungry medical students. We learned to be very careful because “food coma” could be a major problem after one of these great meals.

If we were studying at one of our houses, we would “pot luck”. Sometimes it would be a mixture of supermarket “take out” but we tried to keep our “study meals” nutritious and non-fattening. The worst thing would be those late night sessions before an exam when the Nacho Cheese Doritos would be out on the table. There is something about crunch snacks that fits well with study time.

Collect your favorite study supplies and stock your desk as soon as you can. I had colored pencils, different colored highlighters and my favorite four-color pen. I also had a large cork board above my desk for pinning notices and sticky notes. My other favorite technique was to cut the bindings off the back of my text books, punch three holes and carry only the pages that I needed to read instead of the entire book. To this day, my pathology text (Big Robbins) is divided into two notebooks. I did the same with my Gross Anatomy text, Pharmacology text and all of my syllabi too. Kinko’s can do this little task for you.

Another essential piece for my desk was a kitchen timer. I kept one in my backpack and one on my desk. I would set the timer for 50 minutes and study for those 50 minutes. I would then take a 10-minute break and back to another 50 minutes. This kept my mind refreshed and kept me more efficient. I would also check off each subject as I studied them. This check-off was more psychological so that my mind would see that I was making some progress. During my study breaks, I would walk around, get some water or just look out the window and let my mind rest. (See the purpose of having your desk in front of a window).

Purchase a good medical dictionary such as Stedman’s Medical Dictionary so that you can look up words and terms as you come across them. I made it a point to look up any words that I did not recognize and keep a running vocabulary list. I also obtained a subscription to the New England Journal of Medicine on-line. I would print out the Case Reports and read them on the subway. The medical dictionary came in handy for these articles. I also learned how to present patients and increased my general medical knowledge. I also read the review articles and any original research that was of interest to me. I would scan JAMA in the library but NEJM was my daily reading in some manner.

Other supplies for me were ringed binders, large coated paper clips, erasers, No. 2 pencils, an electric pencil sharpener (I love sharp pencils) and narrow ruled notebook paper for written notes. I usually took class notes on my laptop computer. I used a mini cassete recorder (I have now replaced this with a digital recorder) for those days when I found myself dozing in class. I would make study drill tapes and listen to them when I walked or exercised.

Burnout

I was answering a question from a student on the Student Doctor Network Forums http://www.studentdoctor.net (Click on the “Forums” link from the home page) that dealt with “burnout”. It’s that sensation that you can’t see “the end in sight” and that dealing with your high stress is taking a major toll on both your mental and physical health. Many students find themselves in the middle of a depression that seems to add to the stress. Depression is one of the first ways the mind attempts to handle high stress. This cycle becomes a circle of perpetual positive gain unless you find a way to break the cycle.

I certainly remember days when I felt as if I had 36 hours of work to cram into 24 hours. When this happens, I remind myself that I need to stop, get some organization and eliminate some of the small “stuff”. By small stuff, I mean things that are “low yield” in terms of contribution to the major tasks at hand.

There are things and actions that MUST be done daily. Eating, sleeping, showering and taking care of other physical needs come to mind in terms of the “MUST BE DONE” category. If you are employed, you can add work/study and its necessary tasks. There are things that are optional but necessary like physical exercise that make the other tasks go well but if skipped, are not the end of the world. Then there are the “small stuff” like cleaning out your closet, sink, bedroom etc, that are great to do if you have time but can be postponed to vacation/downtime with few consequences.

One of the biggest problems with the “small stuff” is that it becomes the thing that you find yourself doing with the “major stuff” becomes overwhelming. This can greatly add to your stress level but you are looking for relief and anything that IS relief is a temporarly welcome.

Other actions that can greatly add to your stress is that little “inner voice” that keeps telling you that you “should be ” doing something or “should be better” at work/study. The problem with that little voice is that it gets louder and louder the more stress that you find yourself under. As that project/exam nears, that “little voice” becomes a “constant shout”. This is another sign that you need to change something and break the cycle.

The first thing to do is organize your tasks. What do you HAVE to get done? What is the time frame? How much have you actually accomplished towards your major task? You can list your tasks on a sheet of paper and rate them as A, B, C in terms of importance. Your A tasks HAVE to be done; B tasks are good to do and C tasks carry little penalty of not done.

Take each A task and figure out how long it will take you accomplish each one. Your study schedule can be arranged around your class schedule and thus you want to have time to preview, listen to lecture, quick review, study and preview… Get your A tasks taken care of first and be sure to put in some “break time”. It is not efficient to pencil-in “Study Biochemistry 5 hours” because you will be saturated with Biochemistry after 1 hour (for me it was 50 minutes and I AM a Biochemist!). After one hour, take a ten-minute break, get some water, stretch, walk around, get some fresh air and then come back to your desk refreshed.

Check off your subjects as you get them done. This psychologically gives you a boost because you have a sense of accomplishment. Don’t beat yourself because you can’t look out the window and recite every enzyme of the Citric Acid Cycle complete with affinity constants. Your goal is to understand your studies well enough to apply them. For example: Sorbitol is an alcohol sugar that is produed by enzymatic/chemical reduction of an aldehyde group on a monosaccharide. It provides sweetness but does not increse blood levels of glucose or insulin. This makes sorbital a good sweetner for diabetics. The concepts are alcohol sugar, elevation of insulin/glucose in a diabetic and reduction of an aldose. In addition, since it contains more -OH groups than other monosaccharides, too much sorbitol can produce diarrhea too. Stop, try to link your lectures and keep the concepts in mind as you study. How does this fit into the big picture? Instead of rote memorization that puts information into your short term memory, go for understanding of concepts that links your short term memory with your long term memory.

Finally, do at least 30 minutes of physical exercise. Do something that you like and vary your routine. Take a brisk walk or walk up two flights of stairs and come down one. Do three 10-minute intervals of physical exertion if you can’t find 30 minutes in one block. Lean against the wall and stretch/breathe and laugh. This gets rid of stress and helps to keep you calm and focused. Use your 30-minute exercise period to let your mind go anywhere. Don’t try to study during this time, let this be your cheap “play time”. Remember “recess” when you were a child in elementary school. You didn’t combine “recess” with study back then. Don’t combine your exercise with study either for at least 30 minutes. After that, you put on your earphones and listen to drill/study tapes but do at least 30 minutes free of school work.

Keep your life organized as much as possible. Know how much underwear you have and get your laundry done before you run out. Lay out tomorrow’s clothes the night before so you have them ready in case you get rushed or oversleep. Pack a light lunch the night before (you can make a PB & J on your study break) instead of loading up on heavy and high fat foods that drag you down and decrease your alertness in the afternoon. Fold your laundry and stretch at the same time.

Finally, get yourself a mantra that you can repeat to yourself over and over when you find that you are starting to hear that “should be ” inner voice. You know, the only thing that you “should be” is yourself. Forgive yourself (this means that you give yourself permission to move on) if you make (a mistake or mistakes) and keep moving forward. Just because you did something wrong yesterday is not a good reason to do the same wrong thing today. Change your behavior now and change your thinking now. By doing this, you world will change and you won’t know who “Burnout” is.