Category: Med School: 2nd year

Endo/Repro II

Hello!

I had to take a break during our last block (GI) for personal reasons. Which is why I didn’t put anything up study-wise for it. But I’m back into the swing of things and trying to grasp how to best tackle this information. I’m trying some new study techniques this time around! Although honestly, it feels like I’m always changing up my studying style with each block…

Path is always my worse subject. I don’t normally understand it. There is histopathology and small random facts/clues that don’t seem to correlate. They don’t solely test us on histo pictures anymore in second year, but in general it is a difficult subject that I need multiple exposures in order to start grasping.

Here are some ways to go about it:

1. Reading Robbins. I personally hate this one. I don’t absorb what I’m reading. Even if I feel like I understand that half page I just read, I will completely forget it when I move on. But if you absorb well from reading, this is one way to get the material into your head.
2. Previous outlines of Robbins. We have a prior KCU student that outlined the chapters in Robbins. Complete with fancy charts, some highlighted information, bolded important information, and sometimes they go back and add in prior high yield test/quiz topics. This is what I have started using as my first pass.
3. Lecture. Now, I dislike this method, but it does give me another pass and I use it to point out what the professor deems important. Sometimes the professor will actually teach, other times they just say “know this” and list a bunch of crap. It’s up to you how you best learn, but I have heard from many of my classmates that they at least listen to lecture on 2x speed just to star the topics the professor highlights in lecture; especially if they don’t really teach. Unfortunately, there are some professors who don’t touch on some topics in lectures. But because they are in the book, they write questions on it (even if they didn’t go over it…)
4. Pathoma. I recommend if you are having trouble understanding the basic concepts or even just getting a good organizational start on the material to go with this. They are short, sweet videos with accompanying high yield points. It does not always correlate in order with Robbins though.
5. You can use sketchy path as another way to get information in. I know classmates who prefer using this since they already have it from micro and pharm. I personally don’t like using this for path, but it presents information in the same way it does for micro.
6. Learning objectives. I’m hit or miss on this. Sometimes in path I will use this to help fill out the information; others I don’t. For path, basically every learning objective is a header in the book or a chart. So you have to know all of it anyways. But for other disciplines I find learning objectives helpful.
7. Practice questions. In general is usually helpful. But sometimes you get too used to the way questions are written by the authors of the practice questions instead of your professors. Just be mindful of this!

My way:

1. I first use the outlined notes. I print them out and underline, re-write, whatever it is I need. I go in smaller sections and have my book open if I need clarification or need to write it slightly differently for my brain to understand it.
2. I then go over this section of notes, either by writing it out or using a write board. Can I make associations with the material? Can I define the disease? What are the prominent features I need to know? Buzzwords? You get the idea. I don’t do this for all the pages, but it does help with some of my sections. Occasionally I’ll make a chart if there is a lot of information that I need help picking details out between. But I have not been doing as many charts as I did originally for GI. I may also decide to make organizational flow charts or “mind maps” as well. What’s the main, overarching subject, and what falls under it? Sometimes just reading the book or reading the outlines it is not as apparent.
3. I then listen to lecture to get the points of what the professor deems important. I either have the lecture up or the book open, and take notes either in my margins & highlight in the book, or I put it on my iPad.
4. Notecards. I don’t normally do well with this, but I’m finding that I personally need to increase my exposure to remember it. Just because I understand it before bed the night before doesn’t mean I will remember much the next day. There is a deck that a previous KCU student made that I am modifying/using in Anki. I also add my own cards as well. But you could use any prior deck, make your own, or use a Zanki deck. A lot of students recommend running notecards before bed. I have trouble with this as either the notecards aren’t finished, or I don’t feel confident enough in the material to start using notecards and it causes more confusion for me. If this helps you, then utilize going through them before the end of the day.
5. Pathoma. I use this basically if I am super confused or want to test my own knowledge. It is just another way to expose myself and see if I am making those connections.
6. Practice questions. Really a crucial part in seeing if you understand the material. I’ve mentioned in other posts what practice questions can be helpful. In general, Robbins questions, university of Utah path questions, and/or Truelearn (COMBANK) questions can help.

For Clinical Medicine & Pharm:

I am doing something completely different than what I have ever done for these. Simply because I need to get more on top of the material. Again, if you are like me and you need to see the material 8,000x before the exam, then see how I am doing it. Otherwise, do what you are doing boo.

1. Pre-reading lecture OR filling out objectives the night before. I am doing this basically to set my notes up and to help get exposure. I then print them out so I can write all over them.
2. I actually go to class for clin med. Or as many as I can get up for. I really enjoy the repro clin med lectures, so it is fun to go for me (I know, weird). I am more apt to pay attention if I have an inkling of what is going on (hence the notes the night before). I add in anything to my paper notes that I missed from the night before, that the professor deems super important, or any questions they give us in class. There was a few times I didn’t go to clinical med lectures. In which case I still did my notes before hand and then just watched the lectures.
3. Reviewing this by both reviewing my LO’s and flash cards. Same principle here; I need to see it a lot.

In a previous course I would make giant charts for pharm. I still have charts in my notes, but they are based on the learning objectives.

Is this a lot of work? Yes. Absolutely. Do I want to pass? Yes. I’m finally a bit more motivated and want to do well. I feel like I have wasted my time in medical school not being able to fully grasp the material. Which is due to a multitude of things, but I digress.

As you will see, a lot of second year is learning on your own. You and Robbins are going to be the best frenemies you’ve ever had in your life. It’s a love/hate relationship that you will be ecstatic to be rid of after boards. But until then, trying to find a good way to synthesize a lot of the material and connect the dots is key in second year.

Another big thing (which I can’t help you determine) is:

  • Are you a fast or slow learner?
  • Do you synthesize well by reading or do you have to write it out?
  • Can you just look over the powerpoint and grasp information or do you need to put it in a different format?
  • Do you do better with learning new material in the morning when you first wake up or reviewing when you first wake up?

All of these things will help determine how you will be able to best learn the material and approach it based on your brain and your learning style. There are more questions you could ask yourself, but these are some of the ones I’ve come across while attempting to figure out my learning style.

See, in first year, everything is very piece-meal. You either know it or you don’t. You can easily break it up by discipline or by LO’s and not a whole lot interrelates with each other. In second year, you don’t get that luxury. So it is a bit harder. It also seems like the professors teach less second year than they did in first year. So there is that too..

TEST 1: Repro

  • 64% clinical medicine
  • 27% pathology
  • 9% pharmacology
  • Total: 100 questions

Overall, I would say it was a fair exam. There were some very easy first order clinical med questions, and some very difficult questions. Pharm was if you knew it, it wasn’t that difficult. But if you didn’t you would have to guess. Most of what I felt I got wrong was on the path side, simply because I didn’t have enough time to learn all of the very nitpicky details. But that’s okay! I’m overall very very happy with my raw score for once. I will have to wait for our official scores to come back and to see my specific exam breakdown to see what areas I may need to spend more time on in the future.

Average: 76%. Much higher than our other exams! Our clinical medicine average was pretty high. However our class path average was around a 66%. So ya know… that’s cool.

Test 2: Endo

10% of this exam is from our repro section by the way…

  • Pathology: 43%
  • Clinical medicine: 29%
  • Pharm: 19%

Review from last test:

  • Pathology: 2%
  • Clinical medicine: 6%
  • Pharm: 1%

Total: 70 questions.

Overall, it was a very fair test. I just frankly had a really hard time studying as it was the end of the semester and we had a lot of other exams going on. I did less studying for this particular test because of all the end-of-the-semester crap. But since I had a better idea of how the material was presented given the course directors and the previous test, I cut back on what I did to study.

  • The pre-made notes by a former student were not done for the endocrine chapter. I ended up reading and making my own. Somewhat helpful. I made myself more charts/compare contrasted to help learn some things.
  • I utilized the powerpoints heavily as the professor teaching pathology had most of her information in her slides. I did watch her lectures as well for another pass.
  • For pharm, I wrote out/drew some of the physiology pathways and where the drugs blocked this pathway. It helped me learn them tremendously in this section.
  • Clinical medicine I just reviewed our high yield handouts. Most of what was covered in clinical medicine was a review of sorts for pathology. So the main focus was on treatments for these diseases and what lab tests you would need to identify them.
  • I did review more of the CIS questions which helped a lot.
  • I did not do as much pathoma or flash cards for this section

Average: 83%. So much better!

Anywho, I hope this helped in directing some of your studies for endo/repro!

I got a Nudge From the Universe Today…

Hello!

This is going to a bit more unusual of a post than what I normally post. So let me set the scene for you, and I’m just gunna jump right in…

A few weekends ago I was sitting in my favorite coffee shop in Joplin. I had just arrived and was starting to unpack all of my books and notes. I had a test the next day, and as always, was hoping to get in a few hours of productive study time. The mountain felt high, but I was hoping to chip off a little bit before the exam. Let’s call it extremely hopeful.

Yes, yes… I was that: hopeful.

I was still in good spirits, but also still feeling like I was drowning. Which is the usual feeling in med school.

In hindsight it probably didn’t really matter if I studied at all that day. But I digress.

While opening up my books, a man who had set himself up at a table nearby was walking back. He politely stopped and asked me what I was studying.

Now, I sometimes forget how friendly people are in Joplin. In Michigan, most people aren’t this friendly. And you usually aren’t approached at a coffee shop unless you dropped something or some girl wants to compliment your dress/shirt/bag. So I was a bit caught off guard.

The conversation went something like this:

“Oh, I have a really big test tomorrow, it’s on all of the cardiopulmonary system and the kidneys.”

“Oh? I have lots of people that I know that work in healthcare. In fact, one of them is a nurse. She is on dialysis…”

Hmm…Okay. Not sure why that was important. In fact, I was wondering why we were even going this direction. But alright, it’s conversation I guess.

We got to talking and I later learned his name. But for now, let’s call him M.

M eventually told me the the had interstitial lung disease which is now causing him some depression. Ah! I’m thinking, I actually know what interstitial lung disease is! I don’t know it well (even though I was supposed to know it for my last test… but hey, I know it). And before you ask “Joyce, where the hell are you going with this story?” The answer is I’m about to get there. Calm your tits. Please.

Anywho, long story short and he tells me he thinks medicine is poison.

An interesting stance. One that I obviously do not agree with, but one that I’m sure I will come across more than once in my future.

But a point that I nonetheless wanted to talk about today.

As someone who does not have a chronic illness and as someone who lives a relatively healthy life without many restrictions; I clearly do not have the same hurtles, experiences, or struggles as someone who does. I do not know what it is like to have difficulty breathing. To be gasping for air or feel like you might be suffocating on a fairly regular basis or even all of the time. I understand depression, but my encounter with that illness is different from his experience with it. Simply put, I cannot put myself in his shoes because I have absolutely no reference to base it upon.

But I can understand that he is struggling. That he isn’t happy with the cards he was dealt. And as a future physician, I need to be able grasp this.

This conversation lead me to multiple realizations:

  1. People want to be heard.

As a future a physician, it is our job to be able to lend an ear. Most patients don’t just want to be “fixed” or “cured”. They want to be heard. That their struggles are valid. That their emotions about their struggles are valid. Sometimes they just need to vent. And we need recognize that. Yes, you can say that they can be referred to someone else other than you for this. However, a part of our jobs are to have a human-human interaction. And sometimes, patients just need an our ear.

2. Perspective

I seem to be gaining a lot more of this recently. But perspective in the fact that we know what our lives are; we know our struggles, our obstacles, and what we have to do. But we sometimes don’t stop to think that our patients may have a much more difficult time doing the same things as us given their obstacles. It also reminds me that not everyone has a great experience with medicine. And with that, patients are scared, unsure, or may pushback more because of it.

3. It’s okay to disagree with our patients. Respectfully.

But it means we need to try to understand what is important to them. Their goals may be different than your goals. And sometimes as physicians we have to slightly re-align the goals to be more realistic. Other times, we just need to be on the same page.  Is their life meaningful? Can they do the things they enjoy doing? Do they still have the drive to do the things they enjoy? Can they work on accepting that it may take them longer to do a task now than it did previously? All of these are important. But taking time to just chat with your patient to get an idea of where they are at and sometimes gently nudging them or re-aligning their goals can help them immensely change their frame of mind.

4. And lastly and most importantly, we as physicians and as a medical culture need to stop being so afraid to allow death to happen.

This is the biggest thing that I think we sometimes all forget. Medicine can do many wondrous things. It can save lives, it can improve life and quality of life, and it can extend lives. But it can also extend life with the association of declining the quality of life. And that often times, we as physicians don’t do enough explaining or education that death is not necessarily something to be afraid of.

Do I want my future patients to die? Of course not! I want to give them a fighting chance when it is something that they want and it is within reasonable limits. But I also want them to know that it is okay to decline extra surgeries or procedures. It is okay to say no more. Especially if it may prolong their lifespan, but decline their quality of life.

There comes a point in someone’s life where the answer isn’t always a clear “yes, make me better so I can live longer”. When we are young or younger I should say, the answer is always make it longer. Give them a full life. But when you take someone who is chronically ill or elderly, the amount of sickness or chronic diseases start to pile up. I’m not sure our bodies were ever meant to live as long as we typically do nowadays. And as all of those start to pile up, the quality of life goes down. Sure, most of them are easily fixable on their own. Or if they had a perfectly healthy immune system getting something like pneumonia or a urinary tract infection would be easy to clear. But when put with someone who does not have a healthy immune system, it can seem like attempting to move a very large boulder that is constantly trying to squash you.

So too that, I think as a future physician myself and a lot of my future colleagues need to put our egos aside. We need to start having discussions earlier with our patients about their wants and wishes. So that when shit hits the fan, their family members who aren’t ready to let them go don’t contradict what the patient wants. Because not all family members will agree with what your patient wants. They may be selfish about what they want instead. And even just having that conversation early allows your patients to have the ability to take time and think about what they truly want. Because in some situations, it is better to grant their wishes or let them have a natural death to where they aren’t dying with tubes out of every orifice and hooked up to multiple machines. Or when their heart starts to give out, their defibrillator isn’t constantly shocking them, prolonging death and causing pain.

We also need to be better at discussing that death is not always traumatic. A lot of times, when chronic sickness takes over, your body doesn’t necessarily “kill you slowly”. A lot of times, you will go unconscious because your blood pressure is too low, or you are septic, your metabolites build up in your system, or your heart just gives out.

But it also leads me to this point…

I was sitting there having this discussion with M who I don’t know. This man who clearly wants to vent but also wants to be validated. I thought to myself: I am so wrapped up in my own problems that I forget I have a very fortunate life and situation.

As someone who just came back from Kenya, it is seriously embarrassing to admit that it only took 2 months to forget the perspective I learned while there.

But I also needed this conversation. Call it a nudge. Or maybe a little wind blew in my direction from the universe.

I needed to be reminded of where I was. That yes, this was hard, but that I was doing this so that when a patient like M walks into my office, I can have this conversation with them. That I can reassure them. Listen to them. Allow them that space.

Humans need to feel connected. In a world where we try so hard to be connected via social media, we don’t do a very good job of actually forming connections with people. I’m going to run into having patients who just want to see me to discuss that they are unhappy. To talk it out. For me to remind them or gently nudge them to find the things that they find pleasure in life with. And once that is gone, we should discuss where to go next.

I was at a crossroads in my life before this conversation. The universe gave me a little nudge to remind me that what I’m going through now won’t be the rewarding part. That what I’m doing right this second isn’t what it will be like in practice. That the conversations I have with my patients will be both heartbreaking and rewarding, but worth my white coat.

Just wanted to throw that out there today.