23 April 2007

Going Premed...

(The above photo is me in front of a poster as a graduate student)

At some point in your life, you have made a conscious decision to pursue medicine as a career. For me, that decision came after spending a couple of years doing research with and attending grand rounds with a very high-output cardiologist. At the time, I was far older than many of the professors in most medical schools yet alone the students but I was intrigued by the science and craft of medicine. My cardiologist mentor encouraged me to apply to medical school (after a bachelors degree in chemistry&biology + graduate study in biochemistry) as I definitely had more than mastered the pre-med coursework and had a strong interest in the direct application of my then research (ischemia/reperfusion effects on cell-cell communication).

For most medical students, the decision to pursue medical school comes in high school (or early undergraduate). They sign up for the pre-med classes: one year of general biology with lab; one year of general chemistry with lab; one year of organic chemistry with lab and one year of general physics with lab. In addition, most universities require humanities in addition to science in order to receive a degree. Biology is by far, the most popular major for most pre-med students but definitely not a necessity. Any major (from music to American studies) is a good major for pre-med as long as you are interested in the subject matter and as long as you thoroughly master the pre-med sciences.

For most pre-medical students, freshman year is occupied with General Biology, General Chemistry, English, History, math and a foreign language. Sophomore year is occupied with Organic Chemistry, General Physics and other general education requirements. Sometime during the sophomore year, a major is declared and so forth. The important things to consider are getting your general education requirements out of the way and doing exceptionally well in your coursework.

I was very fortunate to have attended a very strong secondary school. When I entered university, I had already taken Differential and Integral Calculus. My math course freshman year was Differential Equations. I had decided to pursue a double major in Biology with Math as a minor since I was interested in the subject matter. My interests in Biology were along the lines of organismal biology (comparative anatomy, parasitology, histology, cell physiology, biochemistry) and my math interests were very strong. I ended up taking Differential Equations, Applied Differential Equations, Advanced Calculus and Higher Algebra in addition to seminar. The bottom line was that I was passionately interested in this coursework because I was interested in being an excellent scientist and researcher.

At the time, I had no interest in medical school but a huge interest in the subject matter of science. This interest coupled with my study skills, enabled me to thoroughly master the subject matter of my coursework. I cared less about my grades and more about making sure that I knew everything that had been presented in these classes. It was during my freshman and sophomore years that I began to hone my study methods that would later serve me well in both graduate and medical school.

In organic chemistry, my performance in this class was not about getting an "A" but about making sure that I learned the theory and craft of organic chemistry. I made sure that I knew as much about the chemistry of carbon-containing compounds as possible in addition to the basics that I needed to devise synthetic themes. Organic chemistry started with an overview of types of bonding that carbon would participate in along with the introduction of families of compounds. Each family had their own synthetic reactions which intertwined to give more and more synthetic possibilities. My favorite means of devising a synthetic scheme was to take the final compound and work backward to the starting material. I was especially adept at anything that contained an alcohol (-OH) group.

In terms of organic chemistry and other coursework, I did not learn in isolation. All of my coursework was interrelated and contained valuable tools for my future work as a researcher. I never considered any course in isolation. General Chemistry contained principles that were useful in Organic. My math courses were quite useful in Physics for understanding how these principles were studied and developed. For some reason, I always saw the big picture.

Later on, as I moved from pre-clinical to clinical medical student, I could see how my ability to apply the principals of Organic Chemistry to the development of synthetic themes was just practice for applying the principles of my pre-clinical sciences to clinical problems. If I am treating a patient with Peripheral Arterial Occlusive Disease, I have to understand the science of how atherosclerosis is a complex disease process that involves inflammation (chronic) and epidemiology (risk factors). Nothing in medicine is studied in isolation. The nature of the pathological changes that I see in the arterial wall directly affect the physiology of the vessel and the progression of the disease. Organic Chemistry was my launch pad in the sense that it was a course that honed my ability to apply the concepts that I was learning to problem solving from many angles.

When I obtained my second bachelors in Analytic Chemistry (I was passionately interested in this subject matter), I found the ultimate outlet for my interest in problem-solving. My coursework for this degree consisted of Quantitative Analysis, Qualitative Analysis, Advanced Inorganic Chemistry (graduate course), Advanced Analytical Chemistry (grad course in electro-chemistry and mass spectrometry), Advanced Organic Chemistry and Synthesis, Instrumentation, Advanced Spectroscopy (grad course) and one year of Physical Chemistry. In addition, I took an undergraduate research course, Atomic Physics, Nuclear Physics and Analytical Biochemistry. When I began my chemistry degree, I had already taken the freshman and sophomore coursework (transferred in from my first university). I was in heaven in the chemistry lab and in class with graduate students.

Armed with a second bachelor's degree, I applied for graduate school in Biochemistry and was accepted with full departmental funding. I was assigned to a research lab and began the work that would lead to my graduate degree in Biochemistry and Molecular Biology. My mentor was a cardiologist whose research interests were ischemia/reperfusion and low magnesium states. He was the ultimate mentor in that he was a fierce collaborator and Renaissance man. He had two research labs that contained a powerful group of basic scientists with broad research interests. I was fortunate to become associated with this principle investigator who encouraged me to master and study everything that was of interest to me. These broad interests later led to my application to medical school.

Your premed coursework is not torture (shouldn't be anyway) but an opportunity for you to lean and master some fascinating studies. It is also where you set your groundwork for medical school. Your pre-med coursework is where you hone your study skills that will enable you to master large amounts of material in a short period of time. Undergraduate pre-med coursework moves at a very slow pace compared to medical school and thus you have an opportunity to build a solid knowledge base that you can apply (especially on the MCAT).

The whole study of medicine involves development of a solid knowledge base and application of that knowledge base to the treatment of your patients. There are few shortcuts to mastery of the materials that you will need for your day to day practice. If you think of your mastery of your pre-med coursework as the training ground for mastery of the study skills that will enable you to obtain your knowledge base, you will be well on you way to becoming an excellent physician. Medicine is the ultimate problem-solving profession which, makes medicine ultimately quite interesting.


Jacqueline said...

chemistry here I come this summer!!!

Drnjmd, how is your training coming for the MC marathon? I ran it in 2005 - beautiful course!!!

Drnjbmd said...

I am so slowww. At this pace, it is going to take me 4 hours + to finish. I am gradually building up my running base. I just don't want to get injured. At least I have until Fall. Good luck with the Chemistry.

Jacqueline said...

Slow and steady wins the race! Don't worry about time, just enjoy the run. It's really neat, the marines man all the water/gatorade stations, there are parachuters, people running with flags, tons of spectators cheering you on (if you put your name on your shirt they'll call out your name!), and the scenery is breath taking!
Good luck!