Standardized Tests

Standardized Tests
Let’s face it, standardized tests are a “fact of life” if you attend public school in the United States, anticipate attending college/university in the United States, want to enter professional school in the United States and practice any profession (especially medicine) in the United States. These tests are required for medical licensure in every state and most medical colleges require applicants take and score well on the Medical College Admissions Test (MCAT) for admission. These standardized tests need not engender any great “fear” in the test-takers as they are simply tests that are administered (and scored) under some kind of standard conditions. They are tests and like any test, they have characteristics that need to be examined in terms of preparing yourself. Just as you prepare for a course examination, you need to prepare for any type of standardized test that you need to take and score well upon.

Getting your “head” in the game
If you constantly tell yourself that your “bad at” standardized tests, you will fulfill your prediction. You can’t give any standardized test any more deference than you would give any examination in your academic history. Every test tries to measure something and that “something” is what you have to maximize your knowledge of , in order to do well on any test. In short, you survey,prepare, and master the knowledge that is tested on any test under any conditions. Every standardized test has a description which needs to be read, analyzed and used as a guide in your preparation for taking the test. If you decide ahead of time, that you can’t do well on a particular test, you have made your preparation that much more difficult. Any standardized test can be prepared for, taken and mastered by anyone who diligently and systematically prepares for the test.

Timing is everything
Once you know that you have a standardized test (in addition to your course exams), get a description of what will be covered on that particular exam. In the case of the MCAT, there are detailed descriptions of the subject matter for each section of that exam. Download those descriptions when you start your pre-medical preparation (when you start college if you know that you want to enter medical school) and pay close attention to your coursework in order to make sure that you have adequate coursework to cover the subject matter of the MCAT. Make sure that after you download a test description, prepare for the test according to the description and not according to how you prepare for other tests.

If a description says that a test requires that you apply knowledge from a specific knowledge base, simply memorizing that knowledge base is not going to prepare you for that test. In addition to thoroughly mastering the knowledge base, you have to be sure that you master the application of that knowledge base to problem solving. Standardized tests such as USMLE, MCAT and COMLEX have such broad knowledge bases that you can’t hope to memorize every factoid in those bases. You must master the prerequisite coursework (not memorize/cram for each exam) and build upon each courses within that knowledge base in order to apply that knowledge to problem solving.

What about problem-solving?
For many people, anxiety and poor reading skills can destroy any chance that they had of actually answering each question as it comes. If you are thoroughly familiar with the manner in which each test will construct problems, you can greatly decrease your anxiety level and improve your experience and reading skills. You can find reading skills courses (critical reading and analysis) that will hone your ability to pick out the significant parts of any argument, problem, question or survey that will help you extract the information that you need to answer a question about that argument, problem, question or survey. You can practice self-questioning as you read textbooks, newspapers, position papers and peer-journals to learn how to extract pertinent information for problem-solving. Turning off the television and getting away from the social media sites on the computer can free up valuable time for reading and analysis of a wide-variety of journal, texts and other learning materials. In short, you can read and analyze something every day that will hone your reading skills.

Get away from the Powerpoint!
Just attempting to study anything from a Powerpoint summary can be problematic. Professors use Powerpoint to summarize facts which may not be detailed enough for through mastery of any subject matter. If there has been assigned reading from a textbook, make sure that you have completely and critically covered the material. As you are reading, be sure that you look up any unfamiliar words and constantly question yourself in terms of knowledge mastery. If you have a Powerpoint lecture summary, be sure that you thoroughly cover and understand (in the textbook) the material that has been outlined in the Powerpoint lecture. Only after you have completely summarized and learn complete concepts, can you utilize a review-type book for reinforcement of learning. Trying to learn the basics from a review book is not going to give you the in-depth knowledge base that you can use to apply to standardized test problem-solving.

Review courses
A review course is worthwhile if you have a thorough mastery of your coursework in the first place. Just like review books, Powerpoint reviews and other review-type materials, you can successfully utilize these things unless you have had a through underlying knowledge base in the first place. If you are a medical student and you anticipate taking any of the USMLE/COMLEX step exams for medical licensure, you need to have thoroughly mastered your coursework before you begin any type of review course for these exams. This is why review courses are most valuable as soon as you have completed the prerequisite coursework that will be covered in the review. These review courses are not a substitute for thorough mastery of coursework. This same strategy works for pre-med students in that purchasing and taking a review course before you have completed the pre-med courses is largely a waste of time and money.

Finally…
Most standardized tests have a recommended study time frame. If you can’t find this study time frame, make sure that you ask people who have taken (and done well) on a standardized test, how much time they put in. Also be sure to ask a number of people (not just one person) so that you can get an average. Keep the following in mind:

•Don’t tell yourself that you are “bad” at standardized tests because you add to the difficulty of any prep for a particular exam.
•Don’t expect to memorize a review book and be prepared for a particular test or exam.
•Don’t tell yourself that your “whole career” depends on one exam as no exam can totally determine your vocational destiny(influence yes but not totally determine).
•Regular if not daily systematic preparation for the major standardized tests is a sound strategy. Your daily prep can be as simple as practicing your reading comprehension.

Getting the Schoolwork Done.

This is a re-post of some material from a previous post. Some of my current students have asked about this subject matter and thus, the repost.


"The Thrill of Victory or the Agony of Defeat"
The Drama of Human Competition as the opening lines of ABCs "Wide World of Sports" promised. By now, many students have had their first blocks 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.

What if I fail a whole course, like Biochemistry?
The consequences of failing an entire course in medical school are largely school-dependent. Some schools will want you to retake only the material that you did not pass while others will have you go through an entire summer remediation course. In any event, look at your remediation/retesting as an opportunity to hone this material well. You definitely want a strong knowledge base for your upcoming classes and you will have made some steps toward review in terms of preparation for USMLE. In this light, having to retake or remediate is not totally the worst situation that you can find yourself going through.

Plunge into your review with total concentration on the subject at hand. If you have one course or one area of subject matter, this is easier than if you have multiple subjects to remediate. Your only resolve in this situation is to not miss this golden opportunity to thoroughly master this material. You are not a "lesser person" because you need a second review and keep in mind, that you are reviewing at this point. In most cases, you have learned the material on the first shot but this review gives you insight into the material that you likely previously missed.

I am always more concerned about those students who "barely" passed than the students who failed and are re-mediating. In most cases, the student who re-mediates does not carry a knowledge gap forward while the student who barely passed likely has gaps in their knowledge base. It is those who barely pass that will need the most intensive review and preparation for board examinations. I always encourage students who scored below an 80% to study for and take any optional shelf subject exams if offered by their school. These shelf exams can pinpoint knowledge gaps that can be filled in before taking Step I.

Class Attendance - Is this time well spent for me?
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".

Wasting time and less efficient practices
I 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 (or 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.

Striking a Balance
Finally, one key aspect of medical school, residency and the eventual practice of medicine is that you will have to constantly "strike a balance" between study, personal life and professional obligations. The first semester of medical school will definitely test your resolve to keep working away at your studies until you get them mastered but this should not be at the cost of your personal integrity or sanity. Try to find ways of incorporating some stress relief (physical exercise) and socialization (away from your classmates) into your life. Nothing, including the practice of medicine is one-dimensional and there needs to be balance.

For example, if you are studying in the library and know that you won't make it to the gym, try to walk up at least 8 floors of steps on the days that you don't get to the gym. Take 10 minutes and take a brisk walk around the corridors to get your brain relaxed before you keep "grinding" away at your study materials. Study and pace at the same time while reciting the material to yourself in your own words. Try making some study-drill tapes and drill yourself while you are on the elliptical trainer/treadmill in the gym. Finally, picture that professor's head when you are doing your bicep curls or on the fly machine and pound things out. You will be more relaxed, less stressed and more efficient in your studies. In addition, you can enjoy eating without worrying about gaining weight.

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.

Getting Through the Semester (or what if I fail something).

“The Thrill of Victory or the Agony of Defeat”

The Drama of Human Competition as the opening lines of ABCs “Wide World of Sports” promised. By now, many students have had their first blocks 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.

What if I fail a whole course, like Biochemistry?

The consequences of failing an entire course in medical school are largely school-dependent. Some schools will want you to retake only the material that you did not pass while others will have you go through an entire summer remediation course. In any event, look at your remediation/retesting as an opportunity to hone this material well. You definitely want a strong knowledge base for your upcoming classes and you will have made some steps toward review in terms of preparation for USMLE. In this light, having to retake or remediate is not totally the worst situation that you can find yourself going through.

Plunge into your review with total concentration on the subject at hand. If you have one course or one area of subject matter, this is easier than if you have multiple subjects to remediate. Your only resolve in this situation is to not miss this golden opportunity to thoroughly master this material. You are not a “lesser person” because you need a second review and keep in mind, that you are reviewing at this point. In most cases, you have learned the material on the first shot but this review gives you insight into the material that you likely previously missed.

I am always more concerned about those students who “barely” passed than the students who failed and are re-mediating. In most cases, the student who re-mediates does not carry a knowledge gap forward while the student who barely passed likely has gaps in their knowledge base. It is those who barely pass that will need the most intensive review and preparation for board examinations. I always encourage students who scored below an 80% to study for and take any optional shelf subject exams if offered by their school. These shelf exams can pinpoint knowledge gaps that can be filled in before taking Step I.

Class Attendance - Is this time well spent for me?

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”.

Wasting time and less efficient practices

I 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 (or 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.

Striking a Balance

Finally, one key aspect of medical school, residency and the eventual practice of medicine is that you will have to constantly “strike a balance” between study, personal life and professional obligations. The first semester of medical school will definitely test your resolve to keep working away at your studies until you get them mastered but this should not be at the cost of your personal integrity or sanity. Try to find ways of incorporating some stress relief (physical exercise) and socialization (away from your classmates) into your life. Nothing, including the practice of medicine is one-dimensional and there needs to be balance.

For example, if you are studying in the library and know that you won’t make it to the gym, try to walk up at least 8 floors of steps on the days that you don’t get to the gym. Take 10 minutes and take a brisk walk around the corridors to get your brain relaxed before you keep “grinding” away at your study materials. Study and pace at the same time while reciting the material to yourself in your own words. Try making some study-drill tapes and drill yourself while you are on the elliptical trainer/treadmill in the gym. Finally, picture that professor’s head when you are doing your bicep curls or on the fly machine and pound things out. You will be more relaxed, less stressed and more efficient in your studies. In addition, you can enjoy eating without worrying about gaining weight.

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.

Academic Excellence

For many people in both medical school, graduate school and undergraduate school, this is the beginning of the second semester (or quarter). If you are new to your academics, then you finished the first semester/fall quarter with some academic achievements (good or bad) and learned some things about yourself. Since this blog is about strategies for success in medicine (getting into medical school, staying in medical school and other things associated with medical school), I though I would post a note or two about making changes that can enhance your Academic excellence.

Doing well in academics is something that can be mastered with practice. It comes out of having a strong and solid approach to what you have to master in terms of knowledge and it comes out of having a high comfort level with the learning process. If you always feel that you are somehow “not going to be able to get everything learned” or that ” the course is too hard”, then your beliefs can become a self-fulfilling prophecy. There is no task, no matter how great or how formidable, that cannot be approached by taking small steps every day until it is conquered. You have to be willing to “chip away” on a daily basis and note your progress on a daily basis in order to see that you are handling the larger task in smaller steps.

Let’s take Organic Chemistry for as an example. At the beginning of the year, your professor hands you a syllabus that outlines the lecture schedule, laboratory schedule and exam dates in addition to what is expected in terms of how you will be graded in the course. Usually your grade is the result of your grades on some combination of exams and projects. Armed with this information, the first thing that you need to do is make a master subject calendar of lecture topics and test dates. Also include things like “one week to Exam 1 ” and “2 weeks to Exam 1″ along with “3, 2 and 1 week to project due” so that when you look at your calendar daily, you know exactly how much time you have to master the knowledge for the material on your exams/projects.

The next thing to do is look at your reading and problem assignments each week for your lectures/topics. Some topics have many problems and some don’t have so many problems. Divide and conquer here by looking at the amount of time alloted for each topic. This should give you a good idea of the importance of each topic. Your textbook is a good resource in terms of looking at how much time and space it devotes to a particular topic. For example, look at functional groups of organic compounds. This is a topic that can be divided into families with the simpler families being presented first and the more complicated families being presented later. You can use your text to add upon your knowledge base.

The other thing that you want to do is be sure that you are prepared for each lecture. Don’t go to class with the idea that you can sit there, listen to the lecture and learn what you need for mastery. You need to know something about the topic before you hear the lecture. The best way to do this is to read about the topic before you hear the lecture so that you know something about the items that will be presented. Don’t every walk into a lecture “cold” as 50% of your actual studying can be done in your preparation for you upcoming lecture. The other 50% comes in your digestion of both the reading and lecture in addition to any problems that were assigned.

A point about problems and problem solving. With any problem that you are given, try to figure out what learning concept is behind the problem. For example, look at the wording of a problem and then review the concept that applies to that wording. Consider the problem, in diabetic ketoacidosis, glycerol is primarily used for what? To answer this problem, you need to know something about the biochemical derangements that take place in diabetic ketoacidosis. In diabetic ketoacidosis, the patient is acidotic which implies that ketone bodies have been released and have lowered the pH of a patient’s blood. What else do you need to remember? You need to remember that while the blood sugar is high, the patient does not have adequate insulin which allows glucose to enter the cells and undergo glycolysis and be used for fuel. That leads you to thinking about why the ketone bodies are out in the blood stream in such high quantities in order to cause acidosis. This because the brain primarily, needs to have a constant fuel supply and in the face of a huge amount of glucose in the blood, none of it can be used by the brain because there is no insulin to allow the brain cells to take up the glucose. Now what do you need to know about diabetic ketoacidosis in addition to the above and that is that fat is being catabolized into acetyl Co-A that is being used to make the ketone bodies and that the fat comes from the breakdown of stored triglycerides into fatty acids and glycerol. The fatty acids can undergo beta oxidation to acetyl Co-A and then shunted into ketone bodies but the glycerol goes to the liver as a substrate for gluconeogenesis or the making of glucose. In the face of large amounts of glucose in the blood, the diabetic can’t use that glucose to feed their brain and thus they are making more glucose in addition to ketone bodies which are acidic. This is the concept behind this problem and why you need to approach problems like this or questions like this from many different angles rather than just memorize the answer. You have to be able to master the concepts so that in any manner you are questioned, you can figure out the correct answer not attempt to rely on you memory.

The next thing that you must think about is that you have all of the tools that you need to master your coursework under the conditions that work best for you. Don’t compare yourself to anyone in your class. Some people are visual learners (tend to sit in the front of the class) and some folks are aural learners (tend to sit in the back to avoid aural distractions). Most folks use a combination of both visual and aural and thus learn best when they utilize both methods. If you are a visual learner, then make a brief outline of the material to be covered in lecture and take a note here and there. Don’t try to write down every word that the professor says but watch how the material is presented and fill in your notes later. If you are an aural learner, listen to the lecture and take a note here and there. Listen for inflections in the professor’s voice. Listen for key phrases such as “in summary” or lists of important topics. If you worry that you will miss something, take a small digital recorder with you and record the lecture. You can then upload it to your lap top and it’s there if you need to review concepts.

In short, if you have managed to get through first semester, you have every tool that you need to excel second semester. You may need to adjust some of your study habits or you may need to fine tune others. The important thing is not to dwell on what anyone else in your class does but to do what you need to get the results that you want. There is no class invented that could not be mastered because after all, someone had to come up with the facts and concepts for the professor to present. Don’t go into any of your courses with preconceived notions that the course is too “touch” or is a “weed-out” course. The coursework is there for you to master and you have to figure out how you will master it.

Another common mistake that many students make is relying on their perceptions of the professor’s like or dislike of them personally. No one who is lecturing actually cares about you as a person. They don’t have a personal relationship with you, and if they do, it doesn’t matter in terms of the presentation of the material to be mastered. The material is there and it doesn’t care about you or the professor or whether or not you “like” or ”dislike” the subject matter. If you spend the dollars in tuition, then that alone should be enough for you to have a vested interest in mastery of the material that is presented. In short, you need to get your tuition dollar’s worth out of this class for whatever reason. Whether you ”like” or “don’t like” the way the professor talks, looks, or anything else has no relationship to how you deal with the material that is presented. The professor is not your main source of knowledge but someone to help you navigate (by their experience) though mastery of this class.

Finally, you can decide in this very instant, that you will change your “thinking” in terms of how you approach your coursework. You can approach your coursework from a point of fear and trepidation or you can approach your coursework from the standpoint of “hit me with your best shot because I can hit it back and score”. You can decide to toss old habits of trying to “cram” at the last minute and replace them with solid organization and daily study. You can decide that you will either adapt a lifestyle and study style that will allow you to become an excellent scholar or you will continue to do what you have been doing that doesn’t get the academic achievement that you want. The key point is that you are the complete master of your thoughts, actions and reactions.

Study Skills Part IV

On the first day of your class, you will be issued a syllabus that outlines the professor’s grading policy, what will be expected of your in the class and a lecture/test schedule. Once you have that document in your hands, you can begin to set up your schedule for the rest of the semester. Ideally, you may want to purchase a very large desk blotter but the calender in MS Outlook (or something like it) will do just fine. On that calender, you want to place the date and time of every lecture, the topic, and the required reading. You also want to place the dates of your exams and note the dates of 3 weeks to exam, 2 weeks to exam and 1 week to exam. Any papers that are required should be treated like exams with 3 weeks to paper due, 2 weeks to paper due, 1 week to paper due.

If you are taking a lab course, you need to add the dates and times of your various lab sessions to your calender along with the topics of each lab. If you list your labs by subject matter of each experiment, you can relate these to your lecture material for better integration of the course subject matter. If your course has a recitation section, be sure to list this too as you do not want to skip any recitation sections. These sections can be invaluable when it comes to test preparation time.

Once you have set your master schedule for the semester, fill in your schedule for the week. This means filling in how much time it takes for you to get to school, the times of your classes and labs, your study time - remember one hour of study for each hour of lecture and 45 minutes of study for each hour of lab-your meal times, your work out times and your bedtime. If you are using a computer-based program for your daily schedule, print out your next day’s schedule when you are studying the night before. Look at it and be sure that you have organized and prepared for the classes that are on this schedule.

Class preparation means look at the subject matter of the upcoming lecture. Review the assigned readings - pay close attention to any bold words, headings and topics-review the syllabus and do any assigned problems. If you have difficulty with any of the problems, put notes or checks where you had difficulty so that you can walk into your professor’s office during office hours and get your questions answered. Don’t wait until after the lecture to work pre-assigned problems. Most of the time, anything that you had difficulty with, can be answered in class. If you wait until after class, you will be behind. Attempt assigned problems before your lecture.

Listen to your lecture and take notes only on the things that you know are not in the syllabus or text book. (See my previous study skills posts for how I would cut my textbooks). Take notes on things that help you to understand the important points of the lecture or clarify concepts that you previously did not understand. As I have outlined in other study skills posts, I would take notes on the left side of my notebook only using the right 2/3rds of the page. The left 1/3 of the page would be left blank so that I could write in summaries of the notes or definitions of terms that were important. On the right pages of my notebook, I would recopy notes that were taken in a hurry so that they were legible. I would also place notes and information from my text book.

Most of the time, I took lecture notes on my laptop computer or on looseleaf notebook paper. I discovered the utility of using notebooks that were designed for law students (summary paper) and then resorted to making my own version of these summary pages. I would print out my notes and clip them into a looseleaf notebook so that I could highlight them or make notes to myself as I studied. I would review the previous lecture, study the current lecture and preview the upcoming lecture doing the text readings.

As I stated under Organic Chemistry, I never walked into any lab unprepared. My lab prep consisted of knowing the purpose of the experiment; how long each step would take; what data needed to be obtained and what conclusions/observations I would be expected to make. I kept a sticky note in my lab manual or notebook with the steps of the experiment briefly outlined so that I could refer to my note. This make any lab write-ups pretty easy to finish. If there were pre-lab exercises, these were done before I attended lab. I would also consult my textbook if the material covered in lab didn’t correspond with the lecture (most of the time the lab material was a bit ahead of the lecture).

For courses like English and Math, I made sure that I had a solid reading schedule that kept me ahead of the class. Again, I would have problems worked before coming to class. In English, I would make sure that I had thoroughly covered the readings taking notes as to tone, argument and subject matter as I moved along. Again, sticky notes were good for making extra notes in my reading books. I could past them in and add them to my professor’s notes after the lecture.
Soon after each lecture, I would quickly review the lectured material filling in any words that I had left out or drawing arrows to link materials. I would make any quick notes of things that needed to be clarified during office hours. In terms of Math and English, I would have circles around any problems that I had attempted but was not able to complete before class so that I could get my questions/problems taken care of. If these were not taken care of in the lecture, they would be taken care of during office hours.

My professors got to know me pretty well because I would attend office hours even if I was sure that I had mastered the material. It doesn’t hurt to have a “tune-up” and a “knowledge-check” even if you are sure that you are understanding everything. Sometimes these “tune-up” sessions would give me valuable insight as to what to emphasize for the exams and what to place less emphasis on. I figured that if I was paying thousands in tuition for each course, I was going to get every bit of instruction out of the course that was available. It also gave the professor a chance to get to know me which was good when I requested a letter of recommendation for graduate/medical school. I always received high praise for my business-like attitude and organization of my coursework.

Spending so much time preparing and previewing for each class made studying and review for each exam practically effortless. By the time the exam rolled around, I had been over each lecture a minimum of three times. I reviewed the previous weeks lectures on the weekend. By staying ahead of the professor and the class, I always had plenty of time to integrate the materials for every class. My attitude toward university coursework (honed by loads of experience in secondary school) was that my “job” was to master this material. I needed to thoroughly master my coursework because it was background for my graduate studies and I wanted the best undergraduate education that my university offered.

Don’t get the idea that I spent every waking hour in front of a book. I used my university time to attend lectures and seminars on any subject matter that was of interest to me. I went to lectures on the Holocaust, aerospace engineering, mathematical theories, social theories, political science in addition to departmental seminars in biology, chemistry and physics. I obtained a departmental seminar listing during the first week of class and added these to my schedule. Even if you do not completely understand everything in a seminar, you can pick up valuable experience and broaden your knowledge base for free. These seminars are also a great opportunity to get to meet the faculty and learn their research interests.

As a medical student, I tried to attend grand rounds in Surgery, Medicine and Pathology as much as my schedule would permit. These grand rounds became invaluable for USMLE (all steps) as the speakers always presented both the basic and clinical science of their discipline. It was my interest in every aspect of medicine that lead me into academics and today, continues to allow me to keep up with basic science as well as clinical science.

As a student of science and medicine, you have to be quite proactive and a bit of a self-learner when it comes to the mastery of your craft. If you take the time to start keeping up with the literature and attending seminars/grand rounds while you are an undergraduate, you can carry those skills into graduate/medical school. You cannot afford to be a passive learner relying on the professor’s lectures for your entire education. I totally attribute my performance on the Medical College Admissions Test (MCAT), United States Medical Licensing Exam (USMLE) and my specialty board/in-training exams to my attendance at all of those seminars and grand rounds. By listening to the “cutting-edge” leaders in various subjects, you learn to analyze information and you learn to present information logically. These skills are free and the seminars are often free and easy to take advantage of.

Finally, approach your studies as you job. If you are working and attending class, you need to be organized but you need to do both well. I always recommend that students who work, need to take less hours. It is not useful to load up on semester hours only to do poorly or mediocre in the coursework. Take less hours in the first place, do well, and if you find that you have free time, use that time to attend seminars/grand rounds. If you are a full-time student with no employment, use some of your free time for seminars and experiences that widen your educational experience. You only get once chance at your university experience and you need to be sure that you are getting the most out of every class for you money. Make your studies of prime importance and be proactive about getting your needs met.

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.

My First Week of Medical School

Many people have asked me, "What was medical school actually like?" "What was you day-to-day schedule?". I will attempt to describe my first day in medical school from the time I woke up to the time I fell asleep in this essay.

I woke up at my usual time of 4:30AM. I was raised on a farm and getting up early is as much a part of my life as brushing my teeth every morning and evening. I am fortunate that I actually have always had less of a sleep schedule than most of my buddies and thus, I generally awaken around 4:30AM without the need of an alarm clock. I also roll out of bed and hit the shower while my single cup of "Joe" is brewing.

Over coffee, I usually catch up with the newspaper (online) and then I headed out the door for my walk to the subway station. This walk generally took about 20-minutes and was a built-in source of exercise for me for the first couple of weeks of medical school. My coursework on the first day consisted of Introduction to the Practice of Medicine Class at 8:AM- 10AM, Psychiatry at 10AM to noon. Lunch was from 12 noon to 1PM. Afternoon was Gross Anatomy Lecture from 1PM-3PM and Gross Anatomy Lab from 3PM to 5pm.

All of our lectures were in 50-minute blocks with 10 minutes of break in between each lecture. This allowed us to get a drink, walk around and prepare for the incoming lecturer. It also allowed the media person to set up in between the lectures as our lectures were available for download and all PowerPoints were down-loadable from out seats. Most of us took notes on the Powerpoint slide sheets or just listened in class.

Our syllabi had been handed out during orientation so that we knew the objectives and content with each lecturer. We also knew which textbook readings were to be covered. My Introduction to the Practice of Medicine course had a syllabus that contained an outline of the lecture. There was no text reading for this opening lecture that included the duties of a physician, how to fill out a death certificate and how to gather and interpret vital statistics for a locale such as birth rates, death rates and rates of disease.

With all of my syllabi and text books, I would remove the covers, take the books to Kinko's and have the bindings removed. I would then have three-holes punched and I would place these sheets in large 3-ring binders. I had a binder for each course. In the evening before each course, I would remove the syllabus sheets for that course, remove any textbook pages that I thought I might need and place them in a small 3-ring notebook along with sheets of lined notebook paper (for taking notes). This was the notebook that I brought with me to school. I would have the subject matter divided by separators so that I had all of my information with me for the day.

I would download my PowerPoint slides and place copies of these in my subject notebook when I got back home for the day. My lecture notes (or copies of note service) would also go into each subject note book. My textbook pages would go back into that textbook three-ring binder.

On my first day, I took notes and placed them in my Introduction to the Practice of Medicine binder when I arrived home at the end of the day. For psychiatry, again, the lecturer had no slides but discussed Erickson's stages of development and Piaget. I took notes but knew that detailed explanations of these subjects were in my textbook.

For Gross Anatomy, I had the text pages with me and made notes in the margins of the material presented by the lecturer. I also made a few notes on photocopies of my Netter plates for use in our lab. During Gross Anatomy lab, I had my list of structures that I had made from scanning the dissector. I had also reviewed the relevant plates in my Netter atlas and had made photocopies of these plates. My photocopies were stapled to my list of structures.

In our first Gross anatomy lab, we studied the bones of the vertebral system and skeletal structures. We were also given instruction in how to work with the diener to keep our cadavers in good condition for the entire semester. We were also introduced to our cadavers and our tank groups (each was six people).

After lab was over, I took the subway back home (45-minutes) and walked from the subway station to my house. I then took an hour, made dinner, ate and begin to study and review the material from the first day's lecturers. As I studied, I made notes an questions in the margins of my books, syllabi and note sheets. Since most of my notes were typed, I printed these out and placed them in my subject binders. I also studied and memorized the relevant bone structures using my bone box that was issued to me during the first day of Gross Anatomy laboratory.

My next task was to preview the notes for the next day's subjects and do any readings/problems that had been assigned. After my previewing, my textbook pages, relevant notes and syllabi pages were placed in my daily notebook which went into my backpack. My next days courses were Biochemistry, Microbiology and Microbiology lab.

My day ended about 11 PM and I hit the bed because I knew that my next day would be starting at 4:30 AM. Since Tuesdays and Thursdays were shorter days (class started at 8AM but ended at 4PM) I actually had an extra hour on these days. We also had a Microbiology Discussion session on Tuesdays and a Biochemistry Case Discussion session on Thursdays where we would discuss clinical cases from the standpoint of these subjects. Our instructors would bring a case, present it and then we would discuss these cases in detail from the standpoint of the basic science involved.

When we started to actually dissect the cadavers, my Mondays, Wednesdays and Fridays included 2-3 hours of dissection in the evening after class was done. I would get some dinner at school and then get into the dissection laboratory to study and complete dissections. The extra dissection/study moved my bedtime back to after midnight on these nights.

I also studied in the dissection laboratory and with my study group on Saturdays. We would have an early breakfast (at one of the nearby churches to help them raise funds) and then study and quiz each other until noon. We would then study and quiz each other in the Gross Anatomy lab after lunch and generally until 3 or 4pm. After that, we would do another group session in Biochemistry and Micro and then head home around 8pm.

Sunday's were generally my day of rest. I would spend a couple hours in the evening putting together my materials for my Monday classes but most of my studies would be completed in the time that I had put in Monday through Saturday.

If this amount of study time seems extreme, it was extreme in some ways. I would not stop until I felt I had mastered the material. I also made the crucial mistake of neglecting my physical conditioning in favor of my studies when I should have incorporated my studies into my physical conditioning routine. I ended up gaining a considerable amount of weight but my grades were excellent. At this point in my life, I know that I have to strike a balance and now I am in excellent physical condition with no neglect to my academics/reading.

Medical school was all about balancing my studies with my life. I learned to multi-task and I learned how to focus on getting things mastered and completed. I also learned the value of discipline. My schedule didn't allow much "downtime" but the "downtime" that I had was utilized to an ultimate degree.

It becomes easy to procrastinate in medical school because the days are long and the material seems voluminous. I fought procrastination by asking myself, "Why are you avoiding getting on with this task?". Since I never had a good answer for this question, I just broke the task into smaller tasks and checked them off until they were done.

As I have said in other posts on this blog, the telly went by the wayside. I would spend a bit of time on Sunday scanning the log for shows that might be of interest. I would program my recorder for the shows of interest and watch them the next Sunday if I felt like a bit of relaxation. In most cases, my relaxation became hanging out with my classmates and the telly wasn't much entertainment. I still tape shows that I love or documentaries that might be of interest to my students as I am teaching more these days.

Other things that tended to waste my time in medical school were phone conversations. I seldom use my telephone more than 5 minutes per week and tend to use e-mail communication more. I also pick and choose the meetings that I attend. Many times, academic committee meetings can be a total waste of time and energy and thus, I pick and choose whenever possible. If something is mandatory, the organizers generally will time the meetings around the schedules of those folks who are attending.

One of my medicine professors encouraged us to read the case reports in the New England Journal of Medicine every week from the first day of medical school. He said that we might not understand all of the aspects of each case but that this habit would prove invaluable as we moved through the curriculum. He was totally "on the money" with this one. I can't tell you how studying and reading these cases helped me on all steps of USMLE and in residency too.

Medicine requires that you read and keep up with the journals of your discipline. I strive to read selected articles in New England Journal of Medicine, Journal of American Medical Association weekly. I also read American Surgeon and Archives of Surgery regularly along with Nature Medicine (excellent articles to be found in this journal). I keep a computer log of the articles that I have read and their sources. This keeps me current with the literature as much as possible.

Summer School Coursework

For many pre-medical students, summer courses look like a great way to get ahead of the curve and fast-track through your introductory sciences, math or general educational requirements. For some medical students, summer coursework is an opportunity to shore up deficiencies or remediate coursework from the previous year before academic progress is granted. In both the case of the undergraduate and the medical student, there are characteristics of summer coursework that need to kept in mind.

Summer courses at any level go very fast. There simply are not enough weeks during the summer months to allow the same pace as regular-term coursework. Keeping this in mind, prepare to work faster and longer to master the same amount of material as a regular-term course. In the case of repeating a medical course -or remediation of previous course work-you are expected to be able to move through the material faster because this is the second time you will have covered this material. In the case of an undergraduate course, the summer student has to be dedicated and disciplined during a time when many of your friends are enjoying a much needed vacation.

My rules for mastery of coursework apply for summer coursework but let's call the rules "course mastery on steroids" because you have to devote more time and cover more material at each sitting. There is little time to allow the material to "digest" before you move onto another topic or lecture. To this end, your previewing and reviewing become more focused in addition, the student has to be more adept at moving through the material at a more rapid pace. If mastery of concepts comes slowly, summer school is not a very good idea.

In the case of the remediating medical student, this being the second time through gives you an added advantage in the sense that you already have good insight into what you need to master. Each time the material is presented, you will gain new insight. This doesn't mean that doing a summer medical school class is going to be wonderful and a "cake walk" but it does mean that you will likely know your remediated material in great depth for your board exams. This is not a bad trade-off for missing your vacation time and staying with the rest of your medical school class.

I never recommend that pre-medical students take pre-med coursework during a summer session. Summer courses move so rapidly that there often is not enough time for good integration and mastery of the concepts in sufficient depth for application on the Medical College Admissions Test (MCAT). Good summer courses are English courses, History courses, physical education coursework and math coursework. By taking these types of courses during the summer, a pre-medical student can get pre-medical course pre-recs out of the way or get degree requirements out of way allowing more time for concentration of major subjects.

Other great summer coursework for pre-medical students are "immersion" type courses such as marine biology (on a ship at sea), summer semester in Europe or South America, or summer research. Being able to devote your attention to one subject in total immersion can greatly enrich your college experience. Many undergraduate institutions offer immersion language coursework over a summer or opportunities to work with world-class researchers during a summer session.

Summer Course Study Strategies
As soon as you receive your course syllabus, reading/lecture schedule, sit down and plot your study schedule. You need to figure out how much time you will have to devote to study in order to cover the material. A good rule of thumb is two hours of study time for every hour of lecture time (same as for regular session). Since summer lecture are often longer (or take place five times a week instead of two or three), you have to block out your study time without exception.

Be sure that you have a strong and organized approach to mastery of your material. Having a buddy in the same class to study and work with becomes invaluable especially when you quiz each other and explain concepts to each other. It is also a good idea to meet with your instructor on a regular basis to be sure of your understanding of your coursework. Since summer courses go so fast, you do now want to "dig into a hole" that you are constantly attempting to pull out of. Chances are not good for pulling up, if you get into trouble on a test.

Because of the heavy concentration and course time commitment, working will be very difficult with summer courses. Unless you are taking a physical education course or a performance course with minimal prep time, working will be very hard. The effort that it will take to keep up with your course materials will generally rule out employment except for either a Saturday or Sunday on the weekend (but likely not both). If you need money, opt not to register for a summer course unless you have a job that permits long hours of down-time regularly. Even then, attempting to work and do a summer course will be very difficult.

If your family (or you) have an elaborate vacation planned, do not expect that you will be able to "miss a couple of days" of your summer course. You should have enough time for a weekend at the beach or to take a short trip but missing a day of summer work is equivalent to missing a week of regular session work. Again, opt not to take a summer course if you NEED your vacation time. Taking the time off is a better use of your summer instead of attempting to take a summer course and doing poorly because you had to go on vacation. If summer school is your plan, it IS your vacation.

Study Skills Part III

In this short essay, I am going to tell you something that I didn't do that I should have done. It's called "Learning by Experience". When I started graduate school, I vowed to get myself into good physical condition. I had a few extra pounds but nothing that was morbid obesity just about ten extra pounds. I had been a middle distance runner (10K) off and on with my best mile time being 6:25 and my best 10K time being 40 minutes but working in the chemistry lab and getting ready for graduate school had eroded most of my base-line mileage. I saw the pounds creeping on and I decided to "stem the tide" right then and there.

I joined a gym where loads of guys from the U.S. Navy JAG office worked out. Soon I was grunting and sweating with the boys. Those extra ten pounds quickly melted off and I would run 4 to 5 miles daily. My flexibility increased and my brain loved the extra perfusion of oxygen from those daily runs either outside on the bike paths or inside on a treadmill. My workout partners, all JAG guys, introduced me to weight training. Soon I was benching 125lbs and leg pressing 400lbs.

I loved swaggering into the gym in my baggy gym pants and muscle shirt. I would hop on the stationary bicycle for a 6-minute warm up. After a few stretches, I would start my circuit working legs first then arms and finishing up with abs. I wore a red scarf on my head and definitely sweat as much as the guys. When I reached 80lbs on the bench press, I earned a spotter. Nothing gave me more satisfaction then when the guys and I would take turns on the chin-up bar. (No other women came near the bar). My biceps and triceps bulged. I would put 400 lbs on the leg press and just work away with some nice hamstring stretches in between.

After my weight-lifting, I would take a soak in the Jacuzzi and then a dip in the pool. I am not much of a lap swimmer but swimming a few laps would bring my body temperature down and would keep my back stretched out nicely. My entire gym routine took about 2 hours from start to finish. I would get a protein shake in the juice bar and head back to my lab feeling powerful and refreshed.

The best thing about being in such great shape was that the discipline of working out carried over into all aspects of my life. I slept better at night with no stiffness in the morning. I easily ran flights of steps and could carry heavy loads with no problem. My clothes fit great. I had a solid study plan that had gotten me a 4.0 in my graduate studies. While I ran, I thought of new experiments and analyzed my data in my mind. Though my diet was not bad (I am not much of a junk food eater), when I was working out, it was excellent. I ate plenty of fresh vegetables, fruits and little meat.

With all of my energy, I was able to awaken in the morning, run a couple of miles with the Marines from the barracks down the street, and then bike 6 miles to school in the dawn. I would check my experiments and review my lectures for the day. I would then shower (I really sweat when I bike); change into my suit and lab coat, and then do my morning lectures. During lunch, I would hit the gym. After lunch, I would study and prepare more experiments or go to meetings. This was the routine of an assistant professor.

When I decided to attempt medical school, I knew that I needed to take the Medical College Admissions Test (MCAT). I had far more coursework between a double major in biology and chemistry with double minors in physics and math. My graduate work was in Biochemistry and Molecular Biology so those subjects were well covered. I knew that I needed to brush up on my verbal reasoning skills so I bought a review book and worked some problems daily. I also worked on my Physics too since it had been five years since I had taken General Physics. I was solid on the Quantum Mechanics but Classical Mechanics and Optics needed review.

My graduate comprehensive exams were also looming that summer too. We would be examined over the course of two days with eight hours of testing on both days. I studied for my comprehensives and studied for the MCAT at the same time. This turned out to be a great strategy. I simply made a review schedule topic by topic and checked off as I reviewed each concept. As a poor graduate student, I couldn't afford a prep course so I purchased ($35) a huge review book called Flowers and Silver. It was money well spent.

After completing my comprehensives in June and getting my AMCAS application done, I knew I had one month to prepare for the August MCAT. I had stuck to my study schedule and my workout schedule. The funny thing was that none of my graduate school colleagues, except my best friend, knew that I was even interested in medical school. My best friend in graduate school was a neurosurgery resident who was working on his Ph.D. We had been study partners for the comprehensive exams.

On the morning of the MCAT, I hopped on my bicycle and rode the 6 miles to my testing center. It was great rolling off the hills at top speed and feeling the early morning wind in my face. My legs were strong and I imagined myself "smashing" that exam as I pumped up and down the street. I stopped into my favorite coffee shop for a morning cup of fresh "joe" and a high-five from the shop's owner (a little Korean lady who always offered me encouragement).

I stood in line, dressed in my bike shorts and muscle shirt with my helmet and gloves. I stretched some but other than that, I was pretty relaxed. I could feel the tension all around me. As I got to the test room, I hoped for a seat next to the window because outside, there was a beautiful pink blossomed tree. I knew that I would be able to look up and out the window for a little mental break if the test was too much. My prayers were answered as I took my seat next to the window.

I moved through the Verbal Reasoning. My strategy was to do the passages that I found least interesting first and the things I loved last. I paced myself reading the questions first and marking the answers as I read through the passages. I paid close attention to punctuation, tone and critiqued in the margins of the test booklet. Soon this portion of the test was behind me. About ten minutes into the test, three young men, arose from their seats and left the test center. Was I missing something? The entire test went fine for me with my being able to figure out the "hook" behind each question. It was more like a game than anything else.

At the end of the test, I rode to my lab, checked my experiments and said a "thank-you" to God for giving me a nice day to ride and a clear head. From then on, I was stayed in great shape and kept working out clear up until the last day of medical school orientation. When classes started, I started studying and eating. My study group would feast on Nacho Cheese Doritos as we quizzed each other. By the end of first year, I had gained 30 pounds. My teaching over the summer and second year packed on another 20. By the end of medical school, I had gained 65+pounds and carried that weight around until my third year of residency.

After three years of standing and huffing up stairs, I vowed to get the weight off. I didn't have two hours to work out daily but I made time for an hour workout even if I lost sleep. On my call days, I would walk the steps. Soon I had a good aerobic base but I am still working on getting my weight lifting back up to my level before. Even today, I work out at least four to five times weekly doing something. My gym opens at 5:00AM so I can get an hour in on the elliptical trainer if necessary.

In short, in medical school, I let my fitness level drop and endangered my health. I am fortunate to be able to get back to my previous level of fitness though the weight is not coming off as fast as I would like. I know that I won't lose as much weight until I can get my running base back and I won't pound my knees until I have lost another 20 pounds. That day is coming though.

In short, get a good fitness plan today, if you don't already have one. It can be as simple as a 30-minute walk after dinner. Keep yourself in good physical condition and take an hour for yourself because you deserve that time. Physical exercise drops your stress level and makes everything in your life hum. I am having some "zone days" now that my physical condition is getting better and better. Having a good physical conditioning strategy is as important to your studies as your textbooks. Get moving.

Study Skills Part II

Today is my Birthday!
First of all, today's my birthday and I have the day completely off. I have been basking in the warm sunshine (by the pool) and thinking about this post.


Study Skills

Learning Style
One of the most useful things that I did was figure out my learning style. I am a very visual learner. I love to color-code information and I never go anywhere without my different colored highlighters and multi-colored pens. When I am studying, I use my highlighters to circle information, rather than highlighting words. Each color has a particular significance such as blue represents the main headings, pink represents the words that must be defined and all important concepts are circled in yellow. Green is my check-off color as I check off things as I study. This lets me know what I have accomplished.

Visual learners like to sit in the front of the classroom for less distractions. During my first and second year of medical school, I sat on the end of the third row so that I could see. I was not a front-row person (too easy to get covered in saliva) and I would only sit in the back if I was doing something else (like reviewing another subject because I wasn't particularly interested in this lecture).

Aural learners will typically sit in the back. These folks thrive on hearing the information and are not easily distracted. They need a good seat where they can see if they need to but most of the time, they don't look up from their notebook or computer. Aural learners are good at pacing and reciting concepts back to themselves. They are also excellent study group members because they process information as quickly as they hear it. The biggest challenge for the aural learner is making sure that information gets into their "long-term" memory.

Many folks are a combination of both of the above. This is not a bad combination for medicine and medical school. As visual as I am, I tended to make drill tapes for listening when I am doing something like jogging on a treadmill or riding the subway. Sometimes it is nice to hear information organized rather than to keep staring at a page. I would often make a large concept map (on my white board) and then make a drill tape from that concept map.

Tools

Digital Tape Recorder
One of my best purchases was a digital tape recorder. This device enables me to record lectures, notes and thoughts and then download then to my computer. My device is the Olympus WS-100 which allows me to store up to 27 hours of recording. These files are stored as .wma files but I can easily convert them to mp3 for listening on my MP3 player.

Laptop Computer
My laptop accompanied me to class daily. I could download my instructor's power point lectures and have them ready for adding my notes. This was especially helpful for subjects like pathology and physiology. Couple the power points with digital recordings of the lecture or my own digital summaries and I had a visual and aural review. I purchased a motion detector alarm for my laptop so that it didn't develop "legs" and walk off.

Cut Text Books
I would take my textbooks to Kinkos after I had removed the front and back covers. I would have them cut the binding and punch three holes in the sheets so that I could place the pages in a three-ringed binder. I would removed only the pages that pertained to what I was studying for a particular lecture or week and place them in a separate (small binder) that was divided by subject. I would leave the rest of my textbook at home. My small 3-ring binder would have each subject for the day, the pages of text and the appropriate syllabus pages. I would preview each lecture the night before and add what I thought I would need for the day.

Multiple Highlighters
I love nice highlighters but I used them as I outlined above. I would circle things; highlight a single word or use them for checking things off. I really didn't do much highlighting in my textbooks. I kept a pencil box with my highlighters, colored pencils and pens ready for my use.

MP3 Player
This device is as necessary to my studying as my notes. I love to have some music playing in the background when I study. My player has video and radio so I can take a break, catch up on the news and listen to good radio when I am in the mood. I have my favorite songs for every mood and situation. My player is good for drowning out background noise such as subway noise. I generally keep the volume low so as not to damage my hearing.


Study Tactics

Sometimes I can pace and study. I take my notes and just recite to myself out loud. This is especially helpful when I don't understand something. Sometimes just listening to myself read the concept out loud or paraphrase it, can help me to remember it.

I also question myself or imagine how my instructor will question a particular concept. Some things just lend themselves to multiple choice questions. All of the following are branches of the external carotid artery EXCEPT. Other things lend themselves to True-False or Matching.

My attention span is about 50 minutes so I would set a kitchen timer for 50 minutes. I would study my notes for that 50 minutes and take a 10-minute break. On my break, I would get a drink, move around, get a breath of fresh air but I would do anything except continue to sit and look at a page of notes. When I returned from my break, my mind would be ready to focus.

In terms of avoiding distractions, I would study in Starbucks or study in the undergraduate library. I would be less likely to be interrupted in locations outside of the medical library or in a classroom at my medical school. I tended not to study at home because I wanted my home to be a sanctuary where I could completely relax. I never, never studied in the bedroom. My bed was for sleeping (or extra curricular activities) but not a place to study.

Finally, I got rid of the telly. This device can be a huge time-waster. If you have telly programs that you must watch, tape them and watch them when you have free time. I know that folks are hooked on Gray's Anatomy, ER and the like, but tape the show and set aside some time on a Saturday or Sunday to watch. This can be your reward for getting the week's studying done.

Study Skills Part I

As many folks are heading for summer school, medical school or just taking a much-needed break, I thought it would be a good time for me to review some study skills that helped me excel in undergraduate, graduate and medical school. I am planning to present my "Study Skills" in more than one part and as an ongoing series. One of the first things that needs to be done is an assessment of the skills that every student needs in today's world. Along those lines are :

• Excellent reading and reading comprehension skills
• Computer skills
• Excellent writing skills
• Good math skills

The above components are the essence of doing well in your coursework and laying a strong foundation that will enable you to do well on the Medical College Admissions Test (MCAT). If you find that you are weak in one of these areas, use the summer to work on your weakness and convert it into a strength. All of the above skills can be mastered with practice.

Reading and Reading Comprehension

One of the best ways to increase your reading skills is to just read. Start with materials that you enjoy and move into your course materials. If you have the time, read some short fictions authors like Hemingway, Baldwin and Oates. As you are reading their stories, note carefully how their works are organized, how they set the tone of the work and how they use language to convey their thoughts to you, the reader.

Other short materials that you can look into are the editorials in your newspaper. These editorials are generally about the length of the writing sample that you will create on the MCAT. They usually follow the outline of Introduction and thesis, evidence, evidence and conclusion. Look at the paragraph structure; underline the thesis statement and circle their evidence. Are their conclusions logical? Did they have a strong argument? Did they include a counter-argument? If you do not subscribe to a local newspaper, most large-city newspapers now publish on-line. Some of the best writing and editorials can be found in The Washington Post, The New York Times and The Richmond Times-Dispatch.

Another benefit of becoming a good reader is that good readers are almost inevitably good writers. As you read and become adept at critical analysis of your readings, you will likely become more skilled as a writer. Try reading an editorial and writing your version of a counter-argument to the editorial. It doesn't matter if you agree or disagree with the editorial, just learn how to formulate a counter-argument. This task will also helps with getting used to using good grammar, sentence construction and word usage. By taking some time during the summer months (or a hour on the weekend) and practicing your reading and writing skills, you can greatly help yourself when it comes to writing your personal statement for you medical school education.

Another useful reading comprehension skill is learning to read and utilize your textbooks. Many courses such as General Biology, General Chemistry, Organic Chemistry and General Physics have excellent texts that are good adjuncts to your class lectures if you utilize them properly. At the beginning of every semester, you should be handed a course syllabus that contains your assigned readings, a lecture schedule and how you will be evaluated. Making sure that all assigned text readings are done BEFORE lecture can greatly increase your understanding of concepts.

The first task in evaluating a text book is to look at the overall organization of the book. Who is the author(s)? Where are they located? There is usually an "About the author" essay at the beginning (or end) of the book. Look at the table of contents and see how the material will be presented. Finally, look at each chapter and see if there are chapter summaries, key word summaries, concept summaries, questions and problems. Is there a glossary? Look at any appendices (often problem answers can be found here). Compare the table of contents with your course syllabus. This usually gives an excellent indication of how closely your professor will follow the assigned text. Finally, if there is a "study guide" for your textbook, purchase it. Study guides can help keep your mastery of the material on track. Also be aware that many textbooks have on-line study materials and extras. Be sure to take advantage of these materials whether they are assigned or not.

Computer Skills

In 2007, no college student can afford to say, "I don't know anything about computers!" because the computer is as necessary to your college career as pen and notebook. If your computer skills are rusty, rudimentary or weak, go to your schools computer lab and take any free courses or just ask one of the assistants to get you started. Learn to use word processing software and presentation software. Add the use of data entry software after you have mastered word processing and presentation. Most colleges have courses and companies like Microsoft have free on-line tutorials.

If you don't own a personal computer, head for the public library or your school's computer lab. Purchase a portable "thumb" or "jump" drive to keep your documents handy. These drives can be purchased for less than $10 (512 MB) and can be worn around your neck or attached to your school ID card. You can use your jump drive to work on documents at home and at school. Just be sure to save your work on both drives.

Excellent Writing Skills

You should be sure that you have taken both English Composition and a literature course. You need to be very facile with both composition and critical reading. I have outlined some practice skills but your English coursework has to be in place in addition to practice. If your college English department offers a Critical Reading course, take it and do well. Often History and Philosophy Departments will have excellent critical thinking courses. These courses generally have research and writing assignments which should be taken into consideration as you are preparing your course schedules. Beware of taking a semester of heavy lab sciences coupled with heavy writing coursework.

Excellent Math Skills

If you didn't study math in secondary school, most colleges will have remedial math courses for entering students. Take these courses and master mathematics. If you test beyond the remedial courses, the start with the math course that you testing indicates. Be sure to master mathematics as it is your main tool for mastery of General Chemistry and General Physics. Don't "talk" yourself out of doing well in these courses by saying, "I am no good at math" because pre-medical studies will not allow you the luxury of being "no good" at anything. Just as I have to master the skills necessary to do surgery, you have to master the skills necessary to learn math and use it as a tool. Just because you are not working calculus problems in medical school, does not mean that you can afford not to learn calculus. It's a great discipline and tool that enables you to master General Physics.

This is the end of the first edition of Study Skills. No matter where you are in your college or medical school career, you can utilize some of the things that I have outlined. You can decide today, that you are going to acquire the skills that you need to excel in your coursework.

Why Students Fail in Medical School.

One of the biggest myths in the medical school process is that once you get into medical school, it is relatively easy to STAY in medical school. Each year, approximately 5% of those who enter fail one or more courses or fail out of medical school entirely. Why does this happen after being subjected to a selection process that is very stringent?

The biggest reason for students failing a course or failing out of medical school is an inability to put in the study time that a very competitive medical school curriculum demands. A sizable proportion of freshman medical students may have been able to get through their undergraduate studies by the "last minute knowledge cram" method, only to find that they are in deep trouble fast.

Most of these students will adjust their time management skills and do well enough to pass their coursework but some are not able to make the transition from undergraduate to medical school. These folks find themselves behind their class very quickly and fail to catch up enough to pass. Courses like Gross Anatomy and Biochemistry quickly knock them out of the freshman class.

Another small proportion of students will have too many personal demands to keep up with their studies. They may be parents or spouses or they may have personal illness that actually prevent them from the mastery of their work. In these cases, a wise Dean of Students will offer a Leave of Absence before the student finds himself/herself in academic difficulty. It pays to alert your Dean of Students at the first sign of personal trouble. Often the Dean can alleviate the problem and get the student back on track. Again, sometimes the problem is so pervasive, that only a Leave of Absence will allow the student to take care of personal matters and return to academics without penalty.

Few medical students are intellectually unable to master the curriculum. While the amount of information to be mastered is massive, the difficulty of the material is fairly average. This means that the key to keeping yourself academically sound is disciplined study habits that enable you to digest this large body of information in a short period of time. Most students study daily and keep a rigorous study schedule even on weekends.

Many students will become caught in the "no one else is struggling so I must be stupid" trap. Every medical student from time to time will struggle with something. Most students figure out what they need, ask for help and get the task accomplished. Some students will become depressed and procrastinate. Procrastination is the enemy of good scholarship and leads to more depression. Again, chatting with a few classmates or the Dean of Students can often put your problems into perspective and give you new ides that get you on your way.

Here are a couple of examples that illustrate my points above:

Janet A. was newly married and entered medical school. Her husband worked as a high school teacher and had a eight-year-old daughter by his previous marrige. Two months into medical school, Janet discovered that she was pregnant. Her pregnancy zapped her energy level and made the demands of medical school more difficult. In addition, she was having difficulty getting along with her new step-daughter who was unhappy that they had moved from another state. She got behind in her studies, especially Gross Anatomy, and struggled with her other courses. She ended up failing both her Gross Anatomy lab and lecture exams and barely passed her Biochemistry exam. On top of her worsening academics, she miscarried and was absent from class for one week.

Solution: The Dean of Students recommended a medical Leave of Absence for Janet. She started with the next year's class and did very well. She was able to take the time for family counseling and was able to devote full time to her studies.

Chris P had eagerly awaited his medical school acceptance. He had been happy and enthusiastic during orientation week attending all of the social events and developed a lively group of friends and study mates. When classes started, he kept up but partied very hard on the weekends spending Saturday night in the clubs and Sundays recovering from his Saturday night partying. Few people were able to keep up with him. By the second block of exams, Chris found himself just barely passing his coursework yet he continued his active social life. He always said that he "needed to let off steam" in order to concentrate on his studies.

By the end of the first year, Chris found that he needed to take two courses in summer school in order to be promoted with his class. He was able to pass one summer course but failed the other summer course and was dismissed from his class.

Solution: Chris applied for readmission at the end of the summer and was denied. He applied for re-admission after sitting out for a year and was re-admitted. When he returned to school, his discipline and study skills were outstanding. He was able to finish medical school and enter residency.

James P had entered medical school witht he idea of becoming a child psychiatrist. He had extensive experience teaching inner city children (had been a high school teacher) and was the author of several books on innovative teaching methods for children at risk. He embraced his studies and did well on his first block of exams. About halfway through the material for the second block of exams, James decided that he was not interested in medicine at all. He went to the Dean of Students and withdrew from medical school. He later completed his Ph.D in clinical psychology and very happily practices his vocation.

The three medical students above, illustrate the most common reasons that medical students fail. It becomes very difficult to catch up with your studies if you get behind. Many people are overwhelmed with the sheer volume of material to be mastered but make the adjustments necessary to do what is needed. A small proportion of medical students do fail and fail out of school. An even smaller proportion decide that medicine is not what they thought it would be and elect to leave.

The bottom line is that medical school demands a student with good study skills and a strong work ethic. While having a photographic memory will help with pre-clinical materials, the strong work ethic will get the student through the clinical years and through residency.