Surviving Medical School: The Second Year

I write this entry with these people in mind: my unborn child, who [might] consider being a physician someday, for my future students [mwahahahahahaha!], and for myself, that I may be reminded of who I was as a student. This is the second part of the series. 

It’s a Marathon, not a Race

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I wrote earlier that going to medical school is like running a seemingly never-ending marathon. In the second year, you will feel out of breath, out of strength, and out of willpower. This is normal, and you’ll experience it every once in a while. But if you took my advice and took care of yourself and your studies, you’ll be very surprised at what I have to say.

The Parable of the Snowball

I will never forget the advice told to my college roommate by his uncle, a medical doctor:

Take the basics seriously.

I was told how his uncle regretted not taking the first year subjects seriously, and how he struggled with catching up on the higher subjects. I would have to say that this advice is one of the best I followed, and I wish to emphasize this with a parable.

redbitbluebit.com

On a mountaintop, a boy rolled over two snowballs. One snowball rolled downhill and became larger in size. It unfortunately slowed down when it hit some rocks, and stopped completely when it hit a tree. The other snowball rolled resiliently, and despite opposition from jagged rocks, it accumulated more snow and turned into a mighty avalanche that carved the mountainside a path of destruction.

Moral #1: Avalanches are bad for your life.

Moral #2: During the second year, I’ve found out how Medicine is like rolling a snowball on top of a mountain. When you begin the path towards becoming a doctor, you start out as a tiny little snowflake. During the first year, you accumulate the language and grammar of medicine, just as a snowflake rolls over more snow and turns into a snowball. Eventually, this turns into a powerful avalanche  that becomes unstoppable.

A practical illustration would be that during a subject you will take in second year, Pathology. This subject builds upon the knowledge you have of Histology and Physiology, and some Biochemistry. If you don’t know what a kidney looks like under the microscope, and you don’t know the three phases of renal physiology, you will have a difficult time understanding why a kidney looks weird in a case of renal failure.

Practical Tips Section

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I realized that my posts up to this point aren’t really about practical stuff for medical school. Hehehe. The reason is that no two medical students learn the same way. These are some techniques I’ve come up so far to learn medicine effectively and efficiently. My disclaimer is that I’m more of a visual-kinetic learner, but I’ll put in some feedback from audio-learner friends:

  • Take care of yourself: body, mind and spirit. This is the foundation that you will build your character as a professional.
  • Know what you don’t know: I’ve once ploughed through a chapter of a book without understanding a single word of it. Never again. I’ve learned that when I don’t understand something, stop, look for the concepts that I don’t understand, review those concepts, then continue learning. It’s no use reading the different mechanisms of diuretics if you don’t know the renal pumps.
  • Write stuff down!
    • For processes (such as the RAA cascade or the fetal circulation), you can use flowcharts to illustrate how things are interconnected. This really comes in handy during Pathology, where you can see the disease processes simultaneously. Also works great for Pharmacology, for learning the modes of actions of drugs.
    • For info-overload subjects, use tables! This especially comes handy for Pathology, where’ you’ll be asked to compare the different types of cardiac failures (Left vs. Right, Systolic vs. Diastolic) and the different types of cancers (the bane of every medical student).
    • For memory-retention, use index cards. This is especially useful for information that requires one to memorize numbers *shivers* such as equations for Epidemiology, Pediatrics, and Medicine. I also use index cards to summarize some chapters from Harrison’s such as “Approach to a Patient with Rash”, writing the important points to be found when faced with a patient with a rash (Number one: watch out for meningococcemia!)
  • Say concepts aloud: my audio-learner friends tell me that in order to learn, they sometimes talk to themselves aloud to get aural feedback. They also said that they like listening or talking to people about the information they need to learn.
  • Realize that there are a ton of material that can help you learn!
    • YouTube, and other Video sharing sites: can’t understand a concept? Look for videos! I learned the intricacies of the renal countercurrent exchange mechanism *puts nerd glasses up* that way.
    • Board Review Series, “Dummies” books, etc.: I remember in Biochemistry that I understood nothing reading up on the Central Dogma on the prescribed text *puts nerd glasses up*. So I read a simplified book on Biochemistry. When I attempted to read the prescribed text again, I understood it. Disclaimer: simplified books are no substitute for the big books but are a great place to start if you have any difficulty.
    • Your colleagues: this includes your medschool friends and your teachers. A medical student is not a John Rambo cutting through the vast forests of medical knowledge. A medical student is a part of a community that works together for the advancement of medical knowledge.  It’s better to look like a fool asking a question than doing a foolish action that could cost someone’s life.
  • Practice makes perfect: Throughout second year, you’ll learn skills that will help you diagnose disease. Skills are attained through constant practice. I practice my physical examination skills by checking up on my father every other semester; to my unborn child, I’d be willing to be your dummy.
  • Expose yourself to experiences and opportunities: During the second year, you’ll start doing paperwork (at least in the medical school I’m attending), which, while it adds to the workload, exposes you to the drama of the human condition. There are some things that my patients taught me that aren’t in the books. There are also conventions and medical missions you can participate in to hone yourself further.
  • “See one, do one, teach one”: This is a tenet of Surgery, in which one progresses from being a passive observer, to an active learner, to a teacher when learning surgical skills. The ultimate form of learning is teaching. Help others understand a concept that they have a difficulty in. After all, our professional oath exhorts us: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”

Learn to be a Doctor, not Study to be one

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There’s a fine line between studying and learning. Studying, according to the MW dictionary is “the activity or process of learning about something by reading, memorizing facts, attending school, etc.” Learning, on the other hand is “to gain knowledge or skill by studying, practicing, being taught, or experiencing something.” On these definitions, one can discern that the former is a passive process and the latter an active one. Strive to be the latter.

Let’s face it: medicine is a competitive profession. In pursuit of good grades and high marks in order to secure good training programs, I’ve seen how the pursuit of knowledge becomes a rat-race in which only one person wins. Medicine should not be like this; it is a profession where teamwork is of utmost importance. The foe of an aspiring doctor is not the subject matter; it can be learned. The foe of an aspiring doctor are not the marks of his peers; it won’t affect him in any other way anyway. The foe of an aspiring doctor is the self.

It’s quite existential, but second year is a continuation of the struggle against yourself. You see in your everyday medical school life forks in the road that diverge into paths that you will never cross again: “Will I spend 2 hours discerning the intricacies of the protozoa, or will I spend 2 hours playing this awesome video game?” “Will I go out this weekend or will I use it to learn the difference between the different types of cardiac drugs?” I’m not saying this to tell people to become hermits, only to emerge into medical prodigies without a social life (read the first post again); I’m asking you, a future doctor, to make choices. “To be a doctor, will I study, or will I learn?”

Keep going towards your dream! I’ll see you along the way.

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