Surviving Medical School: The Third 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 ofwho I was as a student. This is the third part of the series. 

Third year medicine is, in my opinion, the “boss level” of your academic life. I have never worked as hard as I could until this year.

This year will sum up the discipline you’ve acquired throughout your years of formal schooling. This year will be a year of challenges, a year of great expectations, a year of tribulations. When it is finished, you will find that it will have also been a year of hope, a year of discovery, a year of vindication. By the end of third year, you will feel like a physician, at least in theory. By the end of this year, you will be one step closer to your dreams.

Keeping up the Pace

ECG

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A medical student is a marvel of creation. We are a juxtaposition of contrasts. We feel dumb, but we can answer (some) questions our consultants throw at us. We feel sleep-deprived most days of the week, but we manage to pull through our examinations. We are caffeine-laced junkies, but we can fall asleep on command. We feel like robots in a daily grind, yet we feel compassion and empathy when we talk to our patients. We feel stupid most of the time, but for some reason, our patients and our relatives believe in our abilities. (If you’re my child, I’ll probably be bragging about you to everyone.)

It is essential to keep in mind that taking care of yourself is your first priority. Eat a well-balanced diet, exercise often, go on dates or parties, don’t neglect your personal hygiene, and sleep adequately. There will be lots of times when you will feel burnt out. You’ll try to force yourself to keep going, but you won’t likely be productive if you do. I’ve done that many times, but I would just be frustrated and miserable after.

It is important to know yourself this year. It is important to accept that you are only human, and you will probably not be able to read everything or practice all your skills. It is equally important that you believe you have what it takes to be a doctor. It is important that you discover in yourself the grim determination that will spur you to face your fears.

The greatest challenge this year is not really the tons of material, the gaggle of paperwork, or the physical exhaustion, but the lack of motivation that will sap your strength and affect everything else. Keep up the pace. You’ll get there.

From a Marathon… To a Triathlon

Ocean

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When I first started third year, it felt like being dropped into the ocean. Initially, you’ll feel the unforgiving chill, you’ll thrash about helplessly, you’ll be brought down by the endless waves.

Up to this point, I’ve treated medical school like a marathon, where all you had to do was to keep placing one foot in front of the other. This year, you will need to be faster and stronger and wiser. You will find that you have less time to study because you have to do a lot of paperwork and projects on top off trying to live like a normal decent human being with a social life.

The greatest skill you must master this year is time management. There are many ways to become productive, but the one I’ve always found useful is to divide your day into a pie. Allot 8 hours of rest and 8 hours of lectures everyday, and probably an hour or two for personal hygiene and eating. This will leave you with 6 hours to choose between studying and not studying. How you use those 6 hours is up to you.

If you’re like me, the internet is a bad distraction. I remember looking at a clock and saying: “Hey, I’ll just surf the net for half and hour.” When I look at the clock, it’s jumped by 6 hours. Try to remove distractions from your life and focus on getting to where you want to be.

Smart is the Way to Go

Tactics

forum.ea.com/uk

Studying smart is the norm for third year. You can try to read all the material, but it’s no use if you don’t understand it. I’ve applied new tricks to keep up with the material, some of which are:

  1. Strengthen your basic knowledge by brushing up on your past lectures. I’ve found that having a good background on pathophysiologic processes will allow you to quickly understand material, as well as allowing you to reason logically when confronted with a case you’re not familiar with. An example would be how you’d suspect leukemia in a patient presenting with anemia, easy bruising, and frequent infection. You’ll even know what type of leukemia it is just by recalling your basic knowledge. If you don’t understand what you’re reading, I strongly suggest going back to the basics. If it seems too tedious, know that ultimately, you’ll work faster as you master the basic sciences.
  2. Know the common diseases, their diagnostic criteria, their treatments, and their quirks. Staple cases would be lifestyle diseases such as hypertension, diabetes, and obesity. Infections and antibiotic treatment are also frequently discussed topics. How would you know what the common diseases are? Listen to your lecturers! Or if you really need to sleep in class, at least list down what they’re talking about and just go back to them later.
  3. Simplify! I would suggest using a small index card to take note of the important characteristics of a disease, as above. It will force you to put only the essential information, and it doesn’t hurt how writing helps integrate these into your memory. Another way to simplify is to consider how diseases can be grouped according to their core pathophysiologic concept and directing treatment accordingly. The Integrated Management of Childhood Illnesses (IMCI) chart is a good example of this. Find such material, or develop them yourself.
  4. Use mnemonics, use humor, enjoy the material! Think of funny ways to remember diseases. I remember Takayasu disease being a “pulseless disease” because you can’t “Takaya-pulse”. Or how to memorize the order of CT scan radiodensity: “be sure where fart arises” (bone-soft tissue-water-fat-air). Medicine has a lot of information, so you might as well find humor in it.
  5. Put in your hours everyday. Third year is the worst time to cram. Try your best not to fall into this, as the material this year is not only voluminous, but also requires time and effort to understand. By breaking up huge diseases into simpler concepts, you’ll have a finer understanding and appreciation for the material, as well as the luxury of good sleep during the exam weeks.
  6. Be a team player. Did you forget about the paperworks you’ll have to do already? Because there are a lot of paperwork. Our team created rotations schedules to guide those who are decked to interview patients. This ensures that we all get to hone our skills, as well as getting some respite. Now, don’t be that team member who hogs all the skills, nor be that team member who is just dead weight for the group. You are going to be a doctor, and how you behave with your team will reflect the kind of doctor you’ll be in the future.

For You, Only the Best

Heart

mozdex.com

I believe that a medical student should strive to be the best physician they can be. There will be many times when you’ll be tempted to just breeze through the material and pass the exams. There will be times when you’ll feel lazy and just read through previous exam review questions and hope those concepts will come out of the test. These things have happened to me. But now I have to brush up on cervical cancer because I know squat about it, and OB-Gyne will be my first rotation this April. I’ve learned how each concept you slack off from will bite you back someday.

Third year is the time to think about the future. When you’ll be in the clinics, patients won’t come to ask how you did in an exam; they’ll ask if you can help them. What good is knowing that secondary amenorrhea is caused by polycystic ovarian syndrome 80% of the time when you don’t know what the diagnostic criteria are, or how to treat it? You have to learn these diseases well enough so that you can spot them in the clinic, diagnose them, and treat them accordingly.

In the end, it will all boil down on how much you care about your patient. If you care sincerely enough, you will see all the exams and papers you’ll do as essential steps to become the best physician you’re meant to be. You will grumble and fret, but take each day at a time, and before you’ll know it, you’ll be where I stand now – at the brink of clinical clerkship, anxious and excited at the same time.

I hope this year will be good to you, and I hope to see you along the way.

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