28 September 2007

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.


Anonymous said...


I appreciate this article.I'm a first year that just finished our first set of tests, and didn't do so hot in Anatomy. I think that I fell into the trap of "recopying notes" that took so much time away from actually learning the material. I quickly scrapped that idea!
I've already enlisted the help of a tutor (2nd year who honored the class) and changed my strategy to learn the material that day, and do repetitive reviews.
Hopefully, I'll be ready to take on the next test!

Savantrice said...

thanks for this. i'm only an applicant at the moment, but this post has definitely allayed a few fears.

Drnjbmd said...

To Anonymous,
Just don't be too hard on yourself. More people than you would ever believe, had difficulty with some exam at some point in medical school. You have to be willing to ask for help and get what you need. You have already done that and I am sure that you are on your way to being ready for that next test. Good luck and enjoy the learning. Remember that for every medical student, there are roughly 20 people who would kill to be in your spot. Smile and keep moving forward because you have accomplished much! Good luck!

The Scrivener said...

Thanks so much for this post. My first exams are on Monday and I'm pretty anxious about them. You have a great attitude, and I love reading your blog.

Anonymous said...

NJBMD thanks for your encouraging article. I did pretty well in undergraduate courses but have done poorly in 1st quarter med school, a low pass followed by two below-passes in biochem so far and a fail in gross/histo/embryo. If this continues I'm looking at repeating the year. My tutor says I could be thinking too much and should try "thinking inside the box" because the most brilliant person she knows did poorly in medical school. This seems like anathema to me; I am a problem solver and creative thinker and it's ironic to think that these traits which may serve me well as a future physician are getting in the way of passing my courses! I am feeling a futile cycle coming on--the harder I try, the worse my performance. I tried summarizing my biochem notes down to one page per lecture and reviewing them every day for about 10 days prior to the exam--result was my worst score ever. I am used to getting lots of practice exams and problem sets but at this school they provide hardly any such tools but expect us to bull through the courses somehow. I tried a board review book but the questions were too integrative for my current level of knowledge. I'm sitting here literally not knowing how to go about studying at this point. Maybe I should just stop thinking and do what someone else says--rote memorize and don't worry about understanding it.

Drnjbmd said...

To Anonymous,
You might be putting too much of your efforts on the clerical aspects of your summaries and less on the learning aspects. This is why I always strongly discourage folks from doing too much recopying.

A strategy that you might want to try is only writing a key word or phrase rather than a summary and reciting from those key words. This causes your brain to remember the details rather than you writing the details. Sometimes, you have the type of brain that does the opposite in terms of "if I wrote it down, I don't HAVE to remember it". I have that type of brain and keep lists with check off points so that I don't forget anything. Get my drift here?

See if you can find a study mate who has a totally different learning style from yourself and hang out a couple of hours per week. This activity forces you to think in a different manner. Above all, don't berate yourself for past performance but prepare your self for the future. You will get the "hang" of this as surely as you got the "hang" of getting into your car and getting to school.

The good thing is that you sound like the type of person who is going to honor every rotation during third year so keep moving forward, the best is yet to come for you.