Do I really need an MCAT Review Course?

You have completed your pre-med coursework with no grade less than B+ and a majority of A grades. You feel that you have a solid grasp of the material and the concepts presented in your pre-med courses. Do you really “need” to take a review course for the Medical College Admissions Test (MCAT)? The answer to that question depends on whether or not you are good at solving the types of problems that are presented on the MCAT. If your knowledge base is good, then taking a review course that emphasizes knowledge refreshment is largely going to be a waste of money for you. If it’s been a few years since your pre-med coursework, then getting your knowledge base up to speed is your first priority and thus a knowledge upgrade type of review course may be the key to a strong score on this very important admissions test.
How are your problem-solving skills?
You can quickly find out how well you solve MCAT-type problems by downloading one of the retired exams and working the problems under actual testing conditions. If you are finding that you are struggling with these types of problems, then try to find a review course that gives you plenty of strategy and experience with problem-solving. Problem-solving is often the main gap in the education of most pre-med students. With many undergraduate institutions placing more emphasis on “rote memorization” rather than application of knowledge to problem-solving, pre-med students may have earned high grades in science coursework with little training in how to apply those skills to new situations. Even the so-called “ranked” universities can be seriously lacking in terms of making sure that students have problem-solving skills. Many times these skills are utilized most in coursework like Calculus and applied Differential Equations; courses that many students avoid because of rigor or lack of math background.
How are your reading skills?
In this age of electronic media at every corner, many students have lost the ability to produce (and evaluate) good writing. Many students view the analysis of literature, primary resources and scientific papers as the torture of producing research papers and as a “necessary evil” of obtaining an education. Many professors routinely pass out PowerPoint lecture slides that contain the bare minimum of facts/information that students attempt to memorize verbatim without regard to analysis or research beyond what they have been handed. These processes have tended to rob many students of the skills needed to evaluate information sources and information. While Wikipedia may give starting points for a wide variety of subject matter, many students will often use the “cut and paste” function for research paper writing rather than spend some time evaluating a cross section of resources. Reliance on quick media resources is a great starting point but this reliance can’t be the end point of your information evaluation and gathering skills. Learning how to evaluate the primary literature is a valuable skill that you should have acquired in your undergraduate training regardless of major course of study.
The sections of the MCAT – Biological Sciences
This section will test and evaluate your mastery of General Biology with some Organic Chemistry thrown in. While it may seem strange to put these two subjects together, organic chemistry is largely the most concept application course that is taught in chemistry. Organic Chemistry relies on your understanding of the chemical properties of carbon as an element to solving problems across a wide variety of conditions. Many students hit a major roadblock with organic chemistry because there are many problems that can be created to test your knowledge of carbon chemistry. Trying to sit and memorize every problem that you were presented with in organic chemistry is not going to be very helpful but making sure that you know the concepts of carbon and its chemistry will enable you to solve any problem that you are presented with.
In addition, many student mistakenly believe that they must “take a course” in every type of subject matter that is covered on the MCAT. This could not be further from the truth. A good comprehensive General Biology course will give you the knowledge foundation to apply concepts to the problems that the MCAT will present in Biology. You don’t need specific coursework but you DO need to be able to do some creative thinking in the application of your concepts to novel experiences. A good comprehensive General Biology course will cover physiology, botany, zoology and ecology. Thus, you don’t HAVE to be a biology major to have exposure to the subject matter but you do need to have a grasp of the concepts of a good comprehensive General Biology course. Being able to synthesize and build upon a basic knowledge base are the types of skills that you will use in medicine thus your ability to do these types of problems will be measured by the Biological Sciences section of the MCAT.
The sections of the MCAT – Physical Sciences
This section tests your ability to solve quantitative problems using concepts that you learned in General Chemistry and General Physics. These types of problems are often answered by being able to apply order of magnitude type strategies rather than working though an entire problem. Students who thoroughly know quantitative relationships presented in their coursework will tend to do well on this section. Between General Chemistry and General Physics, the quantitative relationships of many concepts can be probed and tested. It is practically impossible to rote memorize every type of problem that can be presented in these courses but having a sound knowledge of quantitative relationships in addition to being able to apply those relationships can bring success in this section.
The sections of the MCAT – Verbal Reasoning
This section of the MCAT can often be very difficult to improve or prepare for. Being able to analyze critically the reading passages from a wide variety of sources and disciplines generally takes years of careful practice and skill building. Preparation for this section should have been occurring over students previous years of study in practically every subject. College coursework in the humanities with strong achievement can also hone these skills. In addition, good readers are always good writers and thus, the writing section of the MCAT is likely going to mirror the Verbal Reasoning section of this exam. Can you consistently read and learn from your text books and journals? This is a very valuable skill to take into medical school with you as medicine will require a lifetime of learning and the acquisition of new knowledge that will be outside of a classroom.
Some final thoughts…
Finally, the review courses are expensive and time-consuming. You have already paid thousands of dollars in tuition and book purchases in order to master your coursework. Do you actually NEED to pay a few thousand more for a review course of that work? If you didn’t master what you needed the first time around or if you find from doing a few practice retired MCAT exams, you are struggling with this test, and then perhaps a review course can make a difference for you. You should thoroughly investigate the materials offered and you should thoroughly understand what the courses are offering for the fees that they charge. You should also be prepared to master some of the material on your own as many of these courses are taught by people who have a variable ability to teach others. Doing well on the Medical College Admissions Test may not translate into being able to teach others to do well on this exam.
The Medical College Admissions Test is one aspect of your application to medical school. This test requires solid and thorough familiarity with the mode of testing and a solid knowledge base that must be applied to the problems asked on this test. Several retakes of this test do not bode well for medical school admissions. You want to be prepared and take this test one time. With this test being administered 22 times annually, you also have more options in terms of being able to time your preparation for this exam. The important thing to realize is that you don’t want to take this test unless you are thoroughly prepared at your own pace. This is not the time to listen to your peers tell you how much or how little time they needed but the time to set the study schedule that works for you.

Venting

I remember doing a case with one of my favorite attendings. This person was a colo-rectal surgeon who would talk through out the case. I was an intern at the time but I remember him saying that his talking was just “venting” and that he hoped it wouldn’t bother me. I looked at him with amazement because his “venting” was putting to word, many of the thoughts that I was having as we went through the case. I had felt honored to be able to scrub this case with him because usually, one of the chief residents would have taken this case but everyone was tied up and thus I asked if he would mind if I scrubbed with him. He said that he was happy to have me there.

The Teaching

He explained the fine technical points from skin to skin allowing me to mirror many of the things that he was doing. He pointed out anatomy and explained why he loved mobilizing the rectum and why colo-rectal surgery was always a rush for him. I was mesmerized by how fascinating going through this case was. In short, I was being treated to the first of many one-on-one mentor-trainee sessions with this young colo-rectal surgeon. His enthusiasm for his craft and his ability to teach me what he found amazing was delightful. From that point on, I always held a special reverence for colo-rectal surgery.

He marked out the incision line for me and handed me the scalpel. He showed me how to make sure I had just the proper amount of tension and counter tension as we entered the abdominal cavity. He showed me how to explore the abdominal cavity and how to palpate the liver for cancer mets. He pointed out the fine points of living anatomy as we located the tumor that we knew we would be able to resect.

His next lesson was how to put two ends of bowel together. Today, he said, we would do a hand-sewn anastomosis. Sure the stapler is nice to use but once in a while, a hand sewn anastomosis is a good thing to do. He showed me how to resect the section of colon leaving plenty of margin and the fine technique of location the numerous vessels that fed this wonderful organ. Again, the living anatomy is a wonder to behold and being able to see how this tumor would be removed was great.

We carefully sewed the remaining ends of the colon together using Lembert stitching. He talked, he vented and I watched and listened. Together we completed the case and at that moment, I understood why operating on the colon is both fun and something of a challenge. I had to always keep the anatomy in mind, the technique perfect and move in an efficient manner. I remember laughing at him describing the “big honking vessels” that we would be ligating and why one doesn’t want to even think about ties not holding. He said that when he started residency, he would lose sleep over thinking that his ties were not secure.

Technique

One of the great things about doing a case with an attending like my colo-rectal professor is that he does vent the things that go over and over in my mind. Are my ties secure with every knot? Are my hands going in the right direction? Have I identified the vessels correctly and ligated them using proper technique? After all, surgery is a practice which has to take place over and over for years. Even now, year’s later, when I don’t have to think about every suture or every tie, I still mentally revisit some of the cases that were turning points in my training for various reasons.

There isn’t anything magical about surgical technique but there is something magical about having the knowledge, background and education to use that technique properly. This is what I learned across the table from my colo-rectal professor. He vented and I listened to all of those pearls that he would verbalize. For me, his venting was golden and some of the best teaching that I ever encountered. He was an extraordinary teacher and he would often tell us that if he was in our position, his venting would drive him crazy. Well, that was never the case for me. His venting made me see the artistry of colo-rectal surgery and why having impeccable technique was paramount for these patients.

The best teaching

It’s no accident that the lessons that I remember best came from my first two years of surgery. By the time one reaches third year, there is a comfort level with being in the operating room. The lessons of my first two years were magical and have not left me. Those late night cases with the chief residents, moving through the abdominal cavity on a laparoscopic case or the first time I was able to close the abdominal cavity and feel confident that I had done this correctly, were memorable for me.

I was fortunate to be exposed to some of the greatest professors of surgery under a variety of circumstances in addition to having some of the best chief residents who were willing to give me their best too. There is much joy in this type of learning and a great amount of joy in venting.

You Can Go Home Again…

This is going to be one of those posts about a nice experience that I had in the last couple of weeks. A few weeks ago, I was covering for one of my colleagues who was out of town at a meeting. He asked me to stop by an outlying hospital to check on one patient that he had there. This patient was going to be hospitalized for at least another four of five days and I was happy to look in on him for my friend who would do the same for me if necessary.

The patient was out of the room having a diagnostic study completed in the radiology department. A very distinguished gentleman was patiently waiting for him to return. He sat in one of the chairs at the bedside with a magazine on counter-terrorism (spy business). The magazine immediately caught my eye as someone I had known many, many years ago, was an expert on counter-terrorism and a writer. I introduced myself and said that I was the covering physician for my colleague who was out of town. The gentleman said that he was told that I would be the covering physician and introduced himself as a relative. I told him that his loved one would be back from radiology in a couple of minutes and that I would wait.

I also mentioned my old friend who was a writer and who was a counter-terrorism expert. It turned out that this gentleman knew my friend’s writings very well. Their paths had crossed many times in the past. He was also able to tell me that my friend had moved to another state from when I knew him and that I should get in touch with him. I made a note on my “rounding sheet” with my friend’s name and about that time, the patient returned from radiology.

A week or so went by and my secretary asked me about the name on the rounding sheet. “Was this a new patient?” she asked. I had to laugh and tell her “goodness no” but the name of someone that I knew in my “other” life long before medical school and even before graduate school. I told her of my life before college teaching and medicine and said that I had thought about the person from time to time but had no contact. I told her of the patient’s relative and she looked up my friend’s phone number, leaving it on an index card on my desk.

Last Sunday, while I was finishing up some of my paperwork, I called my old friend. He was not available at that time but he returned my call about 45 minutes later. I must admit, I was very happy to hear my friend’s voice. He sounded much the same but was a very nice reminder of how everything in my life has prepared me for this profession. I believe that he was surprised that I had entered medicine and surgery because they were so far away from my previous life but I am reminded of how small our word is and how much one phone call from an old friend can just be one of the nicest things to happen.

I hope my friend’s life has been as rich and rewarding as mine. There isn’t a day that goes by that I don’t pinch myself to make sure that I am not dreaming. I really love my work and taking care of my patients. I am honored that they place their lives and health in my hands and I never find this job routine. Even something as simple as doing a favor for a friend who was out of town has brought just a little extra joy in my life and the renewing of an old friendship that I thought long past. Enjoy the little things in life as they are precious