Dr. Cranquis' Mumbled Gripes

his blog seems to no longer exist :( -prof preg.

I have it on good authority that White-Coat is still alive, but is also getting very busy with his med-school clinical duties and doesn’t have time for Tumblr right now (gasp! no time for Tumblr?! this “med school” thing must be serious!).

I’ll miss his posts and his straight-shooting no-holds-barred attitude. His was the first “big name” Tumblr blog to recommend my fledgling project, and I owe many of my longest-following readers to those recommendations. But med school is a Trial by Fire, and I’m sure his decision to set aside his Tumblr did not come easily. Hopefully we’ll hear more from him — someday. Good luck, Josh.

thisismehidingfromtheworld asked:

and here’s a real question : how did you survive med school? i’m in my second year and i just want to know how did you survive this thing ;)

Part 2 of a 4-year 4-part reply on “Tips for Surviving 4 Years of (American) Med School” — see disclaimer from Part 1, please!

1st year of med school:
Have you ever seen that scene in Full Metal Jacket where the foul-mouthed drill sergeant rips into a bunch of recruits? Imagine sitting in a classroom for hours every day, taking notes frantically while that same guy lectures on Gross Anatomy, Cell Histology, Epidemiology, Neurology, and Biochemistry, knowing that you will be tested on anything and everything he says.

(scribbling on paper, tongue in corner of mouth) “…Circle of F-ing Willis = common f-ing site for f-ing brain aneurysm… 1-tailed vs 2-tailed tests = Sound off like you got a pair… Texas exports = steers + queers…”

But hey, congratulations on getting into medical school! Seriously, you should be very proud of yourself — you have done what it takes to set yourself apart from the pack; you have studied hard in college, you volunteered as a candy striper or a nursing home bath-boy, you took and passed the MCAT, you agonized through the application and interview process, and now here you are. Good job!

Unfortunately, everyone else sitting in the Medical Freshman Lecture Hall with you went through the exact same process. So where before you found yourself easily performing in the top quartile of your college classes, now you will have to claw tooth-n-nail to break out of the BOTTOM quartile in med school. So, above ANY other piece of advice I can give you for surviving Freshman year, you MUST remember this: Your self-worth, self-esteem, and your future ability to be a good (or even GREAT) doctor does not not NOT correlate directly with your percentile score! The old joke is very true:

“What do you call someone who graduates bottom-of-their-class from medical school? DOCTOR.”

At the same time, if you don’t buckle down from the moment the starter’s gun fires on the first day of med school (what, your school didn’t fire a gun into the air before opening the lecture hall doors? Lame, man.), you will miss out on a lot of information which will be totally invaluable and constantly applicable to your daily experiences as a physician on the Step 1 USMLE Board Exam at the end of your 2nd year, and then rarely if ever mentioned again (unless you decide to become a researcher, a pathologist, a radiologist, a surgeon… in which case SOME of your Freshman classes might be more useful beyond Step 1.)

So, here’s my specific 1st-year tips which helped me stay sane while also staying in school:

• Get a white coat and wear it around for a day

The first thing you should buy upon entering med school, apart from the required books and lab materials, is a 2nd white coat. (The 1st white coat will probably be worn for your anatomy labs, and will stink of formaldehyde and be covered in bits of gristle, and you really won’t want to keep that around any more than necessary. Seriously. That thing is a wearable plague rat.). The 2nd white coat is for you to wear with pride. Put that baby on, look at yourself in the mirror. Ok, sure, so your med-student white coat ends just below the butt-cheeks, not like those awesome cape-like white coats that the residents and attending physicians get to flaunt around, but dangit, it’s a WHITE COAT. It means DOCTOR! (Or in some universities, “any healthcare professional or student that stopped by the university bookstore”). It is a symbol of what you have attained and will yet become.

Now go to the nearest hospital and walk around in your white coat for an hour. Notice the subtle ways in which people make room for you in the elevator, let you pass them in the hallways, and try to send you out for coffee. Remember what it feels like to be treated differently JUST FOR WEARING A WHITE COAT. Moral: No matter how poorly you perform in your freshman year, no matter how little you actually retained in some of those long dreary review sessions, no matter how much your classmates out-performed you on the exams, as long as you pass your exams, someday you will wear the white coat (and nobody will care that you earned a minimum-pass on the epidemiology final exam).

• Shadow a doctor

(Please note, this is very different from “stalk a doctor.”) It’s easy to get so bogged down in the details of 1st-year classes that you forget why you’re learning all this random trivia in the first place. Keep your long-term goals in sight by occasionally shadowing a doctor. Any doctor who will let you trot along behind them is fine; you might want to find a resident or attending in a specialty that seems interesting to you and see if you can hang out with them for a weekend call-night. (I personally recommend shadowing a family medicine doctor a couple times as a great way to see the “Bird’s-Eye View” of the common diseases and social situations you will encounter in the future.) You’ll be pleasantly surprised at how those few clinical IRL exposures can energize you to keep chewing through all the 1st-year data, and even help you to learn a little better by having actual medical scenarios on which to hang your accumulating knowledge.

• Get some sleep, healthy meals, and regular exercise

You think 1st year of med school is exhausting? Well, it is — but it’s not the last exhausting year of your education to come. You have YEARS of late nights, early mornings, big exams, difficult patients, late/absent meals, and gut-churning stress ahead of you. Don’t start mistreating your body now; if you push it too hard, you’ll burn out long before you actually start Doing Doctorly Things. Pace yourself like a marathon runner.

And this advice is especially crucial before/during exam weeks. I don’t care if you “Study better when you stay up all night before an exam” — keep it up and you eventually won’t be studying anything except the wallpaper of your bedroom in the mental ward. I had classmates who would literally move into the lecture hall building for the entire week of exams, sleeping on a sofa in the hallway, studying all night before an exam, then sleeping on the sofa for a couple hours before starting to study for the next exam. They developed some really neat-o twitches eventually. And I hate to think what their long-term retention was like for those 3-am cram-session factoids.

Furthermore, you need to be a good example of proper health habits to your patients. Every field of medicine can benefit from more preventive medicine advice, and it’s really hard for patients to take you and your advice seriously if you look like a character actor at Happy Hitler’s Auschwitz-Land or the Before picture in an advertisement for bariatric surgery.

• Re-invent your study styles

I’m sure you developed your own study habits in college. Bad news: Few, if any, of those habits will serve you equally well in med school. Why?

1. You now need to learn how to study for multiple exams at once (you will have regular “Exam Weeks” in med school, often with multiple big-time lecture and lab exams on the same day just hours apart).
2. You will need to start assimilating larger quantities of knowledge in more intricate detail than you thought possible.
3. You will have fewer hours to study every day, because your classes start earlier and go later, and you will usually have labs to attend into the evenings.
4. You will be more exhausted on the weekends, so suddenly you find yourself having to decide: do I spend this Sunday doing something fun, or do I just study MORE?

On the plus side, you are surrounded by many other other people all studying the exact same stuff! So it’s easier than ever to find people to study and commiserate with.

Anyways, don’t be afraid to try various methods and venues for studying. Some possible ideas: flash-cards, review books, group studying, drawing diagrams, inventing mnemonics, studying at the library, Barnes and Noble, the park, in the lecture hall. You won’t know what really works for you until you try it! When it really comes down to it, besides “getting high enough grades to advance to 2nd year”, the main goal of 1st year should be “Learn how to identify what needs to be learned, and learn how to LEARN that stuff fast.”

• Preview, View, & Review: A 3-step Method for Stuffing Knowledge into your Brain

I don’t remember where/when I learned this method exactly, but at least 3 professors in my Freshman Year encouraged us to use this, and it really worked for me (when I would take the time to actually do it). This system depends on your professors providing their lecture notes/syllabus ahead of time, which I believe most med school professors do (but I didn’t go to most med schools, so I dunno for sure). It also requires you to be rather methodical about keeping up with the flow of information, otherwise you can fall behind and get discouraged very easily:

1. Preview - The night before a lecture (or morning of, if you like to get up early), get out your lecture notes and do a quick read-through. Pay special attention to any complicated diagrams or tables. If something doesn’t make sense, make an obvious mark next to it (you can use a special-colored highlighter, or one of those fancy Post-It Arrow Tabs can help to) so that you will be sure to pay attention to this section when it comes up during the lecture.
2. View - Show up to the lecture (I can’t emphasize this enough: You are paying a ton of money to be allowed in to these lectures; if you skip them and just read the material, you are neutering your education.) During lecture, stay awake (another oft-missed element), pay attention, and jot down any important facts that might not already be in the lecture notes INTO the lecture notes. When you come to the areas you marked during the Preview step, be sure the lecturer makes it clear — if they don’t, raise your hand and get it cleared up (chances are good a few of your classmates were also confused, or WILL be when they get around to reading the lecture notes later, so you’ll be doing them a favor too).
3. Review - As soon as your day’s events permits, review the notes. If a particular lecture was very “list-heavy” (i.e. a list of items that just needs to be brute-memorized), this is the time to start your memorization process: write the items on flashcards, design a mnemonic, whatever you will need to do so you can come back to those lists later and review them again. DO NOT WAIT to review the notes until just before exam week — this could be months later, and you will find yourself looking at your scrawled notes in the margin and your “Important” markings and wondering what the heck the fuss was all about.
4. Not really a part of the 3-step method, but one which I had to learn to incorporate sometimes: If you fall behind, don’t try to go back and “catch up” during the week. Make a mark on the lecture notes that you missed (either that you didn’t review, or that you didn’t show up to class for), so that you spend a few extra minutes on those sections later, either during any fortuitous “extra time” on the weekend, or during your pre-exam-week review time. THEN JUST MOVE ON — this is the educational form of medical triage, you just need to patch up the wounds and try to stay ahead of the killing!

• Suck-Up to a Second-Year

Hey, guess who has just recently been through the exact same classes, labs, exams, professors, and depression that YOU are going through? The sophomore class! They are a terrific resource, and unless they are a total herd of stampeding jacktards, they will already be trying to help you in your journey by providing your class with tips, study guides, out-dated review exams, hand-me-down textbooks, etc. Try to find a 2nd year that you can connect to (possibly someone from your alma mater, a neighbor in your apartment complex or dorm, someone who likes studying at Barnes and Noble like you do), and politely ask them for advice. You may be pleasantly surprised at the solid gold they may bequeath to you. (And BIG BONUS POINTS to you if you then turn around and share that information with your Freshman buddies — don’t be a cut-throat, you’re all in this together!)

• Destroy your handwriting for a good cause

Ever wonder why doctors have such horrible handwriting? It’s not (usually) intentional. We probably used to write quite legibly before med school — but then we entered the world of High-Speed Med-School Lectures, and all attempts at neatness went out the window. Thankfully, with the advent of phone dictations and electronic medical records, our handwriting is much less “potentially life-threatening” than before. But my tip here is really this: invent a quick way of taking notes, a personal short-hand, abbreviations and symbols that will mean something to you when you see them later. This will continue to be useful into residency and beyond, as you take notes during patient encounters. There are lists of common medical abbreviations which are helpful, and you can invent your own too (but be careful not to use your invented ones in official documentation, that’s a Medical Records no-no!).

Ok, sorry this was so long — I’m sure I just directly contributed to you flunking your next exam. Stop procrastinating and get back to the books! :)

If you have any 1st-year tips to add, use the Disqus link at bottom.

Coming next time: 3rd year survivor tips.