Cardiopulmonary

Okay. This block was intensely fast with a lot of heavy and difficult things to digest, with all of it being really important. I mean, you can’t function without a working heart or working lungs, so learning these things are vital (literally… haha get it? as in vital signs? no? … okay never mind…) to being able to understand how the body itself works. (I chose not to try to post during this time just to try to stay on top of my course work.)

Currently, my class is a test class for trying out a new scheduling block. What this means, is they took 3 whole weeks out of the academic year to give us 3 weeks back during the summer. Now, this was done so we could use this time to build up our CV’s in-between our first and second year so we look more competitive for residency. They initially explained it as they took out parts of the course that absolutely weren’t vital for the boards, and that is how they could condense the time.

Where and how they took it out is still a bit of a mystery for me. I heard through the grapevine that they took a whole week out of cardiopulm, a whole week out of neuro, and a whole week out of MOD (which I think is more disease related and is structured to transition us for second year- I’ll let you know what it is when I get to it). All 3 courses are pretty important. Well actually, pretty much every course in medical school is important. So, if the above rumor of a week was taken out of each of these courses is true, why these were the 3 blocks chosen to have days removed beats me! There are a few current second years who state that not an entire week was taken out of cardiopulm (given how it lands with Thanksgiving), but it has definitely been a wild ride so far this block. Either way, the course directors chose to shrink down the curriculum and our class is the first to see if it works or not.

Initially it didn’t really bother me for the courses, since other than in MSK, there was a fair amount of time for things (in retrospect here). So it was no big deal. Now that I am in one of those courses where a whole week (allegedly) was removed, its kinda a big deal. It could also just be that there is so much to learn, that it was going to feel intense anyways, but I digress.

My Mindset During this time

Before the Midterm:

Okay, this is a lot. Like a lot a lot, but I might be able to power through it. I’m pretty much staying on top of it, and I’ve had multiple passes, so I think I might actually do decently on this test! (I even did a ton of practice problems too btw…so proud of me.)

I was confident. I felt like I knew a lot of the material, and the fact that I spent multiple times with each lecture made me feel pretty damn good.

How I felt before the exam. Confidence was on point! (courtesy of giphy.com)

Right after my Midterm: 

Courtesy of Wifflegif.com

Imposter syndrome is real. Feeling inadequate is real. Feeling like the dumbest person in med school is exactly how I’m feeling at the moment.

I was feeling pretty defeated. I cried a lot after the exam and practical. I had spent so much time with the material only to feel like I knew nothing on the test. Or at least I was confident enough when answering questions only to find out I had answered them wrongly.

During this test our time was cut down per question. We also had an increased number of test questions, so overall the odds of finishing with much time to spare was slim. I finished answering my last question with 2 minutes to spare and that was after I had to quickly read through questions and make a gut answer because I didn’t have a ton of time to read them.

Not to mention I thought the practical was pretty hard, and I almost started crying the second I turned in my paper for the practical. It was just a bad day for me, I let a few things get to me, and it shot down my confidence pretty badly.

Fast forward a few weeks later…

Right after my final:

I’m finally done. I’m happy to be on break but upset that I feel like I studied so incredibly hard for these tests this round for it to not really show. I’m not asking for A’s here people, but I would like to think I could do a bit better prior to the curve setting in.

The funny thing about this test block is some of the weird graphs/cycles we learned I’ve seen before in COB. However last year, I didn’t really understand them very well despite the amount of time I put into it. This year thankfully, they made much more sense. Maybe it was because I really spent a lot of time with it. Maybe it was because it was my second time seeing it. Who knows? But I did finally learn or at least understand some of those important concepts I was supposed to grasp last year (lol).

Lecture and Exam Breakdown

For the lecture midterm:

Anatomy= 29

Embryology= 21

Histology= 4

Physiology= 46

Total: 100

I gotta tell you, the histology and embryo are not my favorite things to learn. I love the professor teaching them, but I really dislike the topics. They make pretty much zero sense to me in all aspects no matter how much time I spend with them. It really is quite a damper on my spirit at times, especially when there are a large amount of questions dedicated to the material on the exams.

For the anatomy practical: 50 questions, similar to all the other practicals I’ve mentioned in other posts.

For the lecture final:

Biochemistry= 8

Clinical medicine= 19

Histology= 10

Pharmacology= 9

Physiology= 54

Total: 100

The physiology portion of the first test was very much focused on pulmonary, which interestingly had a lot of math involved in it. The math on the test didn’t always make sense, and turns out I think I spent way to much time trying to mathematically figure it out than what I actually had time for. Because of this, I finished my 100th question with 2 minutes to spare, and that was only because I gut answered a fair amount of questions.

The second time around there was much much less math (since we focused on cardio physiology this time, and also didn’t have embryo and gross anatomy which was a plus!), I made sure to get about halfway through the questions or more by the first hour in. This way, I would (hopefully) have more time at the end to go over my flagged answers and see if I could rethink through them or get an extra point.

As stated above, we had our time cut down this time. In actuality, we’ve had our time chipped away at slowly since starting school, it just had the biggest impact on me (and a lot of my fellow colleagues) this time around. Maybe it felt worse because we had a lot more questions this time around. Maybe it felt worse because of the heavily involved math for certain questions. Either way, the time cut down on top of the actual tested material and types of questions asked made it very difficult for I would say about 85-90% of my class to finish before the time was up for the first test. I didn’t see very many people on the midterm get up and leave before everything timed out. There were a lot more people on the final that finished before time ran out, given the type of questions asked. And personally in my opinion, I think because there was much less math.

How I studied:

Hmm, I did a varying degree of different things with this test block. Now, I’m not in the top 10% of my class, so for all I know I could be studying absolutely horribly. In all honesty, how I studied in COB was much more lax than how I have to study in medical school. But as mentioned in prior posts, each person has their own way of digesting the material and their own way of accomplishing their goals for medical school. Actually, I kinda wish our school would get rid of school rank and go to a pass/fail system, this way I couldn’t be categorized based on the specific nuances of each course, just if I passed or not. But, I’m pretty sure they aren’t getting rid of the class rank system any time soon.

Prior to the midterm I didn’t go to every class. However, I did make sure to stay on top of the lectures. There was a lot packed into the first midterm (26 lectures and DSA’s), so I needed to stay on top of the material to get through it all! For the second half, I mostly went to class to get my first pass in. We had 23 lectures and DSA’s the second half, which didn’t feel nearly as awful as the first half (which is weird, because its only 3 lectures/DSA’s less).

For Histology:

I would go to class for these lectures. I really really don’t get histology, so at least going to passively hear it is better for me so far. Although if I’m really tired, I’ll just watch the lecture later. The second pass for histology would be to fill out the objectives/in-depth look at the lecture again. Third plus pass would be to review my filled out objectives and look at the histo specific slides.

There is a book for histo but I don’t find reading in the book super helpful for histo for me. I just gives me more details to confuse me with! So I stick to the information on the slides and the practice that our professor gives us.

For embryo:

I mean, I don’t understand embryology either, but I feel I have to write down every other word during the lecture. Because of this, I actually won’t  go to lecture, and instead will watch the recording. I find I have to stop the recording so often to type things down/ get the full picture that I would most definitely miss 75% of what was said if I went to class, making me more confused. So first pass was to watch the lecture and take notes. Second pass was to fill out objectives (if I could) to try to digest the material better. Third plus pass was to review the objectives and/or watch the recordings multiple times.

There is a set book for embryo, but just like histo, all the extra details actually confuse me.

For anatomy:

Oh man, blue boxes. I ignored this in MSK and learned the hard way on it. For some tests, they test heavily on blue box material from Moore’s book (one of our required texts, also happens to be the same author/book from the COB program). Other tests they don’t test as heavily on them, but its always when I don’t pay attention to them that they happen to pick out more to test on.

For anatomy lectures, I have learned that I can either actually sit in on the lecture in real-time or just watch it. The first pass (just like for histo) is to in-depth look at the lectures and take notes. The second pass I will fill out objectives and draw certain structures in my book. The third plus is reviewing the objectives and my notes/drawings.

Since we had anatomy lab for the midterm portion, constantly reviewing the anatomy or at least keeping up on it was very helpful. I tried to use my anatomy time to reinforce what I learned in lecture. I also made sure to start trying to look for structures on my structure list while in lab. That way, if I had questions I could try to flag down a tutor or an anatomy fellow.

In addition, we had less labs for CP this round in lab, and way less structures to learn or things to do in lab. Because of this, we had more time in lab to actually review/look at structures than we did in MSK.

For physiology:

Oh man, this information was a lot, and it was very detailed and heavy. I had to do multiple passes. Pretty sure I needed at least 3-4 or more for each lecture to really get it to sink it. Which is partly why I was mad when I didn’t get a higher score on my midterm. The pulmonology information was very math heavy and a lot of numbers to remember/understand. The cardiac was more conceptual and less math which was nice. For the midterm I did a lot of practice problems (again, math related and tbh I suck at math). For the final, I didn’t do many practice questions other than during our Q & A sessions because there wasn’t nearly as much math. It as mostly interpreting the cardiac cycle/venous return curve questions that I was able to understand quite well.

For biochemistry:

I honestly did this stuff last-minute. We had 2 lectures right before the test (and by right before I mean the Thursday and Friday before our Wednesday test…) that I watched and just took notes on. There were some practice questions hidden in the lecture that I used, but other than drawing out the pathway and just taking plain old notes, I didn’t do anything additional.

For clinical medicine:

I learned how to read EKG’s this block!! YAY!!!!

Courtesy of wifflegif.com (P wave missing here people and T wave doesn’t look normal…)

Learning this was actually a lot of fun. In fact, I’m pretty sure I did the EKG lectures and practice about 4-5x just because I was happy to finally be doing doctor-y stuff. I attended all of these lectures because I was so excited, and I believe I only got 2 of the EKG questions wrong (if my memory serves me correctly from the review early today). Basically, attending lecture and just reviewing the slides was enough. We have 2 really awesome physicians who are still practicing ER medicine when they aren’t teaching, and they are all about teaching us the “quick and dirty” way of going about things to make sure we get the correct answers, understand, and don’t do extra work. I really really like these professors.

For pharmacology:

Attending lecture/viewing the recording was my first pass. For this time around, we had one actual lecture. This lecturer tends to give us a pre-recording/lecture to view AND DSA material to digest before the actual lecture, and then during the lecture has case studies/questions available. I honestly took forever to digest the pre-material before looking at the recording, but after going through all of this initially, I just needed to refer back to my notes that I took to review. I didn’t bother with doing objectives or anything like that for this.

What I would change if I could do it over again:

I needed to spend much more time with embryo. I feel like this was a huge downfall my first test and even though I tried to spend time with it, it was very complicated and warranted more time to really try to understand it. I also likely would have benefitted from watching the other campus’ lectures on the material as well, but I don’t super love how the professor teaches. Because of this, I usually don’t watch their lectures on top of mine for embryo, but in this case, it could have helped.

The other big thing I could (or should) have changed was asking my professors more questions. I had plans to go to office hours and ask questions, but I’m really bad at doing this. My pride usually gets in the way. My reasoning is always “I haven’t caught up yet and I need to catch up first before asking questions” or “I just need to spend more time with it to understand it… I can figure it out myself”.

Courtesy of wifflegif.com

Only one more course to go before the end of my first semester guys! So excited!

As always, let me know in the comments below what you liked or didn’t, what you found helpful, and what you want to hear about!

 

Immunology Block

Oy Vey!

I tell myself I’m going to do better every single time, and that I’m going to change into better study habits, go to class more, stay on top of things, and live my best possibly healthy self while here.

Courtesy of giphy.com

Yea that’s a joke. Maybe I should look into hiring a personal life coach/motivator, because my self techniques are definitely NOT working right now.  I’m halfway through my first semester of medical school and I still have a lot of work to do. Not sure if I’ll ever get on top of things, but just like always, I’m at the crossroads of just finishing a block and about to start another. So of course I think I’ll miraculously change my current set-in-stone habits when in reality they will probably just get worse.

But let’s get into what you are all really here for. How does immunology in medical school go and how did I approach it?

COB Immunology vs COM Immunology

For those of you new here, I did a one year master’s program at KCU, which happens to be the current medical school I attend. The master’s program I attended is affectionately called “COB” for college of biosciences, while the medical school is designated as “COM” for college of medicine. If you are interested in going into the COM program like most of the students who partake in the COB program, then here are some things you should know:

Books

The authors of the book(s) that you use in COB and COM for this course wrote 2 versions: A large, very detailed more molecular based version of things and a smaller, more condensed version of things. As you can see, the blue book is larger and thicker, and it has a TON more text in it. The purple one is smaller and thinner, and honestly even though the chapters are about 20-25 pages each, the figures take up a lot of space/pages. In reality there really isn’t that much text.

The figures are the same. The content is the same, with the exception that one is paired down. And of course the authors are the same, so literally it’s the same book, just one is more detailed and one isn’t.

Why? Well in COB, it is a program designed to yes, help you get into medical school because it’s all hard sciences, BUT it is also geared towards those that are interested in becoming scientists and researchers. The whole time you are in COB quite honestly you learn SO.MUCH.MORE.DETAIL about a lot of these core classes, because they are assuming you may decide to research. You need this background and minute detail in this case.

Whereas in COM, you really only learn a very general overview of things and then at the end they hit you with a lot of clinical stuff which honestly, I did terrible in.

Detail:

Again, you learn more detail in COB than COM as noted above. Say for example, the molecular pathways of activating T and B cells, we had to learn every single step in COB. Every step! And then only ended up getting like 2 questions on it. Ugh I was so mad that I spent all that time on it. But, we needed to know those pathways in molecular for the next test block, so it just made me lazier in studying for molecular at that point in time.

In COM, you kinda learn the activation pathways for T cells, but it’s really general. There aren’t really any specific names for the enzymes involved (there are a few key ones to know/go over) and then it’s like here’s the pathway but you just need to know what happens in the end. For B cells, the book didn’t even really discuss it much. We had a few practice questions on it but NONE on the exam.

What I’m saying is the focus is very different between COB and COM, even though it is taught by the same people.

Questions:

Dr. Shnyra teaches the COB immunology course AND the COM course at the Kansas City campus. Dr. Bowden teaches the immunology course for the COM students here in Joplin. They teach slightly differently, but overall it’s the same stuff as they go off the books. Both teachers ask questions very similarly on exams. Just like in COB, in COM Dr. Shnyra sends out practice questions. And just like in COB, you need to pick the most correct answer out of the bunch. Dr. Shnyra has a ton of questions by the way in a bank, so if you go from COB to COM, you will get new questions when he sends out the practice sets. Most COBer’s used both the old questions from COB and the new ones sent to us during our COM course.

Breakdown of the Exam:

The midterm consisted of 65 questions:

Histo: 15 questions

Immunology: 50 questions

This first test heavily tested if you understood the difference between innate and adaptive immune systems, and if you could tell the difference between MHC class 1 versus class 2. It is very similar in COB, as this course tends to be taught more broadly at first then narrows in to more detail as you progress.

Final: 85 questions from immunology only.

The final was cumulative, minus the histology information.  Unfortunately because the midterm was easier for me I didn’t try to hard on the second test. Which was a massive mistake for me (I seem to making a lot of those here). Either way, in both COB and COM they really like to test hypersensitivity, because that is very relevant to your future patients that you will be treating. In COM there are more diseases you are tested on, but are more rare when treating patients in real life (but still need to be aware of).

How I studied:

#notsponsored

I completely filled up my sketchbook between biochemistry and musculoskeletal, so I had to get a new one. They are by this company called Denik, which you can find at Michael’s craft stores.  I like that the covers have more strength and girth to them than the hardcover sketchbooks, but are still soft and mold-able enough that I can move them fairly easily. They are a bit more expensive, but the money you pay goes towards schools in less privileged countries. Which really means I feel less awful about spending the money. Totally wish this was sponsored but long story short, I like their sketchbooks.

So much so I ended up buying 3.

I didn’t attend class very much although I heard great things about the Joplin professor for this campus. I found myself not able to focus very much sitting in class over the past few weeks, and felt it was better to try to self-study. There are pros and cons with that though.

Immuno notes

Pros include that I could sleep in and go at my own pace. Especially since I had a hard time paying attention in class, it was better that I didn’t feel I was wasting valuable study time and using it for something else instead.

Cons include that I am a terrible self motivator. And really didn’t stay on top of things very well.

But because I self studied, I actually ended up reading the book from cover to cover. Each lecture was correlated with one lecture, so instead of reading the powerpoint slides and just trying to piece things together from there, I read the book. There was some great background and explanations with doing it this way, but also a lot of additional information that wasn’t super necessary/on the lecture slides.

The extend of signaling, which my version was more detailed than the class version.

I also didn’t really feel the need to look at both campus’ lectures this time. Because each lecture has to correlate with the learning objectives posted, each of those learning objectives came from the book. If I felt I needed more explanation and couldn’t get it from the book or my campus’ lecture slides, I would hop on over to the other campus’ slides to see if there was a better explanation there!

I also did a lot of concept maps and drawings for immunology to help organize my thoughts in my book. My first pass was reading the chapter, the second pass was making notes on that chapter, and the third pass was reviewing the notes and/or looking at lecture slides. I would have done slightly better if I spent more time on the last 2 lectures as there were many questions about diseases and disease pathology that I just couldn’t answer on this year’s test.

If you have never taken immunology before, I still stand by using “How the Immune System Works” by Lauren Sompayrac (which was mentioned in one of my COB posts). It doesn’t matter which edition you get, in fact you could still get the 2nd or 3rd as it is much cheaper than the newer one. They don’t really change. I currently have the 4th and I believe E has the 5th version. Literally the same book except a different color cover.

This breaks things down really easily and helps explain some basic concepts in immunology. There are also some great figures in this book regarding pathways that sometimes Dr. Shnyra uses (not sure about Dr. Bowden) but in general can help make things understandable. I recommended this book to several other first years and they got great mileage out of it.

Scheduling:

This was a 3 week course. Our midterm was on the second Monday of the course, and our final was on the last Friday of the 3 weeks. As medical school is progressing, we increasing have other testing and competencies thrown at us that aren’t just involved in the core course we are in.  During this block, we had our first experience with 2 tests in one week on top of an SP encounter (or our practice sessions on how to interact with patients using actors). If you head on over to my Testing Schedule in Medical School post, this will give you a broader view of the amount of testing/competencies I’ve had so far.

Thankfully we didn’t have anatomy lab this time around on top of learning how to deal with juggling multiple testing situations this time.

As always, comment down below for things you found helpful or would like to hear about next!