15 July 2007

Getting off to a strong start

After the heady experience of orientation, it's time to get to the business of medical school. The classes will start, syllabi will be handed out and lectures will be available for download. It's time to "Go Live" and get off to a strong start. At this point, you should have your living arrangements settled (at least for the first semester) and you should have a pretty fair idea of how your class time will be utilized during the first semester. Now, you have to get into some kind of a routine.

As I have mentioned in other posts, you need to be thoroughly prepared for each class before you enter the classroom. The volume of material will not allow you to sit in lecture cold. This preparation means having your text/syllabus reading done before you hear the lecture. In addition, you need to have thoroughly mastered the previous lecture's material before you move into the current lecture's material. Gone are the days of sitting down on the weekend and learning the previous week's work. Studying and learning are daily "friends" once you reach medical school.

You are going to hear differing opinions on class attendance. Some schools have mandatory attendance while others don't care except for the occasional mandatory session. If you have signed up for a problem-based learning curriculum, you are going to be subject to mandatory attendance. In general, if class attendance is optional, attend class until you find that you are more adept at mastery of the material on your own or when you feel that your learning is being slowed by the lecture.

When students are sitting in lecture, they are listening to the lecture material being presented in an aural manner. Their isn't much mental processing of the material unless you have a base to which your are mentally linking as the lecturer presents the material. Most of the "learning" of the lecture material will take place when you go home and review the lecture presentation.

Some students will sit in lecture and "personalize" the material as the lecturer presents. This is generally a distraction and leads to those "sometimes annoying" classroom debates between one student and the lecturer. When I was a freshman medical student, these debates would generally occur during out psychiatry lectures when the professor would present a controversial theory or treatment. There was always one or two students who felt the need to be the "moral pulse" of the class. The rest of us learned to tune out and tune back in once the lecturer got back on track. Most experienced lecturers are adept at redirecting but occasionally, these interludes could go on for several minutes leaving me time to pour a fresh cup of coffee (or water) or take a breather.

For many students, taking notes seems to be oppressive. Don't fall into this category. There are very few notes that must be taken for the most part. Don't fall into the trap of thinking that you need to take down every work that comes out of a lecturer's mouth. When this happens, you become more clerical than engaged in information acquisition. You need only write a word here or there as most lecturers will have downloadable handouts/slides. Once you reach the point of figuring out how the lecturer approaches the subject matter, you can take a word here and there to direct your learning later on.

If you are a participant in a problem-based learning curriculum, you will have to become adept at linking medical concepts. I can tell you that by the time your first two years are done, you will become nauseated at the mention of the words "learning issues" and "learning goals". While problem-based learning (PBL) is admirable, sometimes one or two group members - usually the loudest and less shy - can dominate conversations or delay progression. At this point, an excellent facilitator (another word that will bring on nausea) will intervene but sometimes the group dynamics can get in the way of obtaining the information that you just need to learn.

Other things to think about are time-management in general. Yes, there are only 24 hours in the day and you will need to sleep at some point. I did find that after a couple of weeks, I could actually study when I was tired and that more coffee was not necessarily going to keep me awake. Having and keeping a fairly detailed daily schedule that included timing for the necessities of life (sleeping, eating etc) was helpful but there are going to be some days when the schedule is going "out the window" and your time will be spent in less productive ways. (You want to try not to have too many of these types of days). When this happens, forgive yourself, forgive the person (s) who wasted your time and get back on track as soon as possible.

Getting enough sleep is going to become something of an experimental journey for you. Resist the urge to listen to people who say that they "go for days on 1 hour of sleep" or the people who say "if you are sleeping 8 hours a night, you are not studying enough". Both of these are extremes and you will find that some the amount of sleep you "need" is just that, the amount that you "need".

If you are drowsy most of the daylight hours, you are probably not getting enough quality sleep. If you are drowsy when the lecture hall is too warm and dark and the professor's voice is monotone, you are normal. If your sleep quality is not good, be sure that you are getting enough "de-stressing" (physical exercise is good for this) or getting enough rest (being overtired can disrupt your study efficiency).

If your sleep pattern is disrupted, try some good sleep hygiene such as getting in bed at the same time every night. Don't try to read or study in bed (keep the bedroom for sleeping and recreation). Don't have a television in the bedroom (Ok, but un-plug it). Avoid coffee, tea and high caffeine "energy drinks" within four hours of bedtime. Avoid exercising before bedtime as it can disrupt your sleeping patterns as do naps of more than 45-minutes in the afternoon.
Be sure that your bedroom does not contain molds and too much dust. If you have allergies, these things will decrease your sleep efficiency and disrupt your sleeping patterns. Clean and dust your bedroom on a regular basis. If possible, wash your pillows monthly too.

Finally, forgive yourself if you find that your don't have everything together perfectly for the first set of exams. Adjusting up or down is part of the adjustment phase of medical school. You are definitely going to find that some subjects will demand more of your time and some will demand less. In the beginning, keep up with everything but generally give the time where it is demanded most.

Don't try to "explain" your schedule or study needs to anyone. Every medical student is different. If you can get through the semester, get the material mastered and get some stress relief on a regular basis, then you have gotten off to a strong start. Your family is not going to understand the pressure of your daily routine so don't expect this understanding. Your classmates will understand and your professors (to a certain degree) will understand but searching for "understanding" is largely counterproductive outside of medical school.

Start strong and finish strong but in the first few weeks, just get the start under your belt. Largely the study skills that you have brought with you from undergraduate/graduate school will work in medical school. Do realize that you are human and will make mistakes. At the beginning, there are no fatal mistakes so use this time to "ratchet up" or "ratchet back" until your reach your optimum.

The best words of advice that I received as I started medical school were "you create your own success and you create your own luck". Don't overanalyze and above all, don't be afraid of the task that is in front of you. You will adjust and you will have some successes. Overall, you just have to be willing to make adjustments daily and adapt.


David P said...

I know every profession has its routine. Medicine is not exempt in this. I would like to know if you could comment on the routine of being a physician, and what role creativity plays in being a physician. If you could comment from the perspective of a surgeon or from the perspective of a non-surgeon, I would appreciate it.

Additionally, as someone who came into medicine later in life, do you personally feel that you have avoided the traps of routine since you don't have the years of experience that other doctors your age have. Therefore, the procedures have not yet become so cemented in your head that you become bored doing them (I hope I'm not presuming too much with that thought).

Drnjbmd said...

My comments may just apply to me personally but I always tended to be a person who approached life, in general, as something of an adventure. I can always find something astonishing in things that others would find routine and mundane. I guess you could say that I was always someone who found wonder in the way that chlorophyll works in every blade of grass or the way that the hydraulic shocks work on the landing gear of a Dash 100 as it touches down on an airport runway.

I was drawn to medicine because every patient is different and every patient presents a new puzzle to work on and figure out. I am constantly amazed at how efficient and adaptable the human body can become. I love the one-on-one communication with my patients and appreciated the trust that they have given me with their health.

So far, I have never been bored in life and I don't think that I am likely to become bored in medicine. I am constantly finding new challenges and frontiers even within my limited practice. It's a little art, a lot of communication and great fun every day.

David P said...

Thanks for the heartfelt reply. You clearly love your job and it is very inspiring.