Getting Through The Semester

By now, many students have had their first block of exams in medical school. Some people have done very well and some people have “breathed a sigh of relief” that they passed and some people have not passed one or or more of their exams. To fail an exam at this stage can be a huge personal blow but your actions after discovering that you have not passed (I am going to avoid the word “failure” here) are critical to figuring out what you need to do to get “above the yellow line”. Sure you NEED to do a bit or mourning in terms of the loss of those wonderful feelings that infused during orientation week but don’t let the mourning phase go on longer than a couple of minutes. Replace mourning with a very objective strategical look at what might have gone wrong and how you are going to fix the situation.

There is something in medical school that will throw every person. It may be that first round of exams, that USMLE score or a patient contact that just did go well. The important thing is that out of every experience, good or bad, you learn something about yourself and what you are capable of achieving. It is out of experience that you will learn to treat your future patients so let your experience become your teacher and move forward from here. Not passing an exam just doesn’t feel good and can play with your “head” in terms of how your look at your future. My point here is that nothing except that round of exams is over at this point. You mourn a bit and then you push forward because (and I am not wrong on this), the material for the next round of exams is already upon you.

As soon as you know that anything has not gone well for you academically, ask for help. Your first action should be reviewing the test and trying to figure out where you went wrong. Do you need to rely on more detail? Did you move too fast and not answer the question that was asked? Did you neglect to read every answer choice with a more correct answer further down? Did you not fully understand the material? Were you distracted by something outside of school such as a relationship or illness and not put in enough time studying? In short, try to figure out what went wrong and take steps to make sure that you don’t repeat your mistakes.

In some medical schools, class attendance is not mandatory. If this is the case, and you ran out of study time, try figuring out if there is one day a week that you can stay home and study the material using note service/lecture tapes or vids/textbook and syllabus reading. Many students do not attend class and find that home (or away from school study) works best for them. This may work for you but be careful if you have too many distractions at home or find that not attending class puts you behind. (Getting behind in medical school is deadly.)

If your work is not detailed enough, figure out which classes do not require the detail and which ones DO require more detailed study. In short, give each course what it demands. Many schools have integrated courses that definitely demand loads of detailed work coupled with “professional-type” courses like Practice of Medicine that are more performance-based. Try to look at your coursework from this perspective and see if you can give your integrated course a bit more time and your performance course a bit less time.

Another problem is that in many first year courses, the load of information can seem overwhelming. Resist the urge to dwell on what seems overwhelming and nibble away a chunk at a time. I always remember that scene in the movie “Shawshank Redemption” where the protagonist chips away at the prison wall over the course of 17 years with a small rock hammer. Eventually, he gets through the wall and escapes. Extreme but I think you get my drift in terms of divide your work into manageable chunks and stay on course. Keep moving forward because you can only affect what is happening now and use that to impact the future. Weekends are your friend because you can breathe a bit, relax a bit and catch up if you have fallen a bit behind your class. In the middle of the week, go to where the class is and use the weekend to “catch up”.

I really discourage students from recopying notes as a means of study. When you have volumes of material and information, you can become more of an excellent clerk in terms of producing a beautiful set of notes that you have not mastered. Organizing your material is good (can be done with a highlighter or in the margins of your notebook) but total recopying of every word may be too time consuming and not as beneficial as when you were an undergraduate student with less volume. You may need to review the material and then constantly question yourself or recite the material back to yourself rather than a complete recopy. If you can recopy your work in an efficient manner while learning and your grades are good, then recopying is working for you and don’t change your strategy.

Another problem that can interfere with some freshman medical students is feeling that they “need” to study for boards. You don’t need to take time away from your coursework mastery to do board study at this point in your career. If you absolutely feel that you NEED to do some board study, then do it during the summer between your first and second year but the best preparation for boards is to thoroughly master your coursework and then study for boards at the end of your second year. You cannot “review” what you have not “learned” in the first place. Don’t take valuable coursework study time to do board study. Board review books are most useful because they summarize material but most medical school courses require the details and not summaries. Beware of the “I am going to use a review book to summarize” method of study because it might work against you in terms of you not getting enough of the details to pass your course. The other extreme is to attempt to memorize the textbook which is most likely too much detail. In short, strike a happy medium that will work for you.

Don’t be afraid (0r ashamed) to consult your instructor or your dean if you are struggling. Not to reach out for help (especially because of the amount of money that you are paying for your school tuition) is not wise. It really looks great to a residency program director to see comments from your dean or professor that state that you were able to overcome a deficiency and excel. These types of comments indicate excellent problem-solving skills which are highly prized in a physician.

Finally, tune out the boasting of your classmates who say that they “didn’t study” and “aced” their exams. They are lying period. You have to do what you NEED to do for yourself. Congratulate them for being so “brilliant” and don’t waste a second of your precious time worrying that you are somehow deficient because you studied like a demon and didn’t do so well. There is nothing wrong with you that correcting your study strategy will not solve. Just don’t add “questioning your worth” to your list of things to overcome. It isn’t necessary and it won’t get the job done.

Statistics (and odds) state that if you were accepted to medical school, you will get through the four years successfully. Some people make the adjustment to the rigors of medical school academics faster than others but trust yourself enough to know that you will get the job done. There is very little difference in intellect between the person who graduates first in their medical school class and last in their medical school class. Residency program directors know this which is why the person who graduates last in their class is still called “Doctor”. Run your own race and get what you need.

The Computerized MCAT

Biochemistry, our first lecture as a medical student.

Orientation week was over and frankly, I was exhausted from a week of being hearded for ID photos, syllabi, microscopes and shots (Yes, we all had to roll up our sleeves for Hepatitis B vaccination). We had barbecues, lunches, mixers and drinking “fests” with the incoming dental and law students over the weekend. In addition, we had a great “White Coat Ceremony” featuring Ben Carson, M.D., chief of pediatric neurosurgery at Johns Hopkins University Hospital which was totally awesome (I will write more about that later).

On that Monday morning at 0800h, we all crawled (hungover and half-asleep), into our lecture hall for our first authentic medical school lecture. I had arrived early, thanks to nerves and good luck with the subway system, with plenty of time to do one more cursory pre-read of the material that was in our syllabus. The lecture would be a Review of Organic Chemistry by one of the Biochemistry professors that had been affectionately nicknamed “Rocket” by our upperclass advisors. I was feeling pretty confident since I had plenty of background in Biochemistry and had done extremely well in Organic chemistry. I had reviewed the syllabus and I was far ahead in my text reading. I sat in my seat (about 4 rows back from the front) with my multicolored pen poised (clicked to black) and ready for the lecture to begin.

Rocket came “out of the shute” with “guns blazing” and “white-lightening”. I would never have believed any human being could cover an entire semester of Organic Chemistry in one hour (actually 50 minutes) but Rocket lived up to his name. Reactions rolled off his tongue like Eminem in 8-Mile. After two minutes, I just sat back and marveled. (Thank goodness for my little micro tape recorder). I just made a list of every topic that he mentioned and said a prayer of pity for the person who was assigned to cover this lecture for note service. The fee that I had paid for noteservice already seemed a bargin.

After 50 minutes, we were given a 10-minute break. I looked around the room which, was silent. All of us were sitting there in total terror. Rocket had taken us all out and we were too numb to even get up and mill around. After the break, he started up again, this time explaining the fine points of ph and Buffers. He finished the lecture with a problem sheet that he indicated would be due in two days. I looked at the sheet and shook my head. It was going to take a couple of hours but I would get these problems done.

My best friend looked at the problem sheet and pronounced it “extreme”. I told her not to worry, I would get the problems done and I would write out an explanation of how I did them and share. Well, it turned out that I was the only person in class to finish all of the problems and my solutions went into noteservice for the class with much gratitude from my classmates.
Making buffers and solving buffer problems were pretty routine for me since I had been involved in research before starting medical school. I was happy to help.

During the semester, I would participate in many study sessions with my classmates. It was quite common for one or two of us to write up summary sheets or study sheets that would be shared with the class. I also became one of the primary notetakers for Biochemistry because of my familarity with the subject matter. We, as a class, tried to make sure that every person had the best shot of passing this difficult class. No matter what, there were some folks that just didn’t get Biochemistry on the first try. They would be in summer school that year.

I have to say that I found Medical Biochemistry quite differerent from the graduate school Biochemistry course that I had been used to. Instead of chasing electrons and working on endless problems in enzyme kinetics, Medical Biochemistry had a distinct practical side. One needed to be able to use Biochemistry as a tool in the care of patients. To that end, we didn’t chase electrons but spent some quality time chasing nutrition facts, hemoglobin disorders, molecular biology (theoretical and applied), pathways and numerous disorders such as diabetes, starvation and metabolic defects. It was all good learning and very detailed.

Biochemistry would be the second most demanding course of our first semester of our first year. Gross Anatomy took the top spot in terms of preparation time and study time. For me, since I had a strong background in Biochemistry, I was able to put in loads of extra time in Anatomy while holding my ground in Biochemistry with my usual pre-read, study lecture and repeat the schedule all over again the next day. I never attended lecture unprepared and I always stayed far ahead of the lecturer in case I became ill.

I kept very detailed notes and spent hours of time helping my classmates. They in turn, helped me to hone my teaching skills. When you attempt to explain something to another person, you hone your own learning. To my great pleasure, Biochemistry was a blessing in many ways. It was challenging but totally managable for me and it was my introduction into becoming a good colleague, something that I continue to work at today.

Rocket was our first introduction to the sheer volume-overload that was to come. He certainly received our rapt attention on that first day. We later learned that while he spoke rapidly, he made up the most awesome handouts. It was all good and we were on our way.